Eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a complicated health condition that affects ingestion and even normal functioning of patients. Read and know what this condition is along with its causes, symptoms, diagnosis and treatment.

What is Eosinophilic esophagitis?

It is a condition characterized by an inflammation and soreness of the esophagus, the tubular structure located between the mouth and stomach that helps in swallowing.

Eosinophilic esophagitis Incidence

This is a rare condition. The disease mainly affects adults, though children may also be afflicted. Most grown-up men with the disorder are in their twenties or thirties.

Eosinophilic esophagitis Symptoms

Inflammation usually occurs due to swelling that result from the presence of large numbers of eosinophils (white blood cells) that are not generally located in the esophagus. Eosinophils are a part of the immune system. In healthy individuals, these are not detected in the esophagus. However, they may be situated in other regions of the gastrointestinal tract.

Patients with EoE typically experience a wide range of symptoms, such as:

  • Chest pain
  • Diarrhea
  • Choking (Food getting wedged into the esophagus)
  • Weight loss
  • Indigestion
  • Poor growth
  • Difficulties in swallowing
  • Reflux symptoms (such as acidic taste, vomiting or heartburn), unresponsive to medicines

In some patients with EoE, furrows or ridges develop in the esophagus due to chronic inflammation. This can help in clearly detecting the condition. In other patients, white blood cells plaques may be apparent on the esophageal lining. In some cases, the changes may only be visible with a microscopic examination. Numerous white blood cells (WBC) may be noticed to be interspersed in the normal esophageal cells.

Eosinophilic esophagitis Causes

The causes of this condition are not very clear. Medical researchers, however, have identified several possible causes for the disease. These include:

Allergies

The disorder is supposed to have a possible association with allergies. These include allergens present not only in food items but also in the air that is inhaled.

Asthma

People with a history of allergic reactions and asthma are supposed to be at greater risk from the condition.

Gender

The disorder is also supposed to have a sexual predilection as it is found to be more common in men than women.

Autoimmune disorders

According to some researchers, presence of underlying autoimmune disorders may also result in EoE. Disturbances in the immune system may give rise to swelling in the esophagus as well as other parts of the body.

Eosinophilic esophagitis Diagnosis

In some cases, the disease is challenging to diagnose. This particularly happens when a physician misdiagnoses the condition simply as an acute form of reflux. A diagnosis of this disease is largely based on an in-depth analysis of the symptoms as well as the medical history of a patient.

The diagnostic tests for this disorder mainly involve:

Upper endoscopy

An endoscopy often helps detect whether the esophagus looks perfectly healthy or if it has any sure signs of inflammation. This involves inserting an Endoscope through the mouth and down into the esophagus. The Endoscope is a long, narrow tubular instrument that allows doctors to inspect the inner lining of the esophagus. An endoscopic examination helps reveal sure signs of EoE, such as inflammation, white spots horizontal rings, vertical furrows and narrowing (strictures).

Biopsy

A biopsy is often considered to be critical for diagnosis. The process includes removal of a tiny sample of tissue from the lining of the esophagus. This tissue sample is analyzed in the laboratory. If a large number of eosinophils are found in the tissue, EoE can be confirmed.

Eosinophilic esophagitis Differential Diagnosis

The differential diagnosis of Eosinophilic esophagitis involves distinguishing the condition from other similar disorders like GERD (gastroesophageal reflux disease), esophagitis and allergic non-acid reflux.

Eosinophilic esophagitis Treatment

The treatment of EoE often requires a team of specialists to develop a customized curative plan. This may involve:

Dietary therapy

If esophageal inflammation results from food allergy, dietary modification may alone be enough in effectively treating the condition. Physicians may conduct a skin examination to test for allergies, before prescribing an elimination diet. An elimination diet involves avoiding intake of all such food items that can act as possible allergens, such as wheat, soy, nuts, fish, dairy foods and eggs. These foods may be gradually incorporated again into the diet, with an expert physician monitoring the patient to look for any possible reactions. In some cases, patients need to make permanent changes in their dietary habits and lifestyle to avoid exposure to foods that may lead to a possible recurrence of the inflammation.

Experimental therapies

Depending on the situation, experimental treatments may be required for the long-term management of EoE. Medical researchers are analyzing acid-blocking medicines, asthma drugs (such as leukotriene receptor antagonists) and other medications to check for their effectuality in treating the condition.

Eosinophilic esophagitis Prognosis

For patients with EoE, the prognosis is typically very good. In many patients, the condition appears to stabilize over a period of time. When treated with Esophageal Dilation or Topical Fluticasone the symptoms generally show a good response. However, there is often a need to start treatment again as the condition tends to coming back frequently.

Eosinophilic esophagitis and Cancer

This is not a cancerous condition and does not lead to any malignant complications. Till date, medical researchers have not been able to identify any malignant potential of this syndrome. The disorder does not result in cancer of the esophagus. It has not been found to reduce life expectancy in any manner.

