Eosinophilic Esophagitis

Esophagitis with eosinophilia is a persistent immune system condition. Eosinophils, a kind of white blood cell, accumulate in the lining of the tube that links your mouth to your stomach when you have this condition. The esophagus is another name for this tube. This accumulation, which is a response to meals, allergies, or acid reflux, can inflame or damage the esophagus tissue. Either swallowing becomes difficult or food becomes lodged due to damaged esophageal tissue.

While eosinophilic esophagitis has only been recognized since the early 1990s, it is now recognized as a significant cause of digestive system disease. The diagnosis and management of eosinophilic esophagitis will certainly change as a result of continuing research.

Eosinophilic Esophagitis: Causes

Your digestive system often contains eosinophils, a kind of white blood cell. Yet, in eosinophilic esophagitis, an external material causes an allergic response. The following outcomes might happen −

• The esophagus reacts. Your esophageal lining responds to irritants like food or pollen.

• The growth of eosinophils. In your esophagus, the eosinophils proliferate and create a protein that triggers inflammation.

• Erosive esophageal injury. Inflammation can cause your esophagus to scar, narrow, and produce an excessive amount of fibrous tissue.

• Impaction and dysphagia. You can experience dysphagia, which is a problem swallowing. Maybe you might swallow something that becomes trapped. This is known as impaction.

• Other signs and symptoms. Other signs, such as stomach or chest discomfort, might be present.

In the last ten years, there has been a marked rise in the number of cases of eosinophilic esophagitis. Researchers first hypothesized that this was caused by a rise in knowledge among medical professionals and an expansion in the number of test options. Studies now, however, indicate that the condition is spreading more widely along with the rise in asthma and allergies.

Eosinophilic Esophagitis: Symptoms

The patient with eosinophilic esophagitis mainly presents with the following symptoms that include −

Adults

• Having trouble swallowing is referred to as dysphagia.

• Impaction is the term used when food becomes caught in the esophagus after being swallowed.

• An occasional central chest ache that is unresponsive to antacids

• Regurgitation is the backflow of uneaten food.

Children

• Baby feeding difficulties

• Eating challenges in kids

• Vomiting

• Continent pain

• Having trouble swallowing is referred to as dysphagia.

• Impaction is the term used when food becomes caught in the esophagus after being swallowed.

• Medicine for GERD has not worked

• Malnutrition, stunted development, and weight loss are all symptoms of failure to flourish

When to Visit a Doctor?

If you feel chest discomfort, get emergency medical assistance, especially if you also experience arm, jaw, or shortness of breath symptoms. These may be heart attack symptoms.

Eosinophilic Esophagitis: Risk Factors

Several factors play an important role in the development of eosinophilic esophagitis which includes −

• Climate. A diagnosis of eosinophilic esophagitis is more common in residents of cold or dry regions than in residents of other climates.

• Season. Because there are more people outside and there are more allergens around, you have a larger chance of getting diagnosed between spring and autumn.

• Sex. Males get eosinophilic esophagitis more frequently than females.

• Family background. Since eosinophilic esophagitis occasionally runs in families, researchers believe the ailment may have a hereditary component. You have a better probability of getting a diagnosis if you have relatives who suffer from eosinophilic esophagitis.

• Both asthma and allergies. You are more prone to develop eosinophilic esophagitis if you have asthma, atopic dermatitis, food or environmental allergies, or a persistent respiratory condition.

• Age. Eosinophilic esophagitis was once believed to be a condition that only affected children, but it is now discovered to affect adults as well. The symptoms between children and adults vary considerably.

Eosinophilic Esophagitis: Diagnosis

The diagnosis of eosinophilic esophagitis is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes −

• The upper endoscope. Your healthcare professional will introduce an endoscope—a long, thin tube with a light and tiny camera—through your mouth and down your throat. Your esophageal lining will be examined for swelling, redness, horizontal rings, vertical furrows, constriction (strictures), and white spots. Some individuals with eosinophilic esophagitis will have a typical-appearing esophagus.

• Biopsy. You will have a biopsy of your esophagus performed during an endoscopy. A biopsy entails the removal of a tiny piece of tissue.

• A blood test. You can be subjected to certain tests to confirm the diagnosis if eosinophilic esophagitis is suspected. These tests seek for the allergens, also known as the causes of your allergic reaction. Blood tests may be performed on you to check for abnormally high eosinophil counts or total immunoglobulin E levels, which might indicate an allergy.

• Stomach sponge. This examination is carried out at the doctor's office. It entails ingesting a capsule that is strung up on a string. The provider will use the rope to remove the sponge from your mouth when the capsule dissolves in your stomach. The sponge will take a sample of the esophagus tissues when it is removed.

Eosinophilic Esophagitis: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

• Proton pump blocker (PPI). Most likely, your doctor will first recommend an acid blocker like a PPI. The most straightforward treatment, yet most people's symptoms don't get better.

• A topical steroid. Your doctor will probably subsequently recommend a steroid, such as fluticasone or budesonide if you don't react to the PPI. To treat eosinophilic esophagitis, this steroid is taken orally in liquid form. You are less likely to experience the normal adverse effects of steroids since this kind of steroid is not absorbed into the bloodstream.

• Antigens that are monoclonal. Dupilumab was recently authorized by the Food and Drug Administration (FDA) for the treatment of eosinophilic esophagitis in adults and children 12 years of age and older. It functions to stop the body's production of certain proteins that lead to inflammation. Dupilumab is injected once a week.

Dilation

Your doctor could advise dilation if you have a stricture, which is a significant constriction of the esophagus. Dilation, commonly referred to as stretching, might facilitate swallowing.

Eosinophilic Esophagitis: Prevention

EoE cannot be avoided or prevented. It could be a family trait.

Conclusion

EoE can be difficult to diagnose, and an interprofessional team composed of a gastroenterologist, internist, primary care physician, pathologist, and nurse practitioner is ideally suited to handle the illness. The diagnosis must be verified with a biopsy.

By lowering the number of eosinophils in the esophagus and, consequently, the esophageal inflammation, EoE therapy aims to reduce the symptoms. Dietary, pharmaceutical, and endoscopic treatments are used for management.

Individuals who follow dietary and pharmacological recommendations successfully recover, while those who don't alter their food or lifestyle continue to have symptoms.