EOSINOPHILIC ESOPHAGITIS - THE DIAGNOSIS THAT IS HARD TO SWALLOW

Eosinophilic esophagitis, EoE, is an inflammation of the esophagus characterized by an increase in the white blood cells, eosinophils. This disorder was first described in infants over 20 years ago and now is found in adults as well. In infants the symptoms are reflux with poor growth while in adults symptoms of difficulty swallowing, dysphagia, and heartburn are the most common symptom. In some adults with EoE the dysphasia becomes severe resulting in food becoming stuck, impacted, in their esophagus that may require emergency treatment to remove the impacted food.

Early on when EoE was first recognized in infants, food allergies were typically associated as a cause, but with adults my personal experience is that food allergies are unlikely to be a factor. Rather, many adults are found to be very allergic on skin testing to common allergens such as pollens. How this finding of environmental allergies is related to EoE is not well understood, although some patient’s EoE will worsen during the peak of their allergy season.

The diagnosis of EoE requires findings of increased eosinophils on esophageal biopsy obtained by an upper endoscopy of the esophagus. Unfortunately this is the only diagnostic

option to confirm the presence of EoE.

Treatment to date for EoE for many adults has not been satisfactory. In those few cases in adults were an associated food allergy can be found, elimination of the food may result in significant improvement of their EoE. In another instance some EoE patients respond to a group of medications that primarily are to treat excessive stomach acid, heartburn. This class of medications are the PPIs, proton pump inhibitors, such as omeprazole. The vast majority though require a daily swallowed steroid typically given by a steroid inhaler or a steroid liquid to control their symptoms of EoE. While a cure has not yet been identified, studies are currently being conducted to evaluate new medications, injectable biologics, that have been approved for other allergic inflammatory diseases such as asthma. Our practice is currently involved in one such clinical trial of a biologic medication, Dupixent, that is approved for asthma and eczema. It is the hope that in the future this treatment approach with a biologic will eliminate the need for swallowed steroids for EoE.