I would have never believed you if you told me I would spend many late nights during my GI fellowship fishing food out of someone’s esophagus. Eosinophilic esophagitis? I had never even heard about it during medical school! And here I was getting phone calls on a regular basis about someone swallowing a piece of food and just not being able to get it down (not even able to swallow their own saliva!) and coming in at any hour of the day to get an upper endoscopy and get the food out! Since I had not even heard about it in medical school- I wonder how many readers are hearing about EOE for the first time right now? Once considered rare, EOE is one of the MOST common conditions diagnosed in kids with eating problems and adults with problems swallowing. Let’s get to know EOE.
What IS EOE???
Eosinophilic esophagitis is a chronic, immune-mediated esophageal disease with symptoms related to esophageal problems and eosinophil-predominant inflammation. The inflammatory triggers are usually foods. Reflux must always be ruled out first!
adapted from NEJM
What are the symptoms??
In kids: feeding problems, vomiting, and abdominal pain
In teens/adults: trouble swallowing and food impaction
Risk factors?
IMMUNE SYSMEM DISRUPTION
It’s all about building a good healthy immune system from day 1!
Altered stimulation of the immune system at an early age and lack of exposure to bacteria and a weak microbiome play a role.
Birth by c-section, premature delivery, antibiotic exposure during infancy, food allergy, lack of breast-feeding, and living in an area of low population density have all been associated with EOE.
GENETICS
There’s a genetic predisposition with a ~2% risk of inheriting it from family
ALLERGIC DISEASES
It’s common for EOE to coexist with asthma, eczema, rhinitis, and food allergies
How to find out if you have it?
Talk to your gastroenterologist!
Most likely you will need to undergo upper endoscopy with biopsy
If positive, your GI will send you to an allergist for food allergy testing to understand what allergen is driving the inflammation.
What is the treatment for EOE?
1. Diet: Get rid of the allergen! A 6 food elimination diet can be helpful- getting rid of super allergenic foods like wheat, milk, soy, nuts, eggs, and seafood.
2. Drugs: Calm down the inflammation. Swallowed steroids are the way to go and decrease esophageal scarring
3. Dilation: If you are found to have esophageal narrowing, the GI doc can open it up during endoscopy with a balloon
adapted from NEJM
It is SO very important to get diagnosed! Longstanding untreated EOE can lead to esophageal narrowing, food impaction, malnutrition and even esophageal perforation!
Don’t ignore that food isn’t going down smoothly and get checked out thoroughly- avoid getting that urgent overnight endoscopy for a food impaction!