Eosinophilic Esophagitis (EoE)

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WHAT IS EOSINOPHILIC ESOPHAGITIS (EOE)? Eosinophilic esophagitis (EoE) is an allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cells.  In healthy people, the white blood cells are typically devoid of eosinophils. In EoE, white blood cells called eosinophils build up in your esophagus, the tube that connects your mouth […] Read More

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Eosinophilic Esophagitis (EoE)

WHAT IS EOSINOPHILIC ESOPHAGITIS (EOE)? Eosinophilic esophagitis (EoE) is an allergic inflammatory condition of the esophagus that involves eosinophils, a type of white blood cells.  In healthy people, the white blood cells are typically devoid of eosinophils. In EoE, white blood cells called eosinophils build up in your esophagus, the tube that connects your mouth to your stomach.   RISK FACTORS The frequency of occurrence of eosinophilic esophagitis (EoE) is approximately 1 in 2,000 people (a percentage of 0.05%).  EoE is a relatively newly recognized disease. It was once thought to be a childhood disease, however, it has been discovered that adults do get EoE, which persists from their childhood to their adulthood. But rarely, some people first experience EoE as adults.  Certain people are more likely to get eosinophilic esophagitis. Although anyone can get EoE, boys tend to develop it more often than girls, in the proximity of 3:2. Some EoE patients have high expression of a particular gene; eotaxin-3.  Many genes have been associated with EoE, including CAP-14 and TSLP. EoE may be more common in families.  Exposure to “unsafe foods” or pollen may risk an individual to allergy. Gardeners and workers in factories where grains are packaged in sacks, or cleaners in warehouses, are at risk of getting EoE.  Employees in road construction sites are also at high risk. People living in cold or dry climates and asthmatic patients are more likely at risk. Eosinophilic esophagitis is diagnosed more in spring and autumn. COMPLICATIONS If left untreated, complications may occur, such as:
  • Scars in the esophagus.
  • Narrowing of the esophagus
This makes swallowing more difficult and more likely for the food to get stuck, thus creating an emergency. Sometimes, vomiting takes place.
  • Damage to the esophagus
The buildup of eosinophils can result in esophageal injuries and inflammation. Because of the inflammation of the esophagus, endoscopy can cause perforation or tears in the lining tissues. EOSINOPHILIC ESOPHAGITIS DIAGNOSIS  To diagnose someone with eosinophilic esophagitis (EoE), the following tests may have to be carried out:
  • Upper Endoscopy
Here, a long narrow tube (endoscope), with light and camera, is inserted through your mouth and down the esophagus, to detect inflammation, swelling, horizontal rings, vertical furrows, narrowing, and white spots in your esophagus.
  • Biopsy
Multiple tissue samples are taken from your esophagus and examined with a microscope for eosinophils.
  • Blood Tests
These look for higher eosinophil counts or total immunoglobulin E (IgE) level.
  • Esophageal Sponge Test
Here, a capsule that is tied to a string is swallowed. When the capsule dissolves in your stomach, a sponge is released that is pulled out of your mouth with the string.  The pulled-out sponge will sample the esophageal tissue and allow the doctor to determine the degree of inflammation in your esophagus without having to undergo an endoscopy. EOSINOPHILIC ESOPHAGITIS TREATMENT EoE is a chronic relapsing disease, hence most patients will require ongoing treatment to control their symptoms.  The treatments of eosinophilic esophagitis (EoE) include one or more of the following:
  1. Dietary Therapy
Your doctor may recommend that you stop eating certain foods, after conducting tests for food allergies. This can be considered as eosinophilic esophagitis natural treatment  Eosinophilic esophagitis diet such as dairy or wheat products may be restricted from your meals to relieve your symptoms. These may include:
  • Eggs.
  • Fish.
  • Soy.
  • Nuts.
  • Milk.
  • Wheat.
  • Shellfish.
Medications These include:
  • Proton Pump Inhibitor
PPI is an acid blocker. It is the easiest medication to use when treating eosinophilic esophagitis (EoE). It can be used as a first-line treatment.
  • Topical Steroids
Steroids are only recommended if you don’t respond to PPI. Topical steroids (which can be applied to the skin), such as fluticasone or budesonide are liquids that are swallowed to treat eosinophilic esophagitis (EoE). There are usually no side effects associated with steroids.
  • Dilation
If the use of steroids is not helpful enough (or at all), your doctor may recommend dilation if you experience severe narrowing (structures) in your esophagus. Note the sequence; starting with PPIs→ topical steroids dilation. EOSINOPHILIC ESOPHAGITIS PROGNOSIS Eosinophilic esophagitis (EoE) is a rare chronic disease that requires further intense research, ongoing monitoring, and management. EoE does not appear to limit life expectancy and until now there is currently no data suggesting EoE causes cancer of the esophagus.

