Eosinophilic esophagitis is a chronic immune condition that results in inflammation of the esophagus. This inflammation is caused by an excess of immune cells, known as eosinophils, in the esophageal tissues. This leads to symptoms such as dysphagia (difficulty swallowing), food impaction (food getting stuck in the esophagus), and reflux (stomach acids entering the esophagus). EoE can affect infants, children, and adults. Symptoms can present differently among age groups, making the condition difficult to diagnose.
Oftentimes, EoE is misdiagnosed as gastroesophageal reflux disease (GERD) before it’s correctly diagnosed as EoE. Knowing the symptoms of EoE can help point your doctor to a correct diagnosis so you can start effective treatments.
EoE is an inflammatory condition caused by a specialized type of white blood cell known as an eosinophil. Eosinophils play an important role in the immune system: They release chemicals to help fight off harmful organisms like parasites. These cells move to areas of inflammation to help other immune cells trap and kill invaders. Although eosinophils are generally beneficial, they’re also responsible for causing allergy and EoE symptoms.
People living with EoE have higher levels of eosinophils in their bloodstream and esophagus, compared to those without the condition. When eosinophils become overactivated or too numerous, they release too many chemicals into the bloodstream, which activates immune cells. This brings in more cells and creates too much inflammation, which can damage the body’s healthy tissues.
Allergies to substances such as pollen, pet dander, or certain foods can trigger this reaction. When you eat food or inhale air that contains an allergen, it comes in contact with the esophagus. The tissues in the esophagus then become inflamed. This inflammation can eventually cause the esophagus to narrow. This, in turn, can cause symptoms such as food impaction or swallowing difficulties.
Symptoms of EoE are mainly caused by narrowing of the esophagus from inflammation. Also known as a stricture, this narrowing is associated with rings forming in the esophagus, which make it more difficult for food to travel down into the stomach. In some cases, tissue that lines the esophagus can tear, especially in situations where food gets stuck.
Age plays a large role in what symptoms occur in EoE cases.
Pediatric cases of EoE look different than those in adults. In many cases, getting an infant or young child who’s diagnosed with EoE to eat can be difficult. This may result in a medical condition known as failure to thrive, which means a child isn’t getting enough nutrients to gain weight and grow. A child may lose weight as a result. Some younger children with EoE may also be extra sensitive to certain foods or textures, making it difficult for them to eat.
Children and teenagers may also experience:
These symptoms make eating food — especially solid food — and keeping it down difficult. Food can get stuck in a person’s esophagus. This food impaction can be dangerous if the food isn’t vomited up. If left untreated, it can become a medical emergency.
Infants and children of all ages may experience reflux, where stomach acid enters the esophagus. This may cause a burning sensation or warmth in the chest and neck area. A doctor may misdiagnose these symptoms as GERD and prescribe treatment with proton pump inhibitors (PPIs). Although PPIs can sometimes successfully treat EoE, they also sometimes fail and symptoms will continue. The ongoing symptoms may cause a doctor to re-evaluate their original GERD diagnosis and could eventually lead to a correct EoE diagnosis.
Adults share some symptoms of EoE with younger people, but they also have a few distinct symptoms. Similar symptoms include:
Additionally, adults can experience more intense acid reflux than children, which causes heartburn and pain in the center of the chest.
Adults with EoE rarely show signs of failure to thrive or weight loss. Loss of appetite and disinterest in eating are also less common.
If you notice you’re experiencing EoE symptoms several times a week or if they’re severe, talk to your doctor. If you take heartburn medications frequently, tell your doctor, as it may point them to an EoE diagnosis.
People with EoE often have other related health conditions which involve overactivation of the immune system. Examples include atopic dermatitis (eczema), asthma, and other food or environmental allergies. If you’re diagnosed with one or more of these health issues, you may be at a higher risk of having EoE. Not everyone with EoE has one of these other conditions, but between 50 percent and 80 percent do.
Seasonal and food allergies are both connected to EoE. Some people may even notice their EoE symptoms worsen during allergy season or after eating certain foods. This is because eosinophils are directly involved in both conditions. An allergist may offer allergy testing, such as skin or blood tests, to determine which substances cause a reaction.
Eczema and asthma also may involve an excess of eosinophils. People living with eczema may have too many eosinophils in their bloodstream and skin. In asthma, there can be too many of them in the bloodstream and lungs after a flare. Having too many eosinophils can affect other parts of the gastrointestinal system, including the intestines and stomach.
If you’re experiencing any of the symptoms of EoE, talk to your doctor. They may perform tests and refer you to specialists to help accurately diagnose your condition. Typically, a gastroenterologist or an allergist helps diagnose EoE. Talking to your doctor is the first step in getting the treatment you need.
To help correctly diagnose EoE, these doctors may run some tests to help rule out other conditions and confirm a diagnosis. These include an upper endoscopy and a biopsy. An upper endoscopy involves taking pictures of the esophagus with a small camera so that the specialist can see what is happening inside. A biopsy involves taking tissue samples, which a health care worker will view under a microscope to count the number of eosinophils present.
Although there’s no cure for EoE, many treatment options are available to help target inflammation at its source and address symptoms. Treatment options that help alleviate symptoms of EoE include:
Currently, dupilumab (Dupixent) is the only medication approved by the U.S. Food and Drug Administration (FDA) specifically for treating EoE. This drug works by directly targeting the inflammation created by eosinophils in the esophagus to help alleviate symptoms and treat the condition.
On myEoEcenter, the site for people with eosinophilic esophagitis and their loved ones, people come together to learn more about EoE and share their stories with others who understand life with EoE.
What symptoms have you or a loved one experienced while living with EoE? Share your experiences in the comments below.
I take panterozole and diltiazem.