What is Eosinophilic Esophagitis?

Eosinophilic Esophagitis (EE) is an inflammation of the esophagus as a result of the abnormal infiltration of eosinophils in an allergic reaction. Because many of the symptoms are the same as gastroesophageal reflux disease (GERD) it is usually mistaken for reflux and misdiagnosed, sometimes for years. EE can be considered as food allergies and is usually classed as a blood disorder.

 
EE tends to occur more often in males, but is otherwise an equal opportunity disorder. With EE, you will see painful swallowing and digestion (if they can even get the food down), vomiting and abdominal pain making it very difficult to live with. Children with Eosinophilic Esophagitis will often experience weight loss that can lead to failure to thrive and hospitalization.

What are Eosinophils?

Eosinophils (pronounced: ee-oh-sin-oh-fillz) are actually a certain type of white blood cell, but just not as numerous as the regular white blood cells, and are a vital part of the immune response system. Eosinophils are designed to respond to parasites, or invaders that are too large to be absorbed by white blood cells. They attach themselves to the invader and penetrate the cell walls to kill and destroy the parasite.

 
When your body detects an invader (such as a parasite, or an allergic substance) that it decides is a harmful protein, it calls on the immune system which produces a substance called immunoglobulin E (IgE). These are the antibodies that are sent out to do battle with the intruder (which Eosinophils are a part) and when they contact the detected protein invader, they release reactive chemicals called histamines and leukotrienes and these chemicals are what produce the allergic symptoms such as shortness of breath, hives, swelling, rashes, itchy skin, nausea and diarrhea.

Eosinophils are not normally found in the esophagus, and the buildup and allergic responses are the result of the body deciding certain proteins (such as certain foods) are on the dangerous list when they shouldn’t be. The eosinophils actually end up attacking the lining of the esophagus, causing damage which in the long term the inflammation could cause the esophagus to close up (stricture) and increase of fibrosis, which can interfere with swallowing.

Symptoms
Eosinophils congregating in the esophagus will cause problems all the way down the gastrointestinal pathway, which makes the normal function of eating and digestion difficult and painful. Here is a list of the symptoms:

• Difficulty swallowing
• Choking
• Nausea
• Vomiting
• Cramping
• Diarrhea
• Weight loss
• Abdominal pain
• Chest pain
• Failure to thrive
• Reflux not relieved by standard anti-reflux therapy

These conditions are usually present for many years prior to an EE diagnosis, so keep in mind that occasional reflux, stomach ache or even vomiting may be other common ailments that cause these same symptoms.

Diagnosis

An initial clinical diagnosis is usually made based on the history of symptoms and ruling out other possible causes. A number of tests are performed to try to determine the specific triggers or allergens causing the Eosinophilic reaction. These tests include:

• Elinimination diet and food challenges
• Allergic skin prick testing   
• RAST testing (radioallergosorbent test), a blood allergy test for specific IgE antibodies
• Patch testing where food substances are secured against the skin for a period of time   
• Endoscopy and biopsy of the esophagus

The only way to confirm the clinical diagnosis is by counting the actual concentrations of eosinophils in the tissue samples taken by biopsy during the endoscopy procedure.

Treatment

Eosinophilic Esophagitis is usually treated first by avoiding the allergen causing the reaction. This is where all the allergy testing comes in to generate the “avoid at all costs” and “let’s give it a try” food listing. Many EE kids are on an elemental diet taking an amino based formula as the major source of nutrients and possibly a few other foods that have tested successfully. Elimination diets and food trials are considered normal in the lives of kids (or adults) with Eosinophilic Esophagitis.

 
Some do quite well with an alteration in diet and removal of reactive foods, but for others, medication is needed. Antihistamines can help relieve the histamine produced allergic reactions, and reflux medication can help prevent acid damage to the esophagus. To help reduce inflammation that results from the eosinophil infiltration, corticosteroids are used. Recently EE patients have been treated with fluticasone without the spacer so that the drug is swallowed instead of inhaled.

If the esophagus becomes restricted, a procedure called dilation is used to open it back up so the patient can swallow food a little easier. Esophagial restriction is quite serious and could mean installing a G-tube to be able to get nutrition into the body.

What is the Impact of EE?

Having a diagnosed Eosinophilic disorder means that your life, and the life of your family will never be the same. It is a life altering diagnosis with implications that go beyond the pain and limited diet and extends into the social emotional arena in a society that is completely centered on food.

Helping those around you to understand what Eosinophilic Esophagitis is and how it affects you or your child opens the door to the support you need. Learn as much as you can, stay current on medical advances, work with your doctor and above all, keep a positive attitude. You can do this.

 

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