What is eosinophilic esophagitis?
Eosinophilic esophagitis is an increasingly prevalent disease that is characterized by an inflammation of the esophagus, the organ that brings food from the mouth to the stomach. This inflammation is associated with the presence of eosinophils lining the esophagus. Eosinophils are white blood cells found in many allergic diseases. For example, these cells are often present in the lungs of people suffering from asthma. Certain people actually describe eosinophilic esophagitis as an "asthma of the esophagus".
What are the symptoms of eosinophilic esophagitis?
Symptoms vary among children and adults. Children may present with feeding difficulties, abdominal pain, vomiting and a burning sensation in the stomach whereas adults typically present with difficulty swallowing and/or food obstruction. However, any of these symptoms can present at any age.
Who are those most likely to suffer from eosinophilic esophagitis?
Studies show that this disease mostly affects young men in their thirties, although many cases worldwide have been described in young children and older adults. Moreover, there is often a member of the family who also has eosinophilic esophagitis. Lastly, many patients have additional allergic diseases such as asthma, rhinoconjunctivitis or food allergies.
What are the possible triggers of eosinophilic esophagitis?
In most patients, certain foods are identified as a possible trigger of the disease. The most common food triggers include milk, wheat, egg, soy, peanuts, tree nuts, fish and shellfish. Recent studies suggest that allergens in the environment (such as tree and grass pollen) may also play an important role in the development of eosinophilic esophagitis.
How does one diagnose eosinophilic esophagitis?
In someone who presents with typical symptoms of the disease (difficulty swallowing, food obstruction, heartburn, abdominal pain, etc), the diagnosis is made by examining the number of eosinophils on a biopsy of tissue taken from the esophagus. This biopsy is done during an endoscopy, which involves placing a camera in the esophagus in order to obtain small samples of tissue. Generally, a medication trial in the proton pump inhibitors class (eg: omeprazole, pantoprazole, esomeprazole, lansoprazole…) should take place for at least 2 months before a diagnosis of the disease by endoscopy can be made.
What is the treatment of an eosinophilic esophagitis?
Given that eosinophilic esophagitis can result in symptoms of gastro-esophageal reflux, certain people are first treated with medications called proton-pump inhibitors (ex: Pantoloc™, Prevacid™). In order to control the inflammation found in the esophagus, a doctor may prescribe an inhaled cortisone puffer (ex: Flovent™) which is a medication also used in the treatment of asthma. However, since the patient is treating his/her esophagus, he/she must swallow the medicine instead of inhaling it. He/she must also be careful not to eat or drink immediately after taking the medicine. Sometimes, the doctor may identify specific foods that trigger the disease through the use of allergy skin tests or atopy patch tests. In this case, a diet that excludes these foods may be recommended. It is also possible that the doctor recommends from the very start to avoid certain common triggering foods without allergy tests. All forms of diets undertaken in this manner must be under supervision, so as not to cause nutritional deficiencies. Other medications are currently being studied and have not yet been approved for use in this disease.
Nha Uyen Nguyen-Luu, MD FRCPC
Natacha Tardio, MD FRCPC