Eosinophilic Esophagitis: An Emerging Allergic Disease
Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. In this article, we explore what is currently known about this emerging disease.
What is Eosinophilic Esophagitis?
Eosinophilic esophagitis, also known as EoE, is a condition where there is an abnormal buildup of a type of white blood cell called eosinophils in the esophagus. The esophagus is the tube that connects the mouth to the stomach. In someone with EoE, the immune system responds abnormally to certain triggers, causing the eosinophils to accumulate in the esophagus and cause inflammation.
The buildup of eosinophils damages the esophageal tissue over time and can cause a variety of symptoms. EoE is considered a chronic disease characterized by remission and relapse throughout a patient’s lifetime if not properly treated. The cause of EoE appears to be due to improper immune responses to environmental allergens in genetically susceptible individuals.
Symptoms of Eosinophilic Esophagitis
The most common symptoms of EoE include:
– Dysphagia (difficulty swallowing) – This is usually worse with solid foods than liquids. Bread, meat and pastries tend to cause more discomfort.
– Chest pain – May occur before, during or after swallowing and is usually felt in the upper chest under the breastbone (sternum).
– Acid reflux – EoE can mimic acid reflux (GERD) since both involve swallowing problems. However, unlike GERD, acid reflux medications do not always help EoE symptoms.
– Food impaction – Difficulty swallowing solid food and occasional blockage of food in the esophagus causing stubborn stuck feelings.
– Vomiting – May happen after eating due to blockages. Food only vomiting is common after eating.
– Weight loss – Due to difficulty eating, food avoidance, fear of swallowing or food getting stuck.
Other less common symptoms include abdominal pain, coughing or choking during eating. Symptoms are typically intermittent and vary widely between individuals.
Possible Causes of Eosinophilic Esophagitis
The exact cause of EoE remains unknown, but it is thought to involve a combination of genetic and environmental factors that trigger an inappropriate immune response in the esophagus. The leading theories for EoE include:
Genetics – Family history of EoE or allergic disease increases risk. Some genes have been linked to increased risk.
Immune System Dysregulation – The immune system mistakenly identifies certain foods, aeroallergens and other triggers as threats and mounts an attack of eosinophils in the esophagus.
Environmental Allergens – Common food triggers include milk, wheat, soy, eggs and nuts. Aeroallergens like pollen, dust mites and pet dander are also suspect.
Breach in Esophageal Barrier – Damage to the protective lining of the esophagus may allow allergens access to trigger eosinophil recruitment.
So in summary, EoE is considered a disorder of improper immune activation due to genetic and environmental interactions that leads to inflammation in the esophagus. Identifying causative triggers remains a research priority for prevention and treatment.
Diagnosing Eosinophilic Esophagitis
There is no single test to definitively diagnose EoE, rather it is a combination of evaluation by a physician along with endoscopy, biopsy and ultimately histological examination of biopsies. During an endoscopy, an esophagogastroduodenoscopy (EGD), abnormalities such as vertical lines, rings or furrows in the esophagus may be visible. Targeted biopsies are then taken and examined under a microscope.
To be diagnosed with EoE, biopsy samples must show >15 eosinophils in at least one high power field. Additional criteria include absence of other conditions, such as GERD, pill esophagitis, infections, etc. that may cause similar symptoms and inflammation. Monitoring eosinophil levels with treatment is important for diagnosis as well. Endoscopy allows evaluation of treatment response over time.
Treating Eosinophilic Esophagitis
Currently, there is no cure for EoE but it can be effectively treated and managed long-term. Treatment aims to reduce esophageal inflammation and symptoms through dietary adjustments and medication use, with the goal of inducing and maintaining remission.
The two primary treatment approaches are:
1) Elimination Diets – Identifying and avoiding specific food triggers, usually the top 6-8 allergenic foods, through elimination diets guided by an allergist/gastroenterologist.
2) Topical Corticosteroids – Swallowed, enteric-coated budesonide or fluticasone propionate are the most common medications used to reduce eosinophil levels.
In more severe cases, a short course of oral steroids may be used or the option of dilating the esophagus through endoscopy to relieve blockages. Proper treatment, close monitoring and patient adherence are important for long-term control over symptoms and damage. Overall, the goal is individualized care focused on relapse prevention.
Raising Awareness of Eosinophilic Esophagitis
As research expands our understanding EoE, it is an important priority to raise public and provider awareness of this chronic condition. Some key points to highlight include:
– EoE is an underdiagnosed disease mimicking other more common conditions like GERD or asthma/allergies. Symptoms alone do not make the diagnosis.
– Endoscopy and esophageal biopsies are required for accurate diagnosis according to strict histological criteria. Routine biopsies improve identification.
– Early detection and treatment improves long-term outcomes by preventing scarring and strictures that impact quality of life.
– A multidisciplinary team including gastroenterology, immunology and nutrition support offers comprehensive management of this complex condition.
– Patient empowerment through education is critical for successful self-management of dietary and medication-based treatments long-term.
1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it