Summary about Disease
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus. It's characterized by an accumulation of eosinophils, a type of white blood cell, in the lining of the esophagus. This inflammation can damage the esophagus, leading to difficulty swallowing (dysphagia), food impaction, and other symptoms. EoE is often associated with allergies, though the exact relationship is complex.
Symptoms
Symptoms of EoE vary depending on age. Common symptoms include:
Adults:
Difficulty swallowing (dysphagia)
Food impaction (food getting stuck in the esophagus)
Chest pain
Upper abdominal pain
Heartburn that doesn't respond to medication
Children:
Vomiting
Abdominal pain
Difficulty feeding (infants)
Poor growth or weight gain
Dysphagia (older children)
Food impaction (older children)
Regurgitation
Causes
The exact cause of EoE is not fully understood, but it's believed to be triggered by a combination of genetic and environmental factors. Key factors include:
Immune system response: EoE is an immune-mediated disease.
Allergies: Food allergies are strongly implicated. Common food triggers include milk, soy, wheat, eggs, peanuts, tree nuts, and seafood. Airborne allergens can also play a role in some individuals.
Genetic predisposition: Having a family history of EoE, eczema, asthma, or allergic rhinitis increases the risk.
Medicine Used
4. Medicine used Medications used to treat EoE aim to reduce inflammation in the esophagus. Common medications include:
Topical corticosteroids: These are swallowed corticosteroids, such as fluticasone propionate or budesonide, that coat the esophagus to reduce inflammation.
Proton pump inhibitors (PPIs): These medications reduce stomach acid production, which can help reduce esophageal inflammation in some patients.
Biologic medications: Dupilumab (Dupixent) is an injectable biologic medication that targets specific immune pathways involved in EoE and has been approved for treatment.
Elemental diet: This involves consuming a special formula that contains amino acids instead of whole proteins. It removes food allergens and allows the esophagus to heal. This is primarily used in children.
Is Communicable
No, eosinophilic esophagitis is not communicable. It is not caused by an infection and cannot be spread from person to person.
Precautions
Precautions focus on managing symptoms and preventing complications:
Allergy testing and dietary changes: Identifying and eliminating food triggers through allergy testing (skin prick testing, patch testing, or elimination diets guided by an allergist) can help reduce inflammation.
Careful chewing: Thoroughly chewing food can help prevent food impaction.
Avoidance of known allergens: Strict avoidance of identified allergens is crucial.
Regular follow-up with a gastroenterologist and allergist: Monitoring and adjusting treatment plans are essential for long-term management.
Esophageal dilation: If strictures (narrowing of the esophagus) develop, esophageal dilation may be necessary to improve swallowing.
Educate yourself about EoE.
Maintain an open dialog with your healthcare team.
How long does an outbreak last?
EoE is a chronic condition. Without treatment, inflammation persists. "Outbreaks" or symptom flares can occur if triggers are present or if treatment is not effective. The duration of a flare can vary, lasting from a few days to weeks or even months. With proper management, periods of remission (reduced or absent symptoms) are possible.
How is it diagnosed?
EoE is diagnosed through:
Upper endoscopy: A thin, flexible tube with a camera is inserted into the esophagus to visualize the lining.
Esophageal biopsy: Tissue samples are taken during the endoscopy to examine under a microscope for the presence of eosinophils (typically >15 eosinophils per high-power field).
Review of symptoms: The doctor will ask about symptoms such as difficulty swallowing, food impaction, and chest pain.
Allergy testing: Skin prick tests or patch tests to identify possible food or environmental allergies.
Timeline of Symptoms
9. Timeline of symptoms The timeline of EoE symptoms can vary widely:
Onset: Symptoms can begin at any age, from infancy to adulthood.
Progression: Without treatment, inflammation gradually worsens, leading to increased difficulty swallowing and potential complications like esophageal strictures.
Fluctuations: Symptoms can fluctuate in severity, with periods of remission and exacerbation.
Long-term: EoE is a chronic condition, often requiring ongoing management to prevent complications and maintain quality of life.
Important Considerations
Multidisciplinary approach: Management of EoE often requires a team approach involving a gastroenterologist, allergist, and registered dietitian.
Long-term management: EoE is a chronic condition that typically requires ongoing management.
Psychological impact: Living with a chronic condition like EoE can have a psychological impact. Support groups and counseling can be beneficial.
Importance of adherence: Adherence to dietary restrictions and medication regimens is crucial for effective management.
Complications: Untreated EoE can lead to esophageal strictures, food impaction, and, rarely, esophageal perforation (a tear in the esophagus).
Research: Ongoing research is aimed at better understanding the causes of EoE and developing new and improved treatments.