Eosinophilic esophagitis is a condition in which certain white blood cells, called eosinophils, are found in the esophagus. It results in pain, difficulty swallowing, and heartburn.

Eosinophilic esophagitis is a chronic allergic and immune condition. It’s rare, affecting about 1 in 2,000 people.

The most common symptom is difficulty swallowing or eating. This is due to the buildup of white blood cells in the tissue of the esophagus. Other symptoms can vary between children and adults.

In children, symptoms can include:

  • difficulty eating or drinking
  • weight loss
  • vomiting
  • failure to thrive

Symptoms of eosinophilic esophagitis in adults can include:

  • inability to pass food into your stomach
  • heartburn
  • chest pain
  • abdominal pain
  • food regurgitation

In rare cases, eosinophilic esophagitis can lead to a medical emergency. Having too much food stuck in your esophagus or vomiting up food may result in a tear in your esophagus. This is rare but needs emergency treatment right away.

This condition is mostly associated with people who have environmental or food allergies, asthma, eczema, and celiac disease.

Q: Do I need to do any special prep in case of an emergency related to eosinophilic esophagitis (EoE)?

Anonymous

A:

One possible emergency in EoE is food impaction, which occurs when a bolus (semi-solid mass) of food gets stuck in the esophagus. The food bolus is unable to continue down the esophagus into the stomach and can’t be vomited back up.

Food impactions must be addressed urgently. They can result in aspiration (breathing esophageal contents into the lungs), dehydration due to inability to swallow liquids past the food bolus, and perforation (when the esophageal lining breaks, allowing contents to spill into the internal cavities of the body).

Symptoms of food impaction may include:

  • chest squeezing, pain, or pressure
  • choking sensation
  • neck and throat pain
  • excessive drooling
  • inability to swallow foods or liquid

Seek care immediately if you experience these symptoms.

The best way to prevent food impactions is to see a doctor regularly, even if you feel well, and for urgent follow-ups if your EoE symptoms are flaring. You should also follow their guidance for managing EoE.

Another possible EoE emergency is anaphylaxis. While anaphylaxis is not specifically a manifestation of EoE, some people may have associated IgE-mediated food allergy, which carries a risk for anaphylaxis. If EoE isn’t well-managed, swallowed food proteins may be more readily directly absorbed into the body before digestion, increasing the risk of anaphylaxis.

If you have IgE-mediated food allergies, carrying an epinephrine auto-injector and knowing how to use it is the best way to prepare for serious allergic reactions. If you’re unsure whether you have IgE-mediated food allergy, ask your doctor if an evaluation is needed.

Elizabeth Feuille, MDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Eosinophilic esophagitis is caused by an overabundance of eosinophils in your esophagus, which most likely results from one of the following two causes.

Allergic response

The presence of eosinophils in your esophagus can be a result of your body’s immune response to certain allergens. If you’re sensitive to a particular food or environmental allergen, your body could respond with eosinophilic esophagitis.

You may notice that you have trouble swallowing or intense heartburn after eating certain foods, such as dairy or soy products. You could also be reacting to something in the environment, such as pollen.

Eosinophilic esophagitis isn’t always tied to food, but your diet is a good place to start exploring for possible causes.

Genetics

Another possible cause has recently been discovered. Researchers have found that many people with eosinophilic esophagitis have a higher expression of the gene eotaxin-3.

This gene helps control how many eosinophils your body makes. A higher expression of the gene means you’d produce more of the white blood cells that cause this condition.

Although this is a genetic factor, there doesn’t seem to be a strong family history component to the condition.

The only way to definitively diagnose eosinophilic esophagitis is with an endoscopy.

In this procedure, a gastrointestinal doctor inserts a thin tube with a camera down your esophagus while you’re under sedation. The doctor gathers biopsies of tissue, which they send off to a pathologist to test for eosinophils.

Your doctor will also check your esophagus for other changes, such as:

  • inflammation or swelling
  • narrowing
  • white patches
  • creases

These signs alone aren’t enough for your doctor to diagnose eosinophilic esophagitis, but they do provide a clue about what’s going on.

Once your biopsy results come back from the pathologist, your doctor can determine whether eosinophilic esophagitis is the cause of your symptoms.

If you see an allergist for your diagnosis, they may also order blood tests to check for food allergies. The findings could help determine which foods you may need to avoid to manage your eosinophilic esophagitis.

Your doctor will recommend a treatment based on your unique case. It may involve one or more medications, natural remedies, diet changes, and occasional endoscopies to monitor the disease or to dilate your esophagus, if necessary.

Throughout your treatment, your doctor may recommend additional endoscopies and biopsies to monitor your improvement.

Medication

The Food and Drug Administration has not approved a drug specifically to treat this condition, but some medications can help treat its symptoms.

For example, corticosteroids can help manage the inflammation in your esophagus that makes swallowing so difficult. Your doctor may prescribe a higher dosage to get the swelling under control and then lower the dosage over time.

Proton pump inhibitors (PPIs), which are used to treat acid reflux, can help regulate the amount of acid in your stomach and esophagus. Taking a PPI could decrease the number of eosinophils in your esophagus and help bring down the inflammation.

Natural treatment

Natural treatments may help manage your symptoms, but they won’t cure eosinophilic esophagitis.

Some herbal remedies, such as licorice and chamomile, may help reduce acid reflux symptoms. Acupuncture and relaxation techniques such as meditation can also help prevent reflux.

Other strategies to try at home include raising the head of your bed to prevent reflux, making efforts to maintain a moderate weight, and avoiding foods that you know cause heartburn.

While these strategies do not address the underlying cause of the eosinophil buildup, they could help keep you more comfortable.

Always talk with your doctor before starting any new treatment, especially any new herbal remedies.

Diet

Because eosinophilic esophagitis could be caused or worsened by an allergic response to certain foods, your treatment may include eliminating those foods from your diet. The challenging part is determining which foods are problematic.

This is because, in this condition, food reactions often take several days to show up. It can be difficult to remember exactly which food you ate a few days ago that could now be causing an allergic response.

If you have a known food allergy based on pinprick testing, your doctor will most likely start by recommending that you eliminate that food right away.

If you’re not sure whether you have any food allergies, start by eliminating common food allergens such as:

  • dairy
  • eggs
  • wheat
  • soy
  • peanuts
  • tree nuts
  • fish and shellfish

In an elimination diet, you would completely remove all these foods from your diet and then slowly reintroduce them one by one to determine whether you’re sensitive to any of them. You may also want to try eliminating less common food allergens.

Dilation

If the above treatments aren’t helpful, your doctor may recommend a dilation procedure.

People with eosinophilic esophagitis often experience a narrowing of their esophagus, which makes eating difficult. During a dilation, your doctor stretches your esophagus to make it slightly wider. This can help you swallow more easily.

However, dilation is done on an as-needed basis when eosinophilic esophagitis gets serious enough to cause narrowing of the esophagus and make swallowing difficult.

This procedure does not prevent the buildup of eosinophils. It just relieves the constriction long enough to hopefully allow other remedies to prevent the condition from progressing.

Medical researchers are still learning about eosinophilic esophagitis and how best to treat it.

This condition is chronic and recurring and has no known cure. The current treatments and medications are meant to manage the buildup of eosinophils and the resulting symptoms. You can talk with your doctor about the best treatment plan for you. With the right treatment, you can reduce the discomfort you may have when swallowing.