Eosinophilic esophagitis is a condition in which eosinophils build up in the lining of the esophagus. This causes inflammation and symptoms such as pain, vomiting, persistent heartburn, and difficulty swallowing.
This type of esophagitis occurs due to an exaggerated immune system response to an allergenic substance. It is more common in people with allergic rhinitis, asthma, or eczema, for example. Although it can occur at any age, eosinophilic esophagitis is especially concerning in children. This is because it can interfere with eating and affect normal development.
Although there is no cure, eosinophilic esophagitis can be managed with appropriate treatment. Care is typically guided by a gastroenterologist and/or an allergist-immunologist and usually includes dietary changes and medications, such as proton pump inhibitors, topical corticosteroids, or biologic therapies.
Main symptoms
The main symptoms of eosinophilic esophagitis include:
- Chronic esophageal pain
- Heartburn, nausea, and frequent vomiting
- Difficulty swallowing
- Food getting stuck in the throat
- Abdominal pain
- Reduced appetite
In children, an important additional sign is poor weight gain and difficulty maintaining normal growth and development.
Confirming a diagnosis
The diagnosis of eosinophilic esophagitis usually starts with a medical evaluation of symptoms and health history. Because the symptoms are very similar to those of acid reflux, this condition is often initially suspected, and treatment with acid-suppressing medications may be started.
If symptoms persist or eosinophilic esophagitis is suspected, additional tests are ordered to confirm the diagnosis and rule out other conditions.
According to the American Academy of Allergy, Asthma & Immunology, diagnosis of eosinophilic esophagitis is confirmed through upper endoscopy with biopsy of the esophagus. Blood tests and allergy testing may also be requested, since eosinophilic esophagitis frequently affects people with other allergic conditions.
Possible causes
The exact cause of eosinophilic esophagitis is not known. However, because the condition involves a buildup of eosinophils in the esophagus, it may be linked to an exaggerated immune system response to certain allergens, especially foods.
Although it can occur in anyone, eosinophilic esophagitis is more common in people who already have other types of allergies, such as allergic rhinitis, asthma, eczema, and/or food allergies. Eosinophilic esophagitis also tends to occur in several members of the same family.
Treatment options
Treatment for eosinophilic esophagitis should be guided by a gastroenterologist and/or an allergist-immunologist. Supervision by a registered dietitian may also be recommended.
According to the American College of Gastroenterology, treatment for eosinophilic esophagitis can include dietary therapy and medications that reduce esophageal inflammation. These treatments can help relieve symptoms and improve quality of life.
1. Dietary changes
Making dietary adjustments is usually the first step in treating people with eosinophilic esophagitis. This involves eliminating foods with a higher potential to cause allergies, such as:
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Dairy products
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Eggs
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Soy
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Tree nuts, especially peanuts
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Shellfish
The diet for eosinophilic esophagitis can be very restrictive, so follow-up with a registered dietitian is recommended to help prevent vitamin and nutrient deficiencies.
With guidance from a doctor and registered dietitian, different foods can be tested to see which ones worsen symptoms or increase inflammation in the esophagus. This process helps identify which foods should be avoided and which are safe to include in the diet.
2. Medications
In addition to dietary changes, a healthcare provider may prescribe medications to reduce inflammation and relieve symptoms.
While only a limited number of medications are specifically approved for eosinophilic esophagitis, several treatment options can help manage the condition, including:
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Proton pump inhibitors: reduce stomach acid production, which can help reduce inflammation in the esophagus
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Corticosteroids: in low doses, help keep inflammation in the esophagus under control
In addition, new medications are being studied to help treat eosinophilic esophagitis, especially medications that aim to block the proteins responsible for inflammation in the esophagus.