What is Eosinophilic Esophagitis (EoE)?
Eosinophilic esophagitis (EoE) is a chronic, allergic inflammatory disease that occurs when there is an increased number of eosinophilic in the esophagus (the tube connecting the mouth to the stomach). Eosinophils are a type of white blood cells that help fight parasite infections and are involved in allergic reactions. They are not normally found in the esophagus, although they may be found in small numbers in other areas of the gastrointestinal tract. Gastroesophageal reflux disease (GERD), drug reaction, and inflammatory bowel disease (Crohn’s disease) can also cause elevated numbers of eosinophils. The eosinophils cause injury to the surrounding tissues.
People with EoE often have other allergic conditions such as nasal and eye/ocular allergies, asthma, anaphylactic food allergies, and/or eczema. EoE can be triggered by delayed reactions to foods and in some cases is inherited. Symptoms may vary among individuals and age groups. Vomiting may occur more commonly in young children while older individuals may have difficulty swallowing. Food impactions are more common in adults and adolescents.
How is EoE Treated?
Currently, there are no FDA-approved drugs indicated for the treatment of EoE. The two main treatments recommended are diet management and medications that were approved to treat other conditions, such as swallowed topicals corticosteroids (fluticasone or a budesonide mixture/slurry), and proton pump inhibitors (acid suppressors). A combination of these therapies may be recommended. Repeat endoscopies with biopsies are needed to monitor the effectiveness of the treatment plan.
Diet management may include Common allergen elimination diet- Common allergy causing foods (milk, egg, soy, wheat, and, at times, other foods such as shellfish, fish, peanuts/tree nuts, based on current studies) are removed from the diet, rather than using food allergy test results to determine which food(s) to remove.
Elemental Diet: All sources of protein are removed from the diet and the patient drinks only an amino acid formula. Sometimes, a feeding tube may be required.
- Food Trial- Specific foods are removed from the diet, and then added back, one at a time, to determine which food(s) causes a reaction.
Directed elimination diet- Food allergy testing is used to direct which foods to remove from the diet. While this may help guide food trials and/or evaluate for IgE reactions, empiric allergen elimination diets are more often used for EoE.
How is EoE diagnosed?
To diagnose EoE, a gastroenterologist will perform an upper endoscopy. This procedure is typically not uncomfortable and can be done on an outpatient basis.
- During this procedure, the patient is sedated or put under anesthesia, and a small tube called an endoscope is inserted through the mouth. The esophagus, stomach, and the first part of the small intestine are examined for tissue injury and inflammation, and the esophageal wall is examined for thickening. A patient may have EoE even if the esophagus looks normal during endoscopy.
- Small tissue samples are taken (biopsies) for a pathologist to analyze under a high-powered microscope. If eosinophils are present in the samples, the pathologist will count how many are visible. Increased numbers of eosinophils (usually >15 eosinophils per high-powered microscopic field) is highly suggestive of EoE. It is very important that your GI doctor take an adequate number of samples (ideally 4-5) from at least two areas of the esophagus in order to make an accurate diagnosis.
- An endoscopy with the biopsies is the only reliable method of diagnosing EoE at this time, although less invasive diagnostic and monitoring methods are currently under investigation.
Medication Can Include:
Topical steroids- Swallowed from an asthma inhaler or mixture, to control inflammation and suppress the eosinophils
Proton pump inhibitors (PPIs)- May help reduce inflammation and control acid production
Living With EoE
The initial diagnosis of EoE can be overwhelming. It is almost always a chronic and lifelong disease, but with proper ongoing care and treatment, individuals with EoE can lead a normal life. EoE does not appear to limit life expectancy and data does not suggest EoE causes cancer of the esophagus.
The challenges of living with EoE vary, depending on the severity of illness and other factors. The following tips will help:
- Find a supportive community; connect with others, ask for help, and learn from one another
- Take along safe foods when you leave home
- Communicate your needs to restaurant staff and caregivers
- Organize parties, gatherings, and activities that don’t involve food.
Eosinophilic GI Diesease (EGID)
What is Eosinophilic GI Disease (EGID)?
When a person has a high number of eosinophils in their digestive tract and other non-GI causes for it have been ruled out, he or she may have EGID. The eosinophils cause inflammation and damage to tissues and organs.
EGIDs are rare diseases that affect people of all ages and ethnic backgrounds. It is not known what causes EGID, but food and environmental allergies may play a role. People who have a personal or family history of allergic disorders (e.g., food allergy/anaphylaxis, eczema, hay fever, asthma) or with other eosinophil-associated disease may be at higher risk of developing EGID.
EGIDs are further defined by the area affected:
Eosinophilic Esophagitis (EoE): Esophagus
Eosinophilic Gastritis (EG): Stomach.
- Eosinophilic Gastroenteritis (EGE): Stomach and/or small intestine, or multiple segments of gastrointestinal tract
- Eosinophilic Duodenitis: First part of small intestine immediately beyond the stomach
- Eosinophilic Enteritis: Small intestine
- Eosinophilic Colitis: Large intestine/colon
This brochure provides information about the “lower EGIDs”- eosinophilic gastroenteritis, eosinophilic gastritis, and eosinophilic colitis. Those who have a diagnosis of eosinophilic duodenitis, or eosinophilic enteritis may refer to the panel that discusses EG and EGE, as the information applies to the subsets.
For information specific to eosinophilic esophagitis, or to order brochures about that subset, visit apfed.org.
Gastroesophogeal reflux disease (GERD)
What is it?
Gastroesophogeal Esophogeal Reflux Disease (GERD) us a condition in which stomach acid or contents flow back (reflux) from the stomach and into the esophagus. This condition can occur at any age from infants to older adults however people with asthma are at higher risks of developing GERD. During an asthma exacerbation the sphincter that holds the stomach contents in the stomach relaxes and allows reflux to occur. Acid reflux may also worsen asthma symptoms by causing airway and lung irritation.
Over time this can lead to more severe asthma. Patients may be more sensitive to environmental conditions such as smoke or cold as well because of GERD. GERD commonly causes symptoms such as a burning in the mouth and throat, burping/regurgitation, and pain with swallowing however it also frequently causes symptoms such as recurrent or chronic cough, chest pain and vocal hoarseness/laryngitis. Therefore, it is important to have a thorough evaluation done if you are experiencing these symptoms. There are many lifestyle changes and medications that are used to treat GERD.
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