Eosinophilic Esophagitis

Medically reviewed by Jill Seladi-Schulman, PhD on August 2, 2017Written by Carrie Madormo, RN, MPH on August 2, 2017

What is eosinophilic esophagitis?

Eosinophilic esophagitis is a condition caused when certain white blood cells, called eosinophils, are found in the esophagus. It results in pain, difficulty swallowing, and heartburn. It’s a chronic allergic and immune condition. It’s also rare, affecting about 1 in 1,000 children and 1 to 3 in 10,000 adults worldwide.

Common symptoms

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:

  • trouble feeding or drinking
  • weight loss
  • vomiting
  • failure to thrive

Symptoms of eosinophilic esophagitis in adults can include:

  • being unable to pass food into the 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 food and environmental allergies, asthma, eczema, and celiac disease.

Causes of eosinophilic esophagitis

Eosinophilic esophagitis is caused by the overabundance of eosinophils in your esophagus. This overabundance of eosinophils most likely comes from one of two causes.

Allergic response

Eosinophils in the esophagus can be caused by 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 experience difficulty swallowing or intense heartburn after eating certain foods, such as dairy or soy. 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 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.

How it’s diagnosed

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

In this procedure, your gastrointestinal physician inserts a thin tube with a camera down your esophagus while you’re under sedation. The doctor gathers biopsies of tissue during the procedure. These are later sent off to the pathologist to test for eosinophils.

Your physician 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 give your medical team a clue about what’s going on. Once your biopsy results come back from the pathologist, your physician can determine if the cause of your symptoms is eosinophilic esophagitis.

If you see an allergist for your diagnosis, they may also order blood tests to test for food allergies. The findings could help determine what foods to avoid when managing your eosinophilic esophagitis.

Treatment options

Your doctor will recommend a treatment based on your unique case. It may involve one or a combination of medication, natural remedies, diet changes, and surgery.

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

Medication

The U.S. Food and Drug Administration (FDA) hasn’t approved a drug to specifically treat this condition. However, other medications can help treat its symptoms.

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

Proton pump inhibitors (PPIs) can help control the amount of acid in your stomach and esophagus. They’re used to treat acid reflux. Taking a PPI could decrease the number of eosinophils found in your esophagus and help bring down the inflammation.

Natural treatment

Natural treatments may help control the symptoms, but they won’t cure eosinophilic esophagitis.

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

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

While these treatments don’t 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 treatments.

Diet

Because eosinophilic esophagitis could be caused or made worse 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 with 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’s now causing an allergic response.

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

If you’re not sure if you have any food allergies, start by eliminating common food allergens. These include:

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

In an elimination diet, all of these foods are completely removed from your diet, then slowly reintroduced one by one to determine if 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 physician stretches your esophagus to make it slightly wider. This can help you swallow more easily.

However, this treatment is usually not recommended unless the other options haven’t worked.

Outlook

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

This condition is chronic and recurring without a known cure. The current treatments and medications are meant to control the buildup of eosinophils and resulting symptoms. Talk with your doctor about the best plan for you. With the right treatment, you can reduce the discomfort in your throat.

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