This disorder may be caused by food allergies.
Children may refuse to eat and lose weight, and adults may have food lodged in their esophagus and difficulty swallowing.
The diagnosis is based on the results of an endoscopy and biopsy, sometimes along with x-rays.
Treatment includes proton pump inhibitors, corticosteroids, changes in diet, and sometimes dilation of the esophagus.
The esophagus Throat and Esophagus The throat (pharynx— see also Throat) lies behind and below the mouth. When food and fluids leave the mouth, they pass through the throat. Swallowing of food and fluids begins voluntarily and... read more is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus Overview of the Esophagus The esophagus is the hollow tube that leads from the throat (pharynx) to the stomach. Food does not just fall through the esophagus into the stomach. The walls of the esophagus propel food to... read more .)
Eosinophilic esophagitis can begin at any time between infancy and young adulthood. It occasionally occurs in older adults and is more common among males.
Eosinophils White Blood Cells The main components of blood include Plasma Red blood cells White blood cells Platelets read more are a type of white blood cell that play an important role in the body's response to allergic reactions, asthma, and infection with parasites. Eosinophilic esophagitis may be caused by an allergic reaction to certain foods in people who have genetic risk factors. The allergic reaction causes inflammation that irritates the esophagus. If not treated, the inflammation eventually leads to chronic narrowing (stricture) of the esophagus.
Symptoms of Eosinophilic Esophagitis
Infants and children may refuse to eat and have vomiting, weight loss, and abdominal pain, chest pain, or a combination.
Adults who have a stricture (usually those who have had esophagitis for a long time) often have difficulty swallowing Difficulty Swallowing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become... read more (dysphagia) and may have food lodged in their esophagus (called esophageal food impaction). People may have symptoms similar to those of gastroesophageal reflux disease Gastroesophageal Reflux Disease (GERD) In gastroesophageal reflux disease, stomach contents, including acid and bile, flow backward from the stomach into the esophagus, causing inflammation in the esophagus and pain in the bottom... read more (GERD), particularly heartburn (a burning pain behind the breastbone).
People often also have other allergic disorders, such as asthma Asthma Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are... read more or eczema Atopic Dermatitis (Eczema) Atopic dermatitis (commonly referred to as eczema) is chronic, itchy inflammation of the upper layers of the skin that often develops in people who have hay fever or asthma and in people who... read more .
Diagnosis of Eosinophilic Esophagitis
Endoscopy and biopsy
Sometimes barium swallow x-rays
Doctors suspect the diagnosis of eosinophilic esophagitis in people of any age who have other allergic disorders and difficulty swallowing solid foods. The diagnosis is also suspected in people who have symptoms of GERD that do not go away with typical treatment.
To diagnose the disorder, doctors look in the esophagus with a flexible tube ( endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). Endoscopy can also be used to treat many disorders because doctors are able to pass instruments... read more ). During the endoscopy, doctors take tissue samples to analyze under a microscope (called a biopsy).
Sometimes, doctors also do a barium swallow X-Ray Studies of the Digestive Tract X-rays often are used to evaluate digestive problems. Standard x-rays (plain x-rays) do not require any special preparation ( see Plain X-Rays). These x-rays usually can show a blockage or paralysis... read more . In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see.
Doctors may also do tests for food allergies Diagnosis A food allergy is an allergic reaction to a particular food. Food allergies are commonly triggered by certain nuts, peanuts, shellfish, fish, milk, eggs, wheat, and soybeans. Symptoms vary by... read more to identify possible triggers, but they are of little benefit.
Treatment of Eosinophilic Esophagitis
Proton pump inhibitors
Changes in diet
Sometimes dilation of the esophagus
Adults are given proton pump inhibitors (PPIs), which are drugs that reduce production of stomach acid and can reduce symptoms. In children, changes in diet are often effective, but PPIs are typically used if changes to the diet have not helped.
If PPIs do not help, people are given topical corticosteroids (such as fluticasone and budesonide) that are swallowed to coat the esophagus can help reduce inflammation. People may use a fluticasone inhaler and puff the drug into their mouth without inhaling and then swallow it. This way the drug coats the esophagus and does not enter the lungs. Budesonide in liquid form also can be mixed with a sugar substitute or thickener (such as cornstarch) and swallowed. People may rinse out their mouth afterwards to help avoid a fungal infection of the mouth ( thrush Candidiasis (Yeast Infection) Candidiasis is infection with the yeast Candida. Candidiasis tends to occur in moist areas of the skin. Candidiasis may cause rashes, scaling, itching, and swelling. Doctors examine the... read more ).
Doctors may instruct people to change their diet. People can follow a diet that eliminates wheat, dairy, fish/shellfish, peanuts/tree nuts, eggs, and soy (see elimination diet Diagnosis ). This diet is the most often recommended diet for eosinophilic esophagitis and is better and simpler than eliminating foods based on the results of skin and blood allergy tests. Variations of this diet, where only two or four foods are eliminated, can be tried. The elemental diet, in which people get most of their nutrition in a liquid form usually composed of amino acids, fats, sugars, vitamins, and minerals, is successful in both adults and children but is often not practical in adults.
If people have narrowing of the esophagus, doctors inflate a balloon in the esophagus during endoscopy to dilate it. Doctors often do several dilations using progressively larger balloons to prevent the esophagus from tearing.
Injection and infusion therapies that target the eosinophil pathway in the body are being studied for eosinophilic esophagitis.