What is Eosinophilic Esophagitis?
Eosinophilic Esophagitis is a pathological condition of the gastrointestinal system in which there is a build up of white blood cells along the lining of the esophagus which is a tube which connects the mouth to the stomach through which the food passes from the mouth to the stomach. This build up of white blood cells or eosinophils can occur due to a variety of reasons to include reactions to certain food products, acid reflux, or allergies. This may result in the individual experiencing difficulty with swallowing solid foods or the food to get stuck during swallowing.
Eosinophilic Esophagitis is a chronic disease of the immune system. Eosinophilic Esophagitis is relatively new but as of now is perceived to be one of the major causes of gastrointestinal disorders. Research is still going on as to more precise diagnosis and treatment for Eosinophilic Esophagitis.
What are the Causes of Eosinophilic Esophagitis?
In the days gone by, physicians thought the symptoms caused by Eosinophilic Esophagitis were due to gastroesophageal reflux disease or GERD but that opinion has changed now. Eosinophilic Esophagitis is believed to be an allergic reaction in which the lining of the esophagus gets damaged. This reaction may be due to pollen or other food allergens. White blood cells are commonly found in the digestive tract but in Eosinophilic Esophagitis these eosinophils start to multiply in the esophagus and stick to the lining of the esophagus.
These eosinophils produce a protein which causes inflammation of the lining of the esophagus leading to scarring and narrowing of the esophagus along with development of fibrous tissue in the lining of the esophagus thus causing dysphagia or difficulty swallowing along with some other symptoms. People with certain food allergies may also have Eosinophilic Esophagitis. Other medical conditions that can cause Eosinophilic Esophagitis are environmental allergies, asthma, respiratory dysfunction, and atopic dermatitis.
Some physicians believe that genetics also have a role to play in the development of Eosinophilic Esophagitis. It has been noted in the last few years that there has been an increase in Eosinophilic Esophagitis with the increase of asthma and other allergies in the common population.
What are the Symptoms of Eosinophilic Esophagitis?
Eosinophilic Esophagitis can occur in both children and adults. The presenting features of Eosinophilic Esophagitis are:
Symptoms of Eosinophilic Esophagitis in Adults:
- Food impaction
- Chest pain not getting relieved with antacids
- Persistent heartburn
- Pain in the upper abdominal area
- No relief with medications used for treating GERD
- Food regurgitation.
Symptoms of Eosinophilic Esophagitis in Children:
- Problems with feeding
- Frequent vomiting episodes
- Pain in the abdomen
- Food impaction
- Failure to thrive
- Weight loss.
How is Eosinophilic Esophagitis Diagnosed?
In order to diagnose Eosinophilic Esophagitis, the physician will first make note of the symptoms and rule out any other condition that may be causing the symptoms. Once all other conditions causing similar symptoms are ruled out then the physician may do the following tests in order to confirm the diagnosis of Eosinophilic Esophagitis:
Upper Endoscopy: In this procedure, a narrow tube fitted with a camera is inserted into the mouth and passed down the esophagus. While traversing down esophagus, the physician will examine each and every area of the esophagus to look for signs of inflammation or swelling or any white spots suggestive of Eosinophilic Esophagitis. If these are found then the diagnosis of Eosinophilic Esophagitis is more often than not confirmed.
Biopsy: A biopsy of a tissue of the esophagus is done to look for presence of white blood cells in the lining of the tissue.
Once Eosinophilic Esophagitis is suspected further tests may be done to find out the potential source of the condition and the allergen responsible for development of Eosinophilic Esophagitis. These tests are:
Blood Tests: This will be done to see if there are higher than normal eosinophil count suggesting some form of allergy.
Medications: You may also be given medications used for GERD to see if the symptoms improve. If they do not improve with the medications then it is virtually confirmed that the symptoms are not caused by GERD but may be by Eosinophilic Esophagitis.
Dietary Patch Test: This is a test to check for allergy to certain food. This is done by patching a food item on to the back for some time and then the patch is taken out and the physician checks for any inflammation in that area.
How is Eosinophilic Esophagitis Treated?
Eosinophilic Esophagitis is a form of a relapsing disease condition and hence it may recur again and again and hence the patient may require ongoing treatment for symptom control. There are basically three modes of treatment of Eosinophilic Esophagitis which is dietary, medication, and dilation.
Dietary Therapy for Eosinophilic Esophagitis: In this therapy, the physician will recommend certain change in diet avoiding any food to which the patient may be allergic to. This may include dairy products or wheat. This may help in reducing symptoms and calming down the inflammation. The patient’s diet may be a lot limited so as to control the symptoms of Eosinophilic Esophagitis.
Medication Therapy to Treat Eosinophilic Esophagitis: Medications therapy starts of with a proton pump inhibitor to control the symptoms. If the patient does not respond to this form of medication then steroids will be the next step in controlling the symptoms of Eosinophilic Esophagitis. The steroids prescribed will be topical such as fluticasone. A topical steroid does not get into the bloodstream and hence there are no side effects to these steroids unlike those forms of steroids that get mixed in the bloodstream. Prednisone may also be given in case if topical steroids are not effective. The steroids work by decreasing the buildup of white blood cells in the lining of the esophagus and hence improving the symptoms and also help in reducing inflammation. They also facilitate speedy healing of the esophagus.
Dilation Procedure for Treating Eosinophilic Esophagitis: This procedure is done for those patients whose esophagus gets severely narrowed due to Eosinophilic Esophagitis. This procedure is done to make the esophagus wider so that food may pass through it easily. This is done only when steroids and other forms of medications are not effective in treating Eosinophilic Esophagitis. Dilation procedure may have an inherent risk of esophageal perforation but this is pretty low and most of the time this procedure is effective in calming the inflammation down and control the symptoms of Eosinophilic Esophagitis.
What is the Prognosis of Eosinophilic Esophagitis?
Based on the research done till date, the physicians have come to a conclusion that Eosinophilic Esophagitis does not cause any serious condition like a cancer of the esophagus and in no way affects the life expectancy of an individual with Eosinophilic Esophagitis.