Eosinophilic Esophagitis


What is Eosinophilic Esophagitis (EoE)?

First off, not many people know what Eosinophilic Esophagitis (EoE) is, and sadly that includes many health professionals. American Partnership of Eosinophilic Disorders (Apfed) defines it as “a chronic, allergic inflammatory disease of the esophagus (the tube connecting the mouth to the stomach). It occurs when a type of white blood cell, the eosinophil, accumulates in the esophagus and persists despite acid-blocking medicine.” Basically, this means EoE patients have a delayed allergic reaction in their esophagus to something in their food or environment. What’s really frustrating is figuring out what’s causing it because the reaction can take as short as a few hours to as long as a week to show up!

What are the symptoms for Eosinophilic Esophagitis (EoE)?

EoE adult patients have a difficult time swallowing dense foods like bread, meat, and rice. These aren’t usually the culprits causing the inflammation, although gluten can sometimes be the problem. In most cases adults are told they have LPR or GERD, and are put on a course of Proton Pump Inhibitors (PPIs) to rid their stomach of acid. However, this doesn’t help with EoE. Most adults find out they have EoE after an emergency room visit to surgically remove impacted food like a piece of steak.

EoE in children exhibits more as nausea, food avoidance (due to pain), difficulty swallowing, food impactions, trouble sleeping, failure to thrive, and reflux that refuses to respond to medication.

How does someone find out they have Eosinophilic Esophagitis (EoE)?

The only way to know with absolutely certainty that a person has EoE is to have an endoscopy performed by a gastroenterologist. Specifically, he/she needs to take biopsies of the patient’s esophagus. Those with EoE can have deceptively normal, healthy looking esophaguses, but the biopsies will reveal if you have an issue with elevated white blood cells in your esophagus. Eosinophils or white blood cells are not normally found in the esophagus.

How do you treat Eosinophilic Esophagitis (EoE) once you know you have it?

It’s a chronic condition with no known cure. However, there are courses of treatment that can help make you feel like you again. After receiving the results from your gastroenterologist, you should make an appointment with an allergist. One course of treatment is to start on a corticosteroid inhaler like Flovent. Instead of inhaling the medicine, you hold it in your mouth and swallow it, so it will coat your esophagus. Another is to start an elimination diet of all the common allergens (wheat, dairy, eggs, soy, peanuts, tree nuts, fish, and shellfish). You may also need to eliminate corn and/or beef in some cases. Personally, corn turned out to be one of my culprits. You start by eliminating everything for 6-8 weeks, and then slowly bring food groups back in every couple of weeks to see what is causing your symptoms. You can have traditional allergy tests performed, such as skin tests and blood tests, but with EoE they are not as relevant. Traditional tests don’t look at white blood cells or inflammatory responses, but rather test your IgE levels in response to potential allergens. EoE is not an IgE allergic condition. You may want to look into food sensitivity testing, such as MRT LEAP 150 test. In worse case scenarios some EoE patients need to resort to a liquid diet or a feeding tube for a time to help heal the body.

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