Symptoms

EOSINOPHILIC ESOPHAGITIS SYMPTOMS

The signs of EoE vary with age. However, most of them are the same for both children and adults. They include:

  • Swallowing difficulty (dysphagia).
  • Food impaction (food getting stuck in one’s esophagus).
  • Vomiting (mostly in children).
  • Chest pain.
  • Pains in the upper abdomen.
  • Nausea.
  • Undergrowth (mostly in children).
  • Weight loss.
  • Lack of appetite.
  • Malnutrition (poor or unhealthy feeding).
  • Backflow of undigested food (regurgitation).

From the above information given, it is quite evident that the symptoms of EoE overlap with those of gastroesophageal reflux disease (GERD). 

Many EoE patients are initially thought to have GERD when diagnosed, only to be found that they do not typically respond to anti-GERD therapies. People with eosinophilic esophagitis often have allergic disorders (such as asthma or eczema). 

Other related disorders with almost similar symptoms with EoE include ulcerative colitis (an inflammatory bowel disease of unknown causes) and Crohn’s disease (an inflammatory bowel disease of unknown causes too).

Causes

EOSINOPHILIC ESOPHAGITIS CAUSES

Eosinophilic esophagitis flare-up is caused by the presence of a large number of eosinophils in the esophagus. 

Many factors might have contributed to this production and buildup of eosinophils. Such factors may include immune hypersensitivity responses to particular foods or environmental proteins (allergens) in certain affected persons. 

Genetically, some people with EoE have been found to have an extraordinarily high expression of a particular gene (known as eotaxin-3) that codes for a protein that controls the accumulation of eosinophils. Many genes have been found to contribute to EoE, including CAPN-14 and TSLP.

In normal health conditions, the esophagus is usually devoid of eosinophils. The buildup of eosinophils in the esophagus is a reaction to foods, allergens, or acid reflux. 

Eosinophils are a type of disease that fights against white blood cells. They respond to conditions indicating a parasitic infection, an allergic reaction, or cancer. You can have high levels of eosinophils in tissues at the site of an infection or inflammation, apart from your blood. 

Eosinophilic functions include:

  • The movement to inflamed areas.
  • Trapping substances.
  • Killing cells.
  • Anti-parasitic and bactericidal activities.
  • Participating in immediate allergic reactions.
  • Modulating inflammatory responses.

The accumulation of eosinophils in the esophagus (to fight allergens) can inflame or injure the esophageal tissue. The damaged esophagus can lead to difficulty in swallowing food or making food get stuck while swallowing, as well as other EoE symptoms.

FAQ

What triggers eosinophilic esophagitis?

Eosinophilic esophagitis (EoE) is caused by the presence of a large of eosinophils in the esophagus. The production and pileup of eosinophils may be caused by many factors like immune hypersensitivity to certain foods or allergens, in some EoE patients.

What happens if eosinophilic esophagitis is left untreated?

If left untreated, you can eventually result in scarring and narrowing of the esophagus, which makes the symptoms even worse over time. The first step in treating EoE usually involves taking acid-blocking medications. These drugs can lower the impact of acid reflux and reduce inflammation within the esophagus.

How rare is Eosinophilic Esophagitis?

EoE is a rare disease, increasing in prevalence (with approximately 1 out of 2,000 persons affected per year). EoE affects people of all ages and ethnic composition but tends to affect males more than females.

What foods do you avoid if you have Eosinophilic Esophagitis?

The six food elimination diet (SFED) is the most frequently employed in patients with EOE. This diet typically trials the exclusion of wheat, milk, egg, nuts, soy, fish, and shellfish.

Do antihistamines help eosinophilic esophagitis? 

Antihistamines are frequently used for the treatment of gastroesophageal reflux disease and allergic disorders, and we hypothesize they will be effective in the treatment of eosinophilic Esophagitis as well. The two common antihistamines are loratadine and famotidine.