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Eosinophilic Esophagitis, and Emerging Gastrointestinal Disease
What is Eosinophilic Esophagitis (EoE)?
EoE is an allergic inflammatory condition of the esophagus that can cause difficulty in swallowing and heartburn, and in severe cases it can lead to food impaction (food getting stuck in the esophagus) and in children, a failure to thrive (poor growth or weight loss).
EoE is a disorder in which eosinophils, a type of white blood cell involved in allergic reactions, infiltrate the walls of the esophagus. This eosinophil infiltration leads to inflammation of the esophagus and is believed to cause tissue remodeling and fibrosis if left untreated. A variety of stimuli may trigger this allergic process, including certain foods and environmental allergens. Eosinophils are typically found in small quantities in the blood and intestinal tract and participate in maintaining its health. Eosinophilic disorders (whether of the esophagus, stomach, small or large intestine) occur when the cells accumulate in large quantities1.
EoE is an emerging disease and has only been classified as a separate condition in the last decade2.
Who does it affect?
The most recent U.S. population-based estimate at the Mayo Clinic suggests that there were approximately 316,000 people with EoE in the United States in 20073. Of that number, we estimate that approximately 86,000 are pediatric patients. There has been a dramatic rise in the incidence and diagnosis of EoE over the last three decades3.
People with EoE often have other allergic diseases such as asthma or eczema2.
How is it diagnosed?
EoE will often present symptoms similar to that of gastroesophageal reflux disease (GERD), food allergies and inflammatory bowel disease, so physicians have to be diligent when assessing symptoms and diagnose accordingly. An endoscopy with biopsy of the esophagus is required for a confirmed diagnosis. Endoscopy is a procedure in which a lighted viewing instrument (endoscope) is used to look inside the body, in this case the esophagus, to diagnose or treat disorders. A biopsy is a medical test involving the removal of cells or tissues for examination. From the biopsy, the number of eosinophils is counted. A high number of eosinophils (counted per high power field) suggest the diagnosis of EoE. Consulting with a trained gastroenterologist specialist in this field is highly recommended.
Common Symptoms
The most common symptoms, particularly for children, are feeding disorders, vomiting and abdominal pain. Symptoms can be so severe that a patient is physically incapable of eating normally. Other symptoms may include:
- Dysphagia (difficulty swallowing)
- Food impactions (food getting stuck in the esophagus)
- Reflux that does not respond to PPI therapy
- Failure to thrive (poor growth or weight loss)
- Poor appetite
- Malnutrition
- Difficulty sleeping
EoE may be a chronic disease with persistent or relapsing symptoms2.
What are the current treatment options?
Physicians may prescribe dietary therapy, including eliminating foods thought to be allergens or an elemental diet, which is a diet of liquidized nutrients. In severe cases patients may require tube feedings directly into the stomach to avoid the inflamed esophagus entirely.
There are no pharmacological therapies approved for EoE.
1 North American Society for Pediatric Gastroenterology: Eosinophilic Esophagitis, Flourtown, PA, 2008.
2 Furuta, Glenn T., et. al “Eosinophilic Esophagitis in Children and Adults: A Systematic Review and Consensus Recommendations for Diagnosis and Treatment.” Gastroenterology 2007; 133: 1342 -1363.
3 Prasad, Ganapathy A. et al, “Secular Trends in the Epidemiology and Outcomes of Eosinophilic Esophagitis in Olmsted County, Minnesota (1976-2007).” Abstract, Digestive Disease Week, May 2008.
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