Eosinophilic Esophagitis (EE) is a condition that was literally unheard of 20 years ago. However, over the last five years, the recognition and diagnosis of eosinophilic esophagitis has risen dramatically. It is difficult to say whether the increased frequency of eosinophilic esophagitis is due to an increased level of suspicion, to better diagnostic techniques, or whether the condition recognized as eosinophilic esophagitis has actually become more common.
Eosinophilic Esophagitis is an allergic reaction localized to the esophagus, the tube that transports food from the throat to the stomach. The classic pathologic feature of this condition is the presence of eosinophils, a normal and benign cell that circulates in the blood and is occasionally found in the tissues. Eosinophils are not normally found in the esophagus, but in this condition, eosinophils accumulate in the lining of the esophagus, generally in response to a food allergy. There they release chemical mediators leading to local inflammation.
Eosinophilic esophagitis commonly affects people who have a family history of allergy, especially food allergies, and conditions such as eczema and asthma. It is most common in children. Most adults who develop eosinophilic esophagitis are generally diagnosed in the third or fourth decade of life. Males are affected three times more commonly than females.
Common symptoms of eosinophilic esophagitis include heartburn or reflux symptoms that do not improve with medication, difficulty swallowing, nausea and/or vomiting, poor appetite, a sensation of food getting stuck in the throat, abdominal or chest pain, and in more severe cases, malnutrition. Diagnosis is confirmed by endoscopy, a procedure during which a gastroenterologist inserts a flexible scope to into the esophagus for direct visualization. The presence of “furrows”, “rings” or “white spots” is highly suggestive of eosinophilic esophagitis. The diagnosis is confirmed by biopsy, after which small tissue samples are examined microscopically for the presence of eosinophils. Pathology reports will commonly give an eosinophil count, but the presence of any eosinophils in the esophagus confirms the diagnosis. A high eosinophil count likely represents more severe disease.
Eosinophilic Esophagitis is now known to be caused by allergy to a food or multiple foods. Therefore, if the diagnosis of eosinophilic esophagitis is confirmed, allergy testing to foods by either the prick method or through the blood is necessary in order to try to identify which foods are responsible for the esophageal inflammation. Occasionally, patch testing to foods can be helpful. If a food allergy cannot be diagnosed by testing, an elimination diet may be necessary to help identify the causative agents. Common food allergens which have been implicated include milk, soy, wheat, eggs, peanuts, tree nuts, fish and shellfish. Sometimes an elemental formula may be recommended, after which foods are slowly reintroduced into the diet one by one to identify the food(s) responsible for symptoms.
Once food allergies have been diagnosed, elimination of the causative food from the diet is commonly the only treatment necessary to resolve symptoms of eosinophilic esophagitis. Medications such as swallowed topical steroids may also be helpful in reducing the inflammation in the esophagus.