Eosinophilic esophagitis

DEFINITION

In eosinophilic esophagitis (e-o-sin-o-FILL-ik uh-sof-uh-JIE-tis), a type of white blood cell (eosinophil) builds up in the lining of the tube that connects your mouth to your stomach (esophagus). This buildup, which is a reaction to foods, allergens or acid reflux, can inflame or injure the esophageal tissue. Damaged esophageal tissue can lead to difficulty swallowing or cause food to get caught when you swallow.

Eosinophilic esophagitis is a chronic immune system disease. It has been identified only in the past two decades, but is now considered a major cause of digestive system (gastrointestinal) illness. Research is ongoing and will likely lead to revisions in its diagnosis and treatment.

CAUSES

Previously, doctors thought eosinophilic esophagitis symptoms were caused by gastroesophageal reflux disease (GERD), but they now recognize it as a distinct condition with very different causes. Eosinophilic esophagitis is an allergic reaction in which the lining of your esophagus reacts to allergens, such as food or pollen.

Eosinophils are a normal type of white blood cells present in your digestive tract, but in eosinophilic esophagitis they multiply in your esophagus. The eosinophils produce a protein that causes inflammation, which can lead to scarring, narrowing and formation of excessive fibrous tissue in the lining of your esophagus. As a result, you may have difficulty swallowing (dysphagia) or have food become stuck when you swallow (impaction), as well as other symptoms.

People with eosinophilic esophagitis may also have food allergies, environmental allergies, asthma, atopic dermatitis or chronic respiratory disease. Doctors also think some people are genetically more likely than others to develop eosinophilic esophagitis.

There has been a significant increase in numbers of people diagnosed with eosinophilic esophagitis in the past decade. At first researchers thought this was due to the increase in awareness among doctors and greater availability of upper endoscopy. However, studies now suggest that the disease is becoming increasingly common, parallel to the increase in asthma and allergy.

SYMPTOMS

Signs and symptoms include:

Adults:

• Difficulty swallowing (dysphagia)
• Food impaction
• Chest pain that is often centrally located and does not respond to antacids
• Persistent heartburn
• Upper abdominal pain
• No response to gastroesophageal reflux disease (GERD) medication
• Backflow of undigested food (regurgitation)

Children:

• Difficulty feeding
• Vomiting
• Abdominal pain
• Difficulty swallowing (dysphagia)
• Food impaction
• No response to GERD medication
• Failure to thrive (poor growth, malnutrition and weight loss)

When to see a doctor

Seek immediate medical attention if you experience chest pain, especially if you have other signs and symptoms, such as shortness of breath or jaw or arm pain. These may be signs and symptoms of a heart attack.

Make an appointment with your doctor if you experience severe or frequent eosinophilic esophagitis symptoms. If you take over-the-counter medications for heartburn more than twice a week, see your doctor.