Eosinophilic Esophagitis, an 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.

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 EoE Symptoms
Symptoms of EoE vary among age groups.  Infants and toddlers experience irritability, feeding difficulties (i.e. food refusal, regurgitation) and failure to thrive.  School-aged children may have nausea, vomiting and stomach pain.  Adolescents and adults most often present with symptoms of dysphagia (difficulty swallowing), and food impaction.  Other symptoms may include reflux that does not respond to proton pump inhibitor therapy, heartburn, chest pain and poor appetite.

EoE symptoms may be persistent or may vary in the intensity at different times.  Recognition of and the patient's ability to report EoE symptoms together with an endoscopy is critical in the correct diagnosis of EoE.

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 Liacouras, Chris A., et. al “Eosinophilic esophagitis: Updated consensus recommendations for children and adults." 
   J Allergy Clin Immunol 2011; 128: 3-20.e6.