Eosinophilic Esophagitis

Eosinophilic esophagitis, also known as EE or EoE, is an allergic, inflammatory condition where the wall of the esophagus becomes filled with eosinophils, a type of white blood cell. This buildup is often a reaction to foods, allergens or acid reflux, and can injure esophageal tissue, leading to difficulty swallowing. EE is common in adults and affects men more than women.

Symptoms

  • Chest pain, often centrally located and unresponsive to antacids
  • Backflow of undigested food (regurgitation)
  • Decreased appetite
  • Difficulty eating or swallowing (dysphagia)
  • Food getting stuck in the esophagus after swallowing (impaction)
  • No response to gastroesophageal reflux disease (GERD) medication
  • Persistent heartburn
  • Upper abdominal pain
  • Vomiting

Possible Causes

  • Cold and dry climates
  • Family history
  • Seasons: Spring and fall, due to higher levels of pollen and other allergens
  • Allergies, asthma and related conditions: Food or environmental allergies, asthma, atopic dermatitis or chronic respiratory disease

Diagnosis

Eosinophilic esophagitis should be diagnosed by a gastroenterologist. They will work to rule out other diagnoses and will often work closely with an allergist to test for food allergies:

  • Biopsy: During an upper endoscopy, a long narrow tube containing a light and tiny camera is inserted through the mouth and down the esophagus. In this way, the gastroenterologist can inspect the lining of the esophagus for inflammation or other symptoms, and also perform a biopsy, removing a small piece of tissue from the esophagus. The tissue will be examined under a microscope for eosinophils.
     
  • Blood tests: If your provider suspects EE, your blood may be drawn to test for higher than normal eosinophil counts or total immunoglobulin E levels, suggesting an allergy.
     
  • Food Allergy Testing: Skin testing that can identify an allergy to specific food types.

Treatment

Most people require ongoing treatment to control symptoms of eosinophilic esophagitis. Treatment may include:

Medications

  • Proton pump inhibitor (PPI): Your provider will likely first prescribe an acid blocker such as a PPI.

  • Topical steroid: Fluticasone or Budesonide are spray steroids used if you cannot tolerate a PPI. Because they are not oral and thus not absorbed into the bloodstream, side effects often associated with steroids are far fewer.

Dilation

If you experience severe narrowing of your esophagus, your provider may recommend dilation/stretching of the esophagus to help make swallowing easier. If dilation is successful, ongoing use of medication can be avoided.

Dietary and Lifestyle Changes

  • Avoid certain foods and drinks: Your provider may recommend that you avoid common heartburn triggers, such as fatty or fried foods, tomato sauce, alcohol, chocolate, mint, garlic, onion, and caffeine. Your provider may recommend skipping certain foods, such as dairy or wheat products, to relieve symptoms and reduce inflammation.
     
  • Elevate the head of your bed: If heartburn is regularly experienced while sleeping, it may be recommended to elevate the head of your bed by six to nine inches.
     
  • Maintain a healthy weight: Excess pounds put pressure on your abdomen, pushing up your stomach and causing acid to back up into your esophagus, which can irritate an esophagus inflamed by eosinophilic esophagitis. Weight loss may help relieve symptoms.
     
  • Relaxation therapies: Techniques to calm stress and anxiety may reduce signs and symptoms of heartburn or reflux made more acute by eosinophilic esophagitis.
     

To schedule an appointment with Virginia Mason's Gastroenterology Department, call (206) 223-2319.