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, a biologic agent, 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.
Impedance planimetry is another type of esophageal test that is occasionally done to look for subtle strictures. For this test, a balloon filled with salt water (saline solution) is used to measure the area across the inside of the esophagus and the pressure inside of the esophagus at the same time.
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
Dupilumab
Changes in diet
Sometimes dilation of the esophagus
Options for adults include proton pump inhibitors (PPIs), which are medications that reduce production of stomach acid and can reduce symptoms; topical corticosteroids; and the biologic agent dupilumab.
In children, changes in diet are often effective, but PPIs are typically used if changes to the diet have not helped. Children 1 year old and older can be given dupilumab.
If PPIs do not help, people are given topical corticosteroids (such as fluticasone and budesonidethrush).
Dupilumab may be given to people who are 1 year old and older who weigh at least 33 pounds (15 kilograms). This medication reduces inflammation in the esophagus.
Doctors may instruct people to change their diet. People can follow a diet that eliminates a food such as wheat, dairy, fish/shellfish, peanuts/tree nuts, eggs, or soy (see elimination diet). 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, may be 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.
