Eosinophilic esophagitis is a condition where 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 stuck when you swallow.

Eosinophilic esophagitis is a chronic immune system disease. It has been identified only in the past two decades but is now considered a major cause of the digestive system (gastrointestinal) illness. Research is ongoing and will likely lead to revisions in the diagnosis and treatment of eosinophilic esophagitis.

Symptoms

Signs and symptoms include:

Adults:

• Difficulty swallowing (dysphagia)
• Food getting stuck in the esophagus after swallowing (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)

Causes

Eosinophils are a normal type of white blood cells present in your digestive tract. However, in eosinophilic esophagitis, you have an allergic reaction to an outside substance. The reaction may occur as follows:

• Reaction of the esophagus. The lining of your esophagus reacts to allergens, such as food or pollen.
• Multiplication of eosinophils. The eosinophils multiply in your esophagus and produce a protein that causes inflammation.
• Damage to the esophagus. Inflammation can lead to scarring, narrowing, and formation of excessive fibrous tissue in the lining of your esophagus.
• Dysphagia and impaction. You may have difficulty swallowing (dysphagia) or have food become stuck when you swallow (impaction).
• Additional symptoms. You may have other symptoms, such as chest pain or stomach pain.

There has been a significant increase in the numbers of people diagnosed with eosinophilic esophagitis in the past decade. At first, researchers thought this was due to an increase in awareness among doctors and greater availability of tests. However, studies now suggest the disease is becoming increasingly common, parallel to the increase in asthma and allergy.

Diagnosis

Endoscopy

Your doctor will consider both your symptoms and test results to diagnose eosinophilic esophagitis. This will include determining whether you have gastroesophageal reflux disease (GERD).

Tests to diagnose eosinophilic esophagitis include:

• Upper endoscopy. Your doctor will use a long narrow tube (endoscope) containing a light and tiny camera and insert it through your mouth down the esophagus. The doctor 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. During an endoscopy, your doctor will perform a biopsy of your esophagus. A biopsy involves taking a small bit of tissue. Your doctor will likely take multiple samples from your esophagus and then examine the tissue under a microscope for eosinophils.

Treatment

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. A more limited diet is sometimes required.

Medication

• Proton pump inhibitor (PPI). Your doctor 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.
• Topical steroid. If you do not respond to the PPI, your doctor will then likely prescribe a topical steroid, such as fluticasone or budesonide, which is a liquid that is swallowed to treat eosinophilic esophagitis. This type of steroid is not absorbed into the bloodstream, so you are unlikely to have the typical side effects often associated with steroids.

Dilation

If you experience severe narrowing (strictures) of your esophagus, your doctor may recommend dilation (stretching) to help make swallowing easier. Dilation may be used if steroids are not helpful. Or, dilation may be a choice to avoid ongoing use of medication.