Eosinophilic Esophagitis Information and Articles
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Eosinophilic Esophagitis (EE or EoE) is an emerging disease that is increasingly being recognized among pediatricians, internists, allergist, gastroenterologists (GI specialists), and other physicians. It is a condition that affects the esophagus and has been rising in incidence over the past decade. The main EE symptoms may mimic gastroesophageal reflux disease (GERD) and can vary depending on the age of the child.
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- Poor weight gain (failure to thrive)
- Refusal to eat
- Vomiting often occurring with meals
- Difficulty swallowing (dysphagia)
- Pain or discomfort with swallowing (odynophagia)
- Food becoming lodged within the esophagus (food impaction)
Other related symptoms can include cough or chest, throat, or abdominal pain. In general, lower GI symptoms such as diarrhea or bloating are not typically associated with EE.
Due to a lack of awareness of this GI condition, signs or symptoms of eosinophilic esophagitis are often overlooked by physicians or family members. GI symptoms may be mistaken to be GE reflux disease, or thought to be related to behavioral issues. Symptoms may be explained away by thinking “my son just eats too fast” or “my daughter just doesn’t chew carefully.” In addition, persons with eosinophilic esophagitis may minimize their symptoms feeling that these are things that they can live with. On the side of pediatricians, internists, or other physicians, they may assume either that patients are over-exaggerating their symptoms or that reflux symptoms are persisting because patients are not taking their medications regularly. If this condition is suspected, the only method to confirm the diagnosis of eosinophilic esophagitis is with an Upper Endoscopy (EGD) and Esophageal Biopsies to look for increased numbers of eosinophils. Keep in mind however, that acid reflux disease is a much more common condition than EoE.
Food allergies are the main cause of eosinophilic esophagitis in children. There are a number of studies that have demonstrated the central role of food allergens in triggering EE. When these allergenic foods are removed from a person’s diet, EE symptoms can resolve and the eosinophilic inflammation in the esophagus can be healed. The role of the allergist is to identify underlying food allergies that are triggering EE by a variety of Allergy tests including blood testing looking for IgE-mediated allergies, skin prick testing, and atopy patch testing to foods. There are also allergy diets restricting the most common food allergens (Six Food Empiric Elimination Diet) which has also been used to treat EE. Another dietary option which has also been very successful is the Elemental Diet with amino-acid based formulas.
In addition, there are medical therapies available – the most common drug therapy is the use of Swallowed Inhaled Steroids such as viscous budesonide (Pulmicort) made into a slurry or fluticasone (Flovent) inhalers.
Each of these treatment options have their benefits and disadvantages, therefore it is important to have a discussion with your treating physician (typically an allergist or gastroenterologist) to decide which therapy is best for you. Multidisciplinary centers specializing in the treatment of eosinophilic esophagitis can provide a comprehensive co-ordinated care approach to treat this complex disease.