Eosinophilic Esophagitis (EoE)
Eosinophilic (ee-uh-sin-uh-fil-ik) Esophagitis (EoE) is an allergic/immune condition that causes inflammation or swelling of the esophagus. The esophagus is the tube that sends food from the throat to the stomach.
People with EoE have large numbers of eosinophils in their esophagus. Eosinophils are a type of white blood cell that causes inflammation. Normally there are no eosinophils inside the esophagus, but they can be found in other parts of the gastrointestinal tract. If this inflammation is not treated, the esophagus may scar leading to a stricture. A stricture is a narrowing of the esophagus that can lead to food getting stuck after it is swallowed.
Research suggests that the main cause of EoE is an allergy or a sensitivity to particular proteins found in foods and environmental allergens. Many people with EoE have a family history of allergic disorders such as asthma, rhinitis, atopic dermatitis (eczema) or food allergy.
EoE can occur at any age. It is most common in males, but can also occur in females.
Symptoms & Diagnosis
Symptoms of EoE might be different depending on your age. In young children, vomiting, fussiness during meals, refusal to eat and poor growth can occur. In older children and adults, pain in the abdomen, chest pain, heartburn, vomiting, difficulty swallowing and a feeling of food sticking in the esophagus are more common. Sometimes food can get stuck in the esophagus and has to be removed by a healthcare provider. Eosinophils reflect the level of inflammation of the esophagus, which causes these symptoms.
Currently the only way to diagnose EoE is with an endoscopy and biopsy of the esophagus, which is often done by a gastroenterologist. An endoscopy is a medical procedure that lets your doctor see what is happening in your esophagus. During a biopsy, tissue samples will be taken and analyzed.
It is also recommended to be evaluated by an allergist. An allergist can help manage EoE and treat other allergic conditions such as food allergies, hay fever, asthma and eczema.
Treatment & Management
EoE is a chronic disease that usually requires some form of treatment for life. There are two main ways to treat EoE. The first involves removing foods from your diet that are suspected triggers. dairy, wheat, eggs, and soy are common trigger foods, although others can be too. An allergist, sometimes with the help of a registered dietician, can help develop a plan to avoid these allergens.
A second treatment option for EoE is using medications to control the inflammation.
Dupixent (dupilumab) is the only medical therapy to date that has received approval for the treatment of EoE from the Food and Drug Administration (FDA). It was recently approved for patients 12 years of age and older who weigh at least 40 kilograms (about 88 pounds). Dupixent is a monoclonal antibody (or biologic) that is given as a weekly injection. It reduces the inflammation associated with the disease and helps patients swallow their food.
Other medications have been shown to reduce the number of eosinophils in the esophagus and improve symptoms. Proton pump inhibitors (PPIs), which reduce acid production in the stomach, have also been found to reduce esophageal inflammation in some patients with EoE. PPIs are often used as a first treatment for EoE. However, not all patients respond to PPIs, and other forms of therapy, such as swallowed topical corticosteroids, are considered. Careful monitoring by a doctor knowledgeable in the treatment of EoE is very important.
After a treatment plan is developed, most people with EoE will need additional endoscopies with biopsies to see if their EoE is getting better or worse.
What is Dupilumab and when should it be used? (Now used for EoE.)
American Partnership for Eosinophilic Disorders (APFED)
Campaign Urging Research for Eosinophilic Disease (CURED)