Eosinophilic esophagitis

The esophagus is the tube that connects the back of your throat to your stomach.  People with eosinophilis esophagitis (EoE) have many eosinophils in the esophagus.  Eosinophils are white blood cells involved in the allergic response and are not normally present in the esophagus.  They degranulate like mast cells, releasing chemicals and causing inflammation.

EoE can occur at any age, but is mostly found in white males.  Children generally have abdominal pain, vomiting and trouble swallowing.  Adults mostly present with trouble swallowing and heartburn.

EoE is diagnosed by endoscopy and biopsy.  Reflux must first be disproven as the source of inflammation.  On endoscopy, ridges, furrows or rings may be observed in the esophagus.  This is sometimes called “corrugated esophagus” or “feline esophagus.”  White fluid may also be present. 

In biopsied tissue, infiltrates of eosinophils are observed in the epithelium.  15 or more eosinophils per HPF is diagnostic for this condition.  These eosinophils are often degranulated.  Inflammation should be restricted to the esophagus and not the stomach. 

Most people with EoE have a family history of allergies, allergic disorders or asthma.  Often, patients have food allergies or environmental triggers.  The most common cause of EoE is thought to be allergic reaction to specific foods, but the mechanism of this relationship is not well understood.  Dairy products, soy, wheat and eggs are common triggers of EoE, but there is not always a proven IgE allergy present. 

Diet is important in controlling EoE symptoms.  Eliminating known food triggers is key.  Elemental diets are sometimes necessary.  In these diets, protein is removed and the patient consumes an amino acid formula, sometimes through a feeding tube. 

Corticosteroids can reduce inflammation in the esophagus.  Proton pump inhibitors, like omeprazole, are also being used with some success.  Anti-leukotrienes, such as SIngulair, anti-interleukins, and antihistamines have been tried, mostly with little success.  There are no medications approved for EoE currently, as this condition is only recently being recognized with regularity.   The esophagus can inflame to the point that food cannot pass through it.  If this is present, dilating the esophagus may be considered.

There is a known genetic link to EoE.  A defined set of gene expressions, called the “EoE transcriptome” is present in these patients and not present in unaffected individuals.  Patients can get tested by the EE Diagnostic Panel to see if they have EoE.