AMITA Health Endoscopy Center Lincoln Park

Eosinophilic Esophagitis

Overview

Eosinophilic Esophagitis (EoE) is a chronic disease of the esophagus — the muscular tube that connects your mouth to your stomach. EoE is an immune disease in which eosinophils (white blood cells) build up in the inner lining of the esophagus, causing inflammation in response to allergens such as pollen and mold, certain foods, and acid reflux. The inflammation can cause difficulty swallowing and food getting stuck while swallowing.

EoE was thought to be a rare condition when identified in the early 90s but is now considered a major cause of digestive illness. People with other allergic conditions such as asthma, hay fever and food allergies are at more risk of developing EoE. Diagnosis is established with a thorough medical history, blood and allergy testing including food allergies, and an upper GI (gastrointestinal) endoscopy. The endoscopy involves a tube with a camera that is lowered down into the esophagus to view the lining and take a tissue sample (biopsy). A pathologist will check the biopsy tissue for excessive eosinophils.

Symptoms

In children:

  • Poor growth and weight gain, poor appetite
  • Difficulty feeding or eating
  • Reflux that doesn’t respond to medications
  • Vomiting
  • Abdominal pain

In adults:

  • Heartburn and chest pain
  • *Please seek immediate medical attention with chest pain, especially with arm pain or shortness of breath
  • Reflux that doesn’t respond to medications
  • Trouble swallowing (dysphagia), food getting stuck in esophagus

Treatments

Elimination diet. An elimination diet might be ordered by your doctor. On an elimination diet, you stop eating foods and drinking beverages identified on your food allergy testing results. These foods can be slowly added back to your diet one by one once you are feeling better to see how they are tolerated.

Steroids. Steroids may be prescribed, either in pill form or as a topical steroid that can be swallowed.

Acid suppressors. Acid-reducing medication will likely be prescribed by your provider. Stomach acid can irritate your esophageal lining. The most common medications to reduce acid are proton pump inhibitors or PPIs. Esomeprazole (Nexium) is an example of a PPI. Others include H-2 blockers such as famotidine (Pepcid).

Dilatation. If the above treatments do not improve your symptoms sufficiently and you have narrowing of your esophagus (strictures), your doctor may recommend dilatation. Dilatation is stretching of strictures, usually with an endoscopy and other devices.

Prevention

Avoid triggering foods and drinks. Alcohol, fatty foods, tomato sauce, caffeine and certain other foods can worsen your symptoms. Avoid these foods that typically trigger your heartburn.

Elevate the head of your bed. Many patients experience worsening of their symptoms at night. If so, elevating the head of your bed may help. A common way to achieve this is using a wedge between your box spring and mattress. Elevating your head at night can make gravity your friend by keeping acid in your stomach and out of your esophagus.

Establish or maintain a healthy weight. Extra pounds around the abdomen can push up your stomach and force acid into your esophagus, worsening your symptoms. Ask your provider for a weight loss and exercise plan that matches your needs.

Stop smoking.