Eosinophilic esophagitis

Synonyms

3

Overview

Eosinophilic esophagitis (eosinophilic oesophagitis), also known as allergic oesophagitis, is an allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cell. Symptoms are swallowing difficulty, food impaction, and heartburn.

Eosinophilic esophagitis (EoE) was first described in children but also occurs in adults. The condition is not well understood, but food allergy may play a significant role.The treatment may consist of removal of known or suspected triggers and medication to suppress the immune response. In severe cases, it may be necessary to stretch the esophagus with an endoscopy procedure.

Symptoms

EoE often presents with difficulty swallowing, food impaction, regurgitation or vomiting, and decreased appetite. In addition, young children with EoE may present with feeding difficulties and poor weight gain. It is more common in males, and affects both adults and children.

Many people with EoE have other autoimmune and allergic disease. This includes asthma and celiac disease.

Causes

Its an autoimmune disease where the white blood cells attack food mistaking it for a parasite.

A variety of stimuli may trigger this allergic process, including certain foods and environmental allergens.

Prevention

Try whether a diet eliminating all of the six most commonly allergenic foods (milk, soy, egg, wheat, peanuts/tree nuts and shellfish/fish) improves your symptoms, as suggested by the study of Gonsalves N. et al.

 

 

 

Diagnosis

The diagnosis of EoE is typically made on the combination of symptoms and findings on diagnostic testing.

Prior to the development of the EE Diagnostic Panel, EoE could only be diagnosed if gastroesophageal reflux did not respond to a six-week trial of twice-a-day high-dose proton-pump inhibitors (PPIs) or if a negative ambulatory pH study ruled out gastroesophageal reflux disease (GERD).

Endoscopically, ridges, furrows, or rings may be seen in the esophageal wall. Sometimes, multiple rings may occur in the esophagus, leading to the term "corrugated esophagus" or "feline esophagus" due to similarity of the rings to the cat esophagus. Presence of white exudates in esophagus is also suggestive of the diagnosis. On biopsy taken at the time of endoscopy, numerous eosinophils can be seen in the superficial epithelium. A minimum of 15 eosinophils per high-power field are required to make the diagnosis. Eosinophilic inflammation is not limited to the esophagus alone, and does extend through the whole gastrointestinal tract. Profoundly degranulated eosinophils may also be present, as may microabcesses and an expansion of the basal layer.

Radiologically, the term "ringed esophagus" has been used for the appearance of eosinophilic esophagitis on barium swallow studies to contrast with the appearance of transient transverse folds sometimes seen with esophageal reflux (termed "feline esophagus").

Treatment

Treatment strategies include dietary modification to exclude food allergens, medical therapy, and mechanical dilatation of the esophagus.

The current recommendation for first line treatment is PPI in lieu of diet as a significant portion of EOE cases respond to this, and it is a low risk, low cost treatment.

The second and third line therapies are an elimination diet of either the 6 or 4 most common triggers, or topical corticosteroids, including both fluticasone, and topical viscous budesonide.

Elimination diets would be followed by re-introduction of foods under supervision if the first diet is successful. Allergy evaluation has been found to not be an effective means to determine what foods to eliminate.