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Symptoms

People of all ages can be affected by eosinophilic esophagitis, with symptoms that may vary by age range and individual differences. Those who suffer from eosinophilic esophagitis have a large number of eosinophils—a type of white blood cell that is normally found in small numbers in the blood—and inflammation in the esophagus. A large number of eosinophils in the esophagus may result from a food allergy reaction, acid reflux, or airborne allergens, which can contribute to inflammation, or injury to the esophageal tissue.

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An estimated 50 percent of patients with eosinophilic esophagitis also have seasonal allergies or asthma. Many others also have food allergies or eczema. Some patients note a seasonal flare up of the condition, typically in the spring and in the summer. Researchers studying eosinophilic esophagitis theorize that both genetic and environmental factors play a role in the development of the disease. True pollen induced EoE is very rare and occurs in less 1 percent of the patients in pediatrics and maybe slight more in adults. However, seasonal variation in patients with food induced EoE can be seen as high as 25 percent of the patients.

Eosinophilic esophagitis in children

In infants and toddlers, eosinophilic esophagitis can cause irritability, problems with feeding, and poor weight gain. In older children, the disease can cause reflux, regurgitation, vomiting, and/or stomach pain. Teens and adults with eosinophilic esophagitis may also experience these symptoms, in addition to chest pain and trouble swallowing foods—feeling like a food is “stuck” in the esophagus. They may also find themselves drinking a lot of fluids to finish a meal or be unable to finish a meal because they feel full midway through.

Diagnosis

Proper diagnosis of eosinophilic esophagitis should be confirmed by an allergist and gastroenterologist, who will take a clinical history and may perform food allergy testing and/or an upper endoscopy to get a close look at the esophagus to check for inflammation. It is important that other causes of esophageal eosinophilia such as reflux is ruled out. Sometimes eosinophils may be present in an esophagus that appears normal. A biopsy of the esophagus must be performed to confirm diagnosis.

Management and Treatment

After a diagnosis of eosinophilic esophagitis, in many cases food allergy testing is performed and counseling provided on foods to avoid if food allergy is diagnosed. It is important to note that food-related reactions may not be immediate; some patients may find that the esophagus becomes inflamed by an offending food days or weeks after eating it. Dietary changes can significantly and immediately improve the symptoms of eosinophilic esophagitis.

For the pollen induced EoE or seasonal variation of EoE, the two treatment options are addition of swallowed steroids to established diet or the use of immunotherapy. There is one case report of benefit of subcutaneous immunotherapy in EoE. But, there are several reports of EoE occurring after starting sublingual immunotherapy for pollen or oral immunotherapy for foods.

Currently there are no medications known to cure eosinophilic esophagitis, but some medications may suppress eosinophil accumulation, relieve damage to the tissue in the esophagus, and alleviate symptoms. Oral or topical steroids may be prescribed. Because eosinophilic esophagitis treatment plans are individualized, patients with eosinophilic esophagitis should work closely with an allergist, and if necessary, a gastroenterologist, to implement a specific treatment plan that works best for them.