Eosinophilic Oesophagitis

Eosinophilic Oesophagitis – what is it, what are the symptoms, and is it curable?

Also called EoE and EE, Eosinophilic Oesophagitis (pronounced “e-oh-see-no-fillic e-soffa-jie-tis”) is when you have a chronic (long-term) allergic disease of the oesophagus which causes symptoms such as inflammation, swelling, redness, and itchiness within that area.

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EoE: a general overview

What is EoE?

Eosinophilic oesophagitis is characterized by the oesophagus – part of the digestive system connecting your throat to your stomach via a muscular tube – becoming inflamed and irritable.

This is caused by cells massing due to an allergic reaction, leading to the oesophagus swelling, itching, and reddening. One of the culprits is a confused white blood cell, called an eosinophil (e-oh-seeno-fill), that thinks the body is under attack when it detects certain substances in the area, and rushes to the defence.

Eosinophils are a vital part of your immune system and they are kept busy day and night fighting parasites in the intestines, and performing other important functions. The problems only start when the eosinophils leave the blood and intestinal areas and appear in high quantities elsewhere, like the oesophagus.

With seasonal allergies, eosinophils travel to the nose; if you suffer from asthma, the busy little white blood cells go to the lungs; and if you have eosinophilic oesophagitis, they are in your digestive tract, between the throat and the stomach. If you have any experience with allergies, you will understand they can be irritating and cause much misery when left untreated.

EoE can affect children and adults at any time, but those with other allergies are more prone: eczema, asthma, grass or pet allergies, etc.

EoE was only detected around 30 years ago. Doctors and medical researchers are not sure what has caused the sudden rise in EoE cases, especially over the last 5 years:

  • EoE has simply become more prevalent because of better detection and reporting

  • Patients are quicker to notice when something is wrong with their health and visit a doctor

  • The disease is becoming more common due to other influences

 

It be may a combination of all the above factors, but seeing as EoE only occurs in an estimated 1 out of 1,500 children, it is still considered to be a rare disorder.

What are the signs and symptoms of EoE in children?

If your child has eosinophilic oesophagitis they will experience some or all of the following symptoms:

  • Burning sensation in the oesophagus, similar to that felt by heartburn or acid reflux

  • Nausea

  • Vomiting

  • Constant or intermittent regurgitation

  • Abdominal pain

  • Sometimes difficulty in swallowing

  • Frequent gagging

  • Feeling something is stuck in the throat (dysphagia)

 

What happens if eosinophilic oesophagitis goes undetected or untreated?

If EoE is left undiagnosed or untreated, it can lead to the oesophagus narrowing due to the build-up of scar tissue in the area. The medical term for this is called stricture.

What are the signs of EoE in infants and babies?

Infants and babies with eosinophilic oesophagitis will not want to breast or bottle feed. They may arch their backs as an indication of pain or spit up their feeds. The older a child with EoE becomes, the more obvious the signs will appear:

  • Slow and reluctant eating and/or drinking

  • Slow growth/weight gain/development

  • Irrational aversion to certain foods

  • Trouble sleeping or interrupted sleeping patterns

  • Complaining about heartburn and dysphagia-like symptoms

 

Often times, EoE is only diagnosed when the child or teenager is admitted to hospital because of food trapped in the oesophagus they are unable to cough up (called food impaction).

Because eosinophilic oesophagitis shares its symptoms with common discomforts such as acid reflux and general indigestion, many doctors first prescribe a course of proton pump inhibitor medications (PPI) or acid blockers. Unfortunately, these medications don’t help EoE sufferers and symptoms will continue. This will alert your doctor to the fact that acid reflux is not the cause. An estimated 10% of children with acid reflux symptoms have EoE.

What are the causes of EoE?

The causes of eosinophilic oesophagitis and why it seems to run in families in unknown at this time.

 

How to test and diagnose EoE

Once your family doctor has ruled out acid reflux, you will be referred to a paediatric gastroenterologist. They might also ask for an allergist to consult for further evaluation.

The only method used to effectively diagnose EoE in your child is with an oesophageal biopsy. This will be performed by your paediatric gastroenterologist. Your child is sedated, according to their weight and age, and the physician will insert an endoscope down into the oesophagus, stomach, and upper section of the small intestine, via the mouth. Minute tissue samples are taken.

Signs of EoE your paediatric gastroenterologist are looking for with the endoscope are white plaque “rings. However, as many small children and babies often have oesophageal, stomach, and upper intestinal tissue that appears to be normal, it necessary to biopsy the oesophagus too.

An allergist, working with the gastroenterologist toward a diagnosis, with typically test the skin and blood in order to identify allergic reactions. These tests alone, however, are not effective to determine EoE on its own as, once the allergen is introduced, it can take several days for a reaction to take place.

Skin patch testing is not routinely offered by allergists, but if they are done, it can provide a guideline on which foods should be introduced or omitted. No skin patch test is 100% accurate.

What are the treatments for eosinophilic oesophagitis in children?

The underlying cause of EoE is almost always a food allergy. Your paediatric gastroenterologist might implement dietary restrictions. This will help them pinpoint which foods are triggering the allergic response:

  • Corn

  • Potatoes

  • Milk

  • Eggs

  • Wheat

  • Beef or chicken protein

  • Soy

 

Some of the above foods are the ones most commonly involved in EoE symptoms.

 

Often, the complete elimination of foods is required, in order to determine which are the causative ones. Food elimination diets are also needed to allow the oesophagus to heal. Foods will be slowly reintroduced in a controlled way to determine the ones causing the allergic response.

One of the medications you might be prescribed for your child are corticosteroids (to control the inflammation). This is not a long term solution.

What can I do to help my child with eosinophilic oesophagitis?

Diet modifications and lifestyle changes will help your child live a full and happy life. EoE will never go away completely, but studies are following children diagnosed with the disease into their adult lives, to see the long-term effects.

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Eosin in a histologic sample of a patient with EoE. Image credit: SciELO

Interesting fact about eosinophilic oesophagitis: eosin is a stain used to show white blood cells, among other tissue structures. Eosinophils are associated with allergies, asthma, and other inflammatory responses in airways and other parts of the body. EoE is an inflammatory condition of the oesophagus and when the biopsy tissue sample is taken for diagnosis, it is stained with eosin to show the presence of eosinophils.