DEFINITION OF EOSINOPHILIC ESOPHAGITIS
Eosinophilic esophagitis is a chronic esophageal disorder usually caused by a problem with the immune system. The main symptom is esophageal dysfunction. The manifestations of the disorder can be different depending on the age of the patient. Infants and toddlers experience feeding difficulties. For example they will refuse to eat or show a lot of resistance to eating. Of course you can imagine that this leads to irritability and failure to thrive. School-aged children will have problems swallowing, abdominal pain, reflux-like symptoms, food aversion, or vomiting.
In children, feeding dysfunction is becoming an increasingly recognized presentation of eosinophilic esophagitis. It includes the inability to develop normal eating patterns, such as not advancing past liquids, and adopting coping mechanisms, such as refusing to eat solid foods after previously eating them. Adolescents can have reflux symptoms and food impactions such as the case of the fourth year medical student. They also experience problems swallowing and nausea.
Adults typically present with food impactions, chest pain, upper abdominal pain, or difficulty swallowing—especially bread or meat. People who live with eosinophilic esophagitis are more likely to also suffer from atopic dermatitis, asthma, environmental allergies, and food allergies. Current medical studies and literature also describe associations between eosinophilic esophagitis and celiac disease, antibiotic exposure during infancy, and connective tissue diseases such as rheumatoid arthritis, lupus, and psoriatic arthritis.
HOW IS EOSINOPHILIC ESOPHAGITIS DIAGNOSED?
When doctors use an endoscope to look down into a patient’s esophagus we can often see signs of eosinophilic esophagus, which can be helpful in making a diagnosis. But, the gold-standard or diagnosis is obtaining biopsies from the esophagus. Often a history of typical symptoms combined with a history of atopic dermatitis, environmental or food allergies, or asthma is highly suggestive of the disorder.
Because of the strong association with allergies, many experts recommend patients with eosinophilic esophagitis should undergo evaluation by an allergist. Children are often treated with dietary modifications, as are some motivated adults.
TREATMENT
Dietary management can be particularly helpful in children. There are two different diets that have both proven to be useful. The first is called an elemental diet, which is an amino acid-based formula that children drink as the majority of their diet. Many excellent pediatric studies support this diet. The elemental diet serves to eliminate all potential food allergens.
The second diet is called an elimination diet. There are two types of elimination diets. The first uses allergy testing and, based on the results, eliminates foods to which the patient has allergies. The second strategy is called an empiric elimination diet, and it is based on the concept that certain foods cause an immediate hypersensitivity reaction in some patients. This diet eliminates the foods that are most strongly associated with the majority of immunoglobulin E-mediated food reactions such as milk, egg, soy, wheat, nuts, fish, and shellfish. This diet has also been termed “the six-food elimination diet.”
Treatment in adults can range from treatment with antacids, such as omeprazole or lansoprazole, to swallowed fluticasone, which is an anti-inflammatory medicine used to treat asthma. Some patients who have abnormal narrow sections in their esophagus, called strictures, may require a procedure called esophageal dilation, which stretches their throat under anesthesia. Certain patients, both adults and children, may find it beneficial to see an allergist.