What is eosinophilic esophagitis (EE)?
Eosinophilic esophagitis is one of many types of esophagitis (inflammation of the esophagus). It is not as common as reflux esophagitis, but has many of the same symptoms. It is caused by an abnormal accumulation of eosinophils in the lining of the esophagus (swallowing tube). Eosinophils are a type of blood cell that can be seen in the esophagus. In this condition they are present at an increased level. The reason for this increased accumulation is unknown. Often individuals with eosinophilic esophagitis have allergies or an allergic disorder (i.e. asthma, allergic rhinitis, urticaria, etc.).
What are the symptoms of eosinophilic esophagitis?
Symptoms often include heartburn and more commonly difficulty in swallowing, or the feeling that food is getting caught or stuck in the esophagus.
How common is eosinophilic esophagitis?
Eosinophilic esophagitis is a rare condition. Of those adults affected with EE, the majority are men in their 20-30s. Children can also be affected.
How do you know if you have eosinophilic esophagitis?
The only way to diagnose eosinophilic esophagitis is by upper endoscopy with biopsies (tissue samples) of the esophagus. Upper endoscopy or EGD (esophagogastroduodenoscopy) is a procedure where a small lighted tube is passed through your mouth into your esophagus, stomach and first portion of your small intestine. The tube that is used has a camera within it and is connected to a computer. This test allows the doctor to see the lining of your esophagus, stomach and first portion of your small intestine. Pictures can be taken and can be part of your medical record. Biopsies can be taken at the time of endoscopy. There is no pain associated with taking biopsies.
Findings at the time of endoscopy can show a normal appearing esophagus or an esophagus that appears to have many rings (somewhat like a spring). Biopsies show an increase in the amount of eosinophils that are present.
How is eosinophilic esophagitis treated?
Treatment involves the use of a steroid inhaler. The treatment can be repeated as necessary. If recurrent use is needed, additional anti-allergy medications can be used. Generally, patients are referred to an allergist for additional testing or treatment.
Unlike inhaled steroids where a spacer is used to help get the medication into the lungs, you are to spray the medication without a spacer. This allows for the medication to be delivered to the back of your throat and swallowed. This brings the medication in direct contact with your esophagus.
Side effects to steroid inhalers can include the development of a fungal infection in the mouth (thrush), esophagus or respiratory tract. Other typical side effects of steroids can occur, but with a lessened incidence as compared to oral medication.
Are there any complications to eosinophilic esophagitis?
The most common complication is food becoming caught in the esophagus. This can lead to erosions (irritation) or ulcerations on the wall of the esophagus.