The human immune system is a complex network of organs and processes that protects us from diseases. Our white blood cells are an important part of this network, but sometimes an increase or decrease in the number can cause problems. A somewhat rare example of such a problem is eosinophilic esophagitis, an allergic inflammatory condition that primarily affects the esophagus. While the condition is not generally life-threatening, treating the symptoms can make a huge difference in a person’s quality of life.

What is Eosinophilic Esophagitis?

According to the American Partnership for Eosinophilic Disorders (APFED), eosinophilic esophagitis (EOE) affects about 1 out of every 2000 Americans. While once mainly found in children, EOE is now increasingly found in adolescents and adults as well. This typically chronic condition is characterized by inflammation and swelling of the esophagus, the muscular tube that connects the mouth to the stomach in the digestive system. Such an inflammation of the esophageal tissue is believed to be triggered primarily by an allergic response to specific foods or environmental allergens.

When an allergic reaction like this is triggered, the esophageal tissue is flooded with eosinophils, a type of white blood cell that is normally responsible for fighting off infections by multicellular parasites. Eosinophils are typically found in the intestines, brain, and other parts of the body but not in the esophagus; so when a large number of eosinophils begins to infiltrate the esophagus, the tissue becomes inflamed and the esophagus can narrow and suffer damage. There are a number of symptoms of EOE that can result:

  • Difficulty swallowing: One of the most common symptoms of eosinophilic esophagitis is having trouble swallowing (dysphagia). The difficulty in swallowing can include solid foods as well as liquids, and many people report a feeling of food being stuck in the throat or chest.
  • Food impaction: Another common symptom of EOE is food becoming stuck in the esophagus due to narrowing of the passage. A food bolus getting lodged in this way can also contribute to chest discomfort, dysphagia, and abdominal pain.
  • Chest pain: Whether because of food impaction or inflammation, it is also common for patients with EOE to experience chest pain. Because of the location of the pain, however, it can sometimes be mistaken as heartburn or even a heart attack.
  • Acid reflux: Though eosinophilic esophagitis is a separate condition, it can cause some of the same symptoms that are found in gastroesophageal reflux disease (GERD). These symptoms can include heartburn and regurgitation, and they may worsen after meals or when lying down.
  • Nausea: Nausea and vomiting are also common symptoms that tend to occur either during or after meals, and they can be triggered by food impaction or esophageal inflammation.
  • Weight loss: In pediatric cases, the child may experience unexpected weight loss or poor growth due to problems with swallowing and subsequent inadequate nutrient intake.

    What Causes Eosinophilic Esophagitis?

    While the precise cause of EOE is still not fully understood, it is believed to be due to a combination of genetic, immunological, and environmental factors. In a practical sense, the symptoms of EOE seem to be caused by an immune response to a food allergy, but the reason for any underlying allergic diseases is likely due to genetics. There appears to be a genetic predisposition to EOE amongst family members, and there are likely specific genes involved in the regulation of the immune system that can be passed on.

    Environmental factors like airborne allergens or pollutants may contribute to the development or exacerbation of eosinophilic esophagitis, but it is actually more commonly triggered by a food allergy. Common dietary triggers include milk, eggs, wheat, soy, tree nuts, and seafood, but each individual has their own menu of possible allergens. These dietary factors can also be complicated by an imbalance or other problems related to the gut microbiome. Disruptions in the balance of beneficial and harmful bacteria may add to inflammation and disease progression.

    In general, eosinophilic esophagitis also seems to be connected to dysregulation in the aspects of the immune system related to the gastrointestinal system. This kind of dysregulation means that the body is unable to control or rein in the immune response to an allergen or pathogen in question. So when an inflammatory immune response is abnormally triggered, the inflammation can cause tissue damage. In the case of EOE, the tissue inflammation and damage is centered on the esophagus.

    Diagnosis of Eosinophilic Esophagitis

    The diagnosis of EOE usually involves a combination of a physical exam, review of family history, and an examination of the esophageal tissue. The symptoms a patient presents with can also indicate the condition, but they are less conclusive given how different they can be from person to person. Below are some common methods of diagnosis:

    • Upper endoscopy: An endoscopic examination involves placing a flexible tube through the mouth and down the esophagus. During the procedure, the gastroenterologist may observe characteristic findings in the esophagus, such as rings, strictures, linear furrows, or other abnormalities.
    • Biopsy: In the process of an endoscopic exam, the gastroenterologist can also use tools mounted on the endoscope to take tissue samples from the esophagus. The presence of eosinophils is easy to detect because of the reddish color they have when viewed under a microscope.
    • Allergy testing: In addition to looking for the signs of the disease, allergy tests may be used to determine the kinds of allergens that are causing an immune response. Testing may include skin prick or blood tests.

    Treatment Options for Eosinophilic Esophagitis

    Even though there isn’t technically a cure, the treatment of eosinophilic esophagitis aims to alleviate symptoms, reduce inflammation in the esophagus, and prevent any complications. These goals can be achieved with a variety of potential strategies:

    • Dietary therapy: Since food allergies are one of the most common triggers of EOE, changing one’s diet is typically the first step in the treatment process. A food elimination diet is one basic approach that involves identifying and eliminating allergens. In more severe cases where multiple triggers are present, an elemental diet may be recommended; this involves consuming a liquid formula that contains amino acids, vitamins, and minerals but without any of the whole proteins that can trigger inflammation.
    • Medication: There are also several medications that can ease symptoms and make inflammation less likely. Proton pump inhibitors (PPIs), for instance, reduce gastric acid production and reduce the kinds of inflammatory symptoms that are shared with GERD. Additionally, topical steroids (administered via inhaler like fluticasone or budesonide) and oral corticosteroids may be used to directly reduce esophageal inflammation. There is also a medication called dupilumab that is normally used to treat eczema (atopic dermatitis) but that also can improve the symptoms of EOE.
    • Procedures: In cases where EOE has led to strictures or narrowing, esophageal dilation may be necessary to alleviate symptoms and improve the ability to swallow.

      Contact Cary Gastroenterology

      The good news is that eosinophilic esophagitis is a relatively rare condition that results in mild symptoms for most people. If left untreated, however, it can become a bigger problem that can lead to digestive problems and even malnutrition. If you have been experiencing any of the symptoms noted above, it may be time to connect with a gastroenterologist. Our team of highly qualified and empathetic healthcare providers at Cary Gastro is eager to help you improve your quality of life. Please contact us today to request an appointment.