About Eosinophilic Esophagitis
The exact disease causes of EoE are not yet fully understood. However, experts believe that it is an abnormal immune system response triggered by a food allergy or environmental factors.
Non-modifiable risk factors for EoE cannot be changed or controlled. These include:
- Sex: EoE affects three times as many males as females.
- History of allergies or asthma: About 50% of people with EoE also have asthma.
- Family history: Specific genes may contribute to the development of EoE.
Modifiable risk factors for EoE can be influenced or changed. These include:
- Food allergies: Having a food allergy increases the risk of developing EoE.
- Environmental triggers: Substances like pollen, pet dander, and dust may trigger symptoms in people who are easily affected.
It's important to note that while these factors may increase the risk of developing EoE, they do not guarantee its occurrence. If you suspect you have EoE or have concerns about your risk factors, it's best to consult with a healthcare professional for an accurate diagnosis and personalized advice.
The most common early symptoms of eosinophilic esophagitis (EoE) can vary depending on age:
- In infants and toddlers, the common symptoms include feeding problems, vomiting, poor weight gain and growth, and reflux that does not improve with medication.
- In older children, vomiting, abdominal pain, trouble swallowing (especially with solid foods), reflux that does not improve with medication, and poor appetite are common symptoms.
- In adults, the common symptoms include trouble swallowing (especially with solid foods), food getting stuck in the esophagus, reflux that does not improve with medication, heartburn, and chest pain.
As EoE progresses or becomes more severe, the following symptoms may occur:
- Food getting stuck in the throat
- Nausea and vomiting
- Stomach pain
- Weight loss
- Poor appetite
- Malnutrition
- Symptoms similar to gastroesophageal reflux disease (GERD), such as heartburn
It is important to note that these symptoms can vary between individuals and may be influenced by factors such as age and race. If you experience any of these symptoms or suspect you may have EoE, it is important to consult with your healthcare professional for an accurate diagnosis and appropriate treatment.
To diagnose eosinophilic esophagitis (EoE), doctors commonly perform the following examinations, tests, and procedures:
- Review of symptoms: Doctors will ask about your symptoms, such as difficulty swallowing or food getting stuck in your esophagus.
- Physical exam: A physical examination will be conducted to look for any physical signs of EoE, such as pain or swelling.
- Upper endoscopy: This procedure involves inserting a small tube into the esophagus through the mouth to take a tissue sample. The sample is then analyzed to check the eosinophil count.
- Biopsy: During the upper endoscopy, a small sample of tissue is taken from the esophagus for further analysis.
To determine the stage or severity of EoE, additional examinations, tests, and procedures may include:
- Repeat endoscopy and biopsy: These tests may need to be repeated over time to assess the progression of the disease.
- Imaging studies: Doctors may recommend imaging studies like an X-ray or MRI to check for changes in the esophagus that can make swallowing or moving food difficult.
- Allergy testing: Since many individuals with EoE also have allergies, allergy testing may be done to identify specific allergens that could be triggering the condition.
It's important to consult with your doctor about which examinations, tests, and procedures are appropriate for your individual situation.
The goals of treatment for eosinophilic esophagitis (EoE) include:
- Improvement in medical symptoms: The aim is to relieve symptoms such as difficulty swallowing, food getting stuck in your esophagus, and abdominal pain.
- Resolution of esophageal eosinophilia (EoE) and other unusual changes in tissues or cells that can be seen under a microscope (histologic abnormalities): Treatment aims to reduce the number of eosinophils (a type of white blood cell) in the esophagus and restore normal tissue appearance.
- Endoscopic improvement: The goal is to improve how the esophagus looks during an endoscopy, focusing on reducing inflammation and narrowing.
- Improved quality of life: Treatment aims to enhance overall well-being by reducing symptoms and improving daily functioning.
- Improved esophageal function: The objective is to restore normal esophageal motility and prevent complications such as strictures or narrowing.
To achieve these goals, various treatment approaches are recommended:
- Medication types:
- Proton pump inhibitors (PPIs): These reduce stomach acid production, which can help relieve symptoms of heartburn and reflux.
- Topical steroids: These medications, when swallowed, reduce inflammation in the esophagus by working directly on the esophageal lining without affecting the rest of the body as much.
- Biologic therapies: Biologics, such as dupilumab, help reduce inflammation in the esophagus.
- Therapeutic procedures:
- Esophageal dilation: This procedure widens the esophagus to improve food passage if it becomes too narrow due to strictures or narrowing.
- Lifestyle changes:
- Elimination diets focus on avoiding foods that might trigger allergic reactions. A common approach is the six-food elimination diet (6FED), which removes the top food allergens to help identify and manage triggers.
It's important to consult with a healthcare professional for personalized advice on medication dosing and potential side effects. Additionally, they can provide guidance on specific dietary modifications and therapeutic procedures based on individual needs.
Medication dosing may be affected by many factors. Check with your health care professional about dosing for your individual situation. Other side effects can occur. Check with your health care professional or read the information provided with your medication for additional side effect information.