In eosinophilic esophagitis 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.
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)
Doctor will consider both your symptoms and test results to diagnose eosinophilic esophagitis. This will include determining whether you have:
• Gastroesophageal reflux disease (GERD), in which eosinophils usually are not present
• Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE), in which eosinophils are present, but symptoms improve with proton pump inhibitor (PPI) medication
Tests to diagnose eosinophilic esophagitis include:
• Upper endoscopy. Doctor will use a long narrow tube (endoscope) containing a light and tiny camera and insert it through your mouth down the esophagus. He or she will inspect the lining of your esophagus for inflammation and swelling, horizontal rings, vertical furrows, narrowing (strictures) and white spots. Some people with eosinophilic esophagitis will have an esophagus that looks normal.
• Biopsy. Your doctor will perform a biopsy of your esophagus, likely taking two to four samples of cells from two locations.
• Blood tests. You may be given a blood test to look for higher than normal eosinophil counts or total immunoglobulin E (IgE) levels, suggesting allergy.
• Medication trials. You may be given anti-reflux medication, specifically proton pump inhibitors (PPIs), to see if your symptoms improve
• Dietary treatment trials. This will include taking biopsies from your esophagus to learn how the disease responds to these dietary changes.
• Food-patch test. In this test, food is placed in a small container, which is then taped on your back, touching your skin. The doctor looks for inflammation on that spot.
Eosinophilic esophagitis is considered a chronic relapsing disease, meaning that most people will require ongoing treatment to control their symptoms.
Treatment will involve one or more of the following:
Dietary therapy
Depending on your response to tests for food allergies, your doctor may recommend that you stop eating certain foods, such as dairy or wheat products, to relieve your symptoms and reduce inflammation
Medication
Doctor at Aadil Hospital will likely first prescribe an acid blocker such as a PPI. This treatment is the easiest to use, but most people's symptoms don't improve. If you do not respond to the PPI, doctor will then likely prescribe a topical steroid, such as fluticasone or budesonide, which is taken orally to treat eosinophilic esophagitis.
Dilation
In case of severe narrowing (strictures) of esophagus, doctor may recommend dilation to help make swallowing easier. Dilation may be used if steroids are not helpful.
Consult dietition at Aadil Hospital for diet plan and gastroentrologist for medival treatment.
