What Is Eosinophilic Esophagitis?
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder characterized by eosinophil accumulation in the esophageal lining. This condition leads to esophageal inflammation, dysphagia, and, if untreated, fibrosis and strictures.
Causes and Risk Factors
EoE is primarily triggered by allergens, with food and environmental allergens playing a key role. The exact etiology remains unclear, but contributing factors include:
- Genetics: A family history of allergic conditions increases susceptibility.
- Food Allergies: Common triggers include dairy, wheat, soy, eggs, nuts, and seafood.
- Environmental Allergens: Seasonal pollen exposure can exacerbate symptoms.
- Gastroesophageal Reflux Disease (GERD): While distinct, GERD can coexist with EoE, complicating diagnosis.
- Immune System Dysfunction: An abnormal immune response leads to excessive eosinophil recruitment.
Symptoms of Eosinophilic Esophagitis
Symptoms vary by age and disease severity, often resembling other gastrointestinal disorders:
- In Infants and Toddlers: Feeding difficulties, failure to thrive, vomiting.
- In Children: Abdominal pain, nausea, reflux-like symptoms, food refusal.
- In Adults: Dysphagia, food impaction, chest pain, persistent heartburn.
Diagnosis: How EoE Is Identified
Accurate diagnosis requires a combination of clinical evaluation, endoscopic findings, and histopathological examination.
1. Endoscopy and Biopsy
An esophagogastroduodenoscopy (EGD) with biopsy is essential. EoE is confirmed if eosinophils exceed 15 per high-power field (HPF) in esophageal biopsies.
2. Allergy Testing
- Skin Prick Tests (SPT) and serum IgE tests identify potential food and environmental allergens.
- Elimination Diets and reintroduction protocols help pinpoint specific triggers.
3. Esophageal Functional Tests
High-resolution manometry assesses esophageal motility, while pH monitoring distinguishes between EoE and GERD.
Treatment Options for EoE
Management focuses on reducing inflammation, preventing complications, and improving quality of life.
1. Dietary Therapy
Dietary elimination remains a cornerstone of treatment:
- Six-Food Elimination Diet (SFED): Avoids milk, wheat, soy, eggs, nuts, and seafood.
- Elemental Diet: A hypoallergenic, amino acid-based formula used in severe cases.
- Targeted Elimination: Based on allergy test results.
2. Medications
- Proton Pump Inhibitors (PPIs): Reduce acid production and inflammation.
- Topical Corticosteroids: Swallowed fluticasone or budesonide suppress eosinophilic inflammation.
- Biologic Therapies: Monoclonal antibodies targeting interleukins (e.g., dupilumab) show promise in clinical trials.
3. Dilation Therapy
In cases of esophageal strictures, endoscopic dilation is performed to relieve dysphagia and prevent food impaction.
4. Long-Term Management
- Regular Monitoring: Endoscopic follow-ups assess disease progression.
- Lifestyle Adjustments: Identifying and managing allergens, stress reduction, and proper nutrition are key.
Complications of Untreated EoE
Without treatment, chronic inflammation can lead to:
- Esophageal Strictures: Narrowing of the esophagus, increasing food impaction risk.
- Fibrosis: Permanent tissue remodeling, leading to chronic swallowing difficulties.
- Malnutrition: Due to dietary restrictions and feeding challenges.
Prognosis and Future Directions
While EoE is a chronic condition, effective treatment significantly improves symptoms and quality of life. Ongoing research aims to refine biologic therapies and develop non-invasive diagnostic tools.
