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Eosinophilic Esophagitis


Kristle Lee Lynch

, MD, Perelman School of Medicine at The University of Pennsylvania

Last full review/revision Oct 2020| Content last modified Oct 2020
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Eosinophilic esophagitis is an inflammatory disorder in which the wall of the esophagus becomes filled with large numbers of eosinophils, a type of white blood cell.

  • 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 is the hollow tube that leads from the throat (pharynx) to the stomach. (See also Overview of the Esophagus.)

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 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 (dysphagia) and may have food lodged in their esophagus (called esophageal food impaction). People may have symptoms similar to those of gastroesophageal reflux disease (GERD), particularly heartburn (a burning pain behind the breastbone).

People often also have other allergic disorders, such as asthma or eczema.

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). During the endoscopy, doctors take tissue samples to analyze under a microscope (called a biopsy).

Sometimes, doctors also do a barium swallow. 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 to identify possible triggers, but they are of little benefit.

Treatment of Eosinophilic Esophagitis

  • Proton pump inhibitors

  • Corticosteroids

  • 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 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).

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). 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. 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.

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Effects of Aging on the Digestive System
Although aging does not affect the digestive system as much as it affects other organ systems, it can be a factor in several digestive system disorders. However, aging has only minor effects on the structure of which of the following parts of the digestive system?
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