Eosinophilic esophagitis Recurrence

EoE carries good chances of a recurrence. Once food items that act as trigger factors are re-introduced into the diet, EoE tends to come back. Due to this reason, when foods are being added again into a patient’s diet, gastroenterologists may need to periodically carry out endoscopy along with biopsy.

Eosinophilic esophagitis Complications

Some patients with EoE may suffer from a constriction of the esophagus or a more severe form of fibrosis. The most frequent complication, however, is trapping of food particles within the esophagus. Esophageal blocking may result in problems like:

  • Irritation (Erosions) of the wall of the esophagus
  • Formation of ulcers on the esophageal wall

Eosinophilic esophagitis Prevention

There are no specific ways to prevent this condition. Gastroenterology specialists have access to clinical trials, information and latest treatment protocols. These can help patients with preventive advice. Reflux medication may also help avoid acids from causing damage to the esophagus.

Eosinophilic Esophagitis and Medications

Treatment for eosinophilic esophagitis usually involves medicines that

  • Suppress inflammation
  • Controls stomach acid
  • Address malfunctions of the immune system, which results in the abundance of white blood cells

If recognized allergens act as underlying causes for the profusion of white blood cells, it must be treated. Since reflux gives rise to EoE and vice-versa, doctors usually recommend reflux medications for patients.

In some patients, medications may be provided to help blockage of esophagus due to food particles. This may involve:

  • Oral steroids, which are only used for a brief duration
  • Steroid inhalers, which are generally used to cure asthmatic problems

Once the swallowed steroid is administered for three months, a Gastroenterologist may repeat endoscopy to check for the presence of Eosinophils.

Steroid medications are often found to be an effective cure for Eosinophilic esophagitis. Generally, the form of steroid preparation used for this disease dissolves only to a small extent into the bloodstream. Naturally, only a few side effects are associated with steroids. In some patients, systemic steroids like Prednisone are put in use. Steroids can show effective results by

  • Quickening healing time for esophagus
  • Reducing the accumulation of white blood cells (WBC) in the esophagus
  • Decreasing the inflammation resulting from an allergic reaction

Eosinophilic esophagitis in children

In toddlers and infants, the condition may give rise to a number of symptoms like:

  • Irritability
  • Difficulties in feeding
  • Poor weight gain

Older children may display more complicated symptoms like vomiting, regurgitation, reflux. In some cases, patients may also suffer from stomach pain. Teens and adults with EoE can also experience discomforting symptoms like,

  • Chest pain
  • Trouble in swallowing foods

Allergic Triggers for EoE

Various medical studies have displayed patients with EoE to suffer from allergies due to various foods. Avoiding such foods, which act as trigger factors for EoE, may lead to the resolution of its symptoms. Food items that are reported to be the cause of EoE include

  • Milk
  • Eggs
  • Peanuts
  • Shellfish
  • Oats
  • Tomatoes
  • Wheat
  • Peas
  • Beef
  • Corn
  • Soy
  • Potatoes
  • Chicken
  • Fish
  • Rye

Of all these food products, the most common triggers include egg, milk, wheat, beef and rye. Environmental allergens, such as molds, pollens, cat, dust mite allergens and dog may also give rise to EoE.

Eosinophilic Esophagitis in Infants

Infants with this condition cannot describe the problems that they experience. Due to this reason, it is highly challenging to diagnose EoE in patients of this age group. Parents and other family members of EoE infants should look out for signs like frequent vomiting. In infants, this is found to be a very common symptom of EoE. Vomiting can occur all through the day and night for a number of times or at every time there is an intake of food.

Other symptoms of the disease may be more subtle in nature and can include problems like:

  • Chronic cough
  • Refusal to be fed
  • Reduced weight gain (too much weight loss can be a cause for worry)
  • Very retarded growth

Vomiting symptoms are often accompanied by Acid reflux disease, also referred to as Gastroesophageal Reflux Disease (GERD). This can make it quite tough distinguish between EoE and an acute case of acid reflux. However, GERD is much more common in infants and can be used as the first diagnostic criteria. If the infant does not respond to anti-reflux medications, the vomiting may be due to EoE rather than Acid reflux disease. Common anti-reflux medications include Proton Pump Inhibitors (PPIs) like Lansoprazole (Prevacid) or omeprazole (Prilosec) and H2 Blockers such as Cimetidine (Pepcid) or Ranitidine (Zantac).

If you suspect anyone in your family to be showing EoE symptoms, get in touch with a physician immediately. If timely treated, this condition can go away quite fast. However, it is necessary to monitor the health of patients for a long time as Eosinophilic esophagitis often tends to recur.

References:

http://www.medicinenet.com/eosinophilic_esophagitis/page5.htm

http://www.mngastro.com/gi-system-amp-disorders/gi-system-amp-disorders/eosinophilic-esophagitis

http://www.mayoclinic.org/eosinophilic-esophagitis/

http://www.umm.edu/pediatrics/eoe.htm

http://www.eosinophilicesophagitishome.org/symptoms/eosinophilic-esophagitis-symptoms-infant.shtml

Published on December 25th 2011 by  under Digestive System.
Article was last reviewed on 25th December 2011.

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