Eosinophilic Esophagitis

November 2020

What is Eosinophilic Esophagitis?


Eosinophilic Esophagitis (EoE) is a chronic disease of the esophagus caused by a buildup of eosinophils, a type of white blood cell that is not normally found in the esophagus, that leads to damage and inflammation. This damage and inflammation can lead to pain, trouble swallowing, and food getting struck in your throat.


While EoE is rare, it is a newly recognized disease with more and more people being diagnosed. Some people who have reflux (GERD) may actually have eosinophilic esophagitis.


What causes Eosinophilic Esophagitis?


Researchers are not certain as to what the exact cause of EoE is. However, they think it is immune system or allergic reaction to foods or environmental substances, such as dust, animal dander, pollen, and molds. Genetics may also play a role in EoE.

What are the risk factors for Eosinophilic Esophagitis?


While EoE can affect anyone, factors that could increase your risk include:

• Gender – Males are affected 3 times more than females

• Allergies and asthma – people with food or environmental allergies like hay fever, eczema, or asthma

• Family history – If you have family members with EoE, you are more likely to develop the disease.

• Season – More people are diagnosed in the spring, summer, and fall when pollen levels are at their highest.

What are the signs and symptoms of Eosinophilic Esophagitis?


Symptoms are typically age-dependent.

Age Group
Signs/Symptoms

Infants and Toddlers

• Feeding problems

• Vomiting

• Poor weight gain and growth

• Reflux that doesn’t get better with medication

Older Children

• Vomiting

• Abdominal pain

• Trouble swallowing, especially with solid foods

• Reflux that doesn’t get better with medication

• Poor appetite

Adults

• Trouble swallowing, especially with solid foods

• Food getting stuck in the esophagus

• Reflux that doesn’t get better with medication

• Heartburn

• Chest pain

When should I see a doctor?


Chest pain, especially when it occurs with shortness of breath or jaw or

arm pain, can be a symptom of a heart attack. Seek immediate medical

attention if you are experiencing these symptoms. See your doctor if you:

• Experience frequent or severe symptoms of EoE

• Take over-the-counter medications for heartburn more than twice per week

How is Eosinophilic Esophagitis diagnosed?


To diagnose EoE, your doctor will:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.

• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.

• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.

• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

Image Credit: https://jamanetwork.com/journals/jama/fullarticle/2730115

What are the treatments for Eosinophilic Esophagitis?

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet. Medicines

used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (tablets) to treat people who have serious swallowing problems or weight loss.

• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:

- With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.

- For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.

• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them. Which treatment your health care provider suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.


If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

How can compounded Budesonide help with Eosinophilic Esophagitis?

Budesonide, a prescription corticosteroid, is one of the first line treatments for EoE. By compounding budesonide into a viscous suspension, it allows for more contact time between the drug and your esophagus. According to a study in the peer-reviewed journal, Clinical Gastroenterology and Hepatology, a budesonide suspension provides better relief than inhaled or nebulized budesonide. It provides better relief due to the longer contact time. Budesonide suspensions also provided a better reduction in eosinophils in the esophagus.

Can Eosinophilic Esophagitis lead to other conditions?


In some people, EoE can lead to complications like:

• Narrowed areas of the esophagus, often caused by scarring, can make it difficult to swallow.

• If the esophagus is too narrow, food can become stuck and cause pain and other symptoms.

• Forceful vomiting or prolonged food impaction can cause a tear or hole in the esophagus, which requires immediate medical attention.

Are there any over-the-counter products that can help with Eosinophilic Esophagitis?


• Curcumin – Curcumin, which comes from Turmeric, has long been used for many diseases since ancient times. It exhibits anti-inflammatory, antioxidant, and antitumor properties. Researchers have found that curcumin can have a positive effect on multiple gastrointestinal disorders include esophagitis.

• Proton Pump Inhibitors (PPIs) – Many PPIs are available over-the-counter now, such as Prilosec and Nexium. These medications can help rule out GERD and sometimes reduce inflammation and reflux symptoms.

• Vitamin D – Research has found lower vitamin D levels in patients with EoE.

Vitamin D levels are also associated with immune regulation. By increasing vitamin D levels, it may help to regulate immune responses.

Sources:

https://medlineplus.gov/eosinophilicesophagitis.html

https://gi.org/topics/eosinophilic-esophagitis/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6471759/

https://college.acaai.org/publications/college-insider/look-vitamin-d-levels-eosinophilic-esophagitis-patient

https://www.mayoclinic.org/diseases-conditions/esophagitis/diagnosis-treatment/drc-20361264

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4076881/