Eosinophilic esophagitis (EE) is an allergic inflammatory disease. In EE, the esophagus (tube connecting the mouth and stomach) has too many eosinophils. Inflammation (redness, swelling) of the esophagus results. Eosinophils, a kind of white blood cells, are an important part of the immune (infection-fighting) system. Foods, airborne allergens, and acid reflux can cause too many eosinophils.
Children and adults of any ethnic group can get EE. Almost three-fourths of people affected are white males, often young boys and men. It can run in families.
The exact cause isn’t known. EE is more common in people with other allergic conditions such as asthma, hay fever, food allergies, and dermatitis than in people without allergies. It’s most often related to allergies to foods, usually milk, soy, eggs, wheat, corn, chicken, and beef.
Symptoms depend on age. Adults usually have trouble swallowing solid food (dysphagia), or less often, have solid food stick in the esophagus (food impaction). Children may have pain in the abdomen (belly), nausea, vomiting, coughing, chest pain, diarrhea, or failure to thrive (poor growth, weight loss). Heartburn often occurs, especially in older children and adults. People can also have reflux that doesn’t respond to usual medicines. About half of people have other allergic symptoms.
The health care provider uses a medical history and upper endoscopy and biopsy for diagnosis. In endoscopy, the health care provider puts a long, narrow tube (endoscope) with a light source and camera into the esophagus. The health care provider checks for inflammation, horizontal rings, vertical furrows (narrow, long channels), and white spots. In a biopsy, a microscope is used to look at tissue samples. EE can be confused with gastroesophageal reflux disease (GERD).
Food allergy testing (skin pricks) is often done to guide treatment. In elimination diets, problem foods are avoided. These foods are often dairy, eggs, wheat, soy, nuts, and fish. Foods are then slowly added back to the diet. A dietitian or nutritionist can help make sure that enough nutrients are eaten.
If special diets don’t work, medicines such as anti-inflammatory steroids (corticosteroids) can help. Corticosteroids can be given in pills, liquids, or sprays. They include oral prednisone tablets, topical swallowed fluticasone spray, and swallowed budesonide.
Children do better with dietary therapy. Drugs are more commonly used in adults.
Other treatments include asthma medicines, acid-blocking drugs, and dilating (stretching) the esophagus (for severe disease).
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