By Nicholas Ditzler
Do you have trouble swallowing? Does food get stuck on its way down? Do you drink large amounts of liquids to get food down? A yes to any of these questions suggests you may have a chronic allergic condition called Eosinophilic Esophagitis (EoE).
EoE occurs when an increased number of inflammatory cells called eosinophils cause swelling in the esophagus – the tube that carries food from the mouth to the stomach – making it difficult to swallow.
“In some people, it can be triggered by food or by environmental allergies such as pollen and mold — but we’re often not sure what causes it,” says board-certified allergist Matthew Greenhawt, MD, assistant professor of pediatrics at University of Colorado Denver School of Medicine.
Allergy & Asthma Today spoke with Dr. Greenhawt about EoE symptoms, diagnosis and treatment:
AAT: How common is EoE?
Dr. Greenhawt: I would say it’s more common than we think. Many times patients will experience symptoms for years and never see a doctor. They may think it’s normal to have food get slightly stuck going down or experience pain as they swallow.
EoE occurs in children and adults, it’s common to see it more in males than females, and it’s prevalent in families that have a history of allergic disease.
AAT: What are the symptoms?
Dr. Greenhawt: In infants and young children, there is refusal of food, poor growth, abdominal pain, reflux and vomiting. In teenagers and adults, there is difficulty swallowing, worsened reflux, chest pain, a narrowed esophagus, and food slightly stuck going down.
People with EoE tend to develop eating behaviors to accommodate the disease. They cut their food into tiny pieces, overchew food, or drink excessive amounts of liquid to get food down.
It’s important to note that if food gets stuck in the throat, this is a medical emergency and patients should go to the hospital immediately.
AAT: How is it diagnosed?
Dr. Greenhawt: A gastroenterologist will perform a biopsy – inserting a small tube, or endoscope, through the mouth to examine the esophagus and stomach and take small tissue samples. White patches inside the esophagus indicate the presence of eosinophils; there may also be visible swelling, lacerations, ulcers or nodules. If there are 16 or more eosinophils in at least two sites, the diagnosis is EoE.
An allergist will identify triggers, monitor symptoms and coordinate care with other healthcare professionals on the patient’s team. If food is a trigger, a dietician will make appropriate dietary recommendations.
AAT: What are treatment options?
Dr. Greenhawt: EoE can be treated and managed through diet therapy, medication therapy, or a combination of both.
There are three types of diet therapies. The first type involves a diet that eliminates the major food allergens — milk, egg, wheat, soy, nuts and seafood — without any prior food allergy testing. The second type involves a diet that removes known EoE trigger foods identified by skin prick and patch testing. And the third type — generally reserved for children — limits the diet to an amino acid-based formula that’s completely nonallergenic. Some drink the formula, but others need assistance from a feeding tube.
Patients should be able to find a diet therapy that fits their needs and preferences. Compliance is critical – a dietician can help find replacement foods and ensure nutrition.
There is no medication approved specifically to treat EoE; however oral corticosteroids are very effective at controlling inflammation. They are not considered a long-term EoE treatment, and patients must take into account unwanted side effects involved with the medication.
An important secondary therapy is using a proton pump inhibitor – an antiacid, anti-reflux medication. It’s first used as part of EoE diagnosis – to rule out gastroesophageal reflux disease (GERD) – and it also helps relieve symptoms.
Reviewed by Michael Pistiner, MD and Prem Menon, MD
Patient Education Resources
• American Partnership for Eosinophilic Disorders (APFED): www.APFED.org
• Campaign Urging Research for Eosinophilic Disorders (CURED): www.CuredFoundation.org