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Eosinophilic esophagitis

Eosinophilic esophagitis involves a buildup of white blood cells, called eosinophils, in the lining of your esophagus. The esophagus is the tube that carries food from your mouth to your stomach. The buildup of white blood cells is due to a reaction to foods, allergens, or acid reflux.

Causes

The exact cause of eosinophilic esophagitis is not known. It is believed that an immune reaction to certain foods leads to a buildup of eosinophils. As a result, the lining of the esophagus becomes swollen and inflamed.

Most people with this disorder have a family or personal history of allergies or asthma. Triggers such as mold, pollen, and dust mites may also play a role.

Symptoms

Eosinophilic esophagitis can affect both children and adults.

Symptoms in children include:

  • Problems feeding or eating
  • Abdominal pain
  • Vomiting
  • Problems swallowing
  • Food getting stuck in the esophagus
  • Poor weight gain or weight loss, poor growth, and malnutrition

Symptoms in adults include:

  • Food getting stuck when swallowing (dysphagia)
  • Chest pain
  • Heartburn
  • Upper abdominal pain
  • Backflow of undigested food (regurgitation)
  • Reflux that does not get better with medicine

Exams and Tests

Your health care provider will take a detailed history and perform a physical exam. This is done to check for food allergies and to rule out other conditions, such as gastroesophageal reflux disease (GERD).

Tests that may be done include:

Treatment

There is no cure and no specific treatment for eosinophilic esophagitis. Treatment involves managing your diet and taking medicines.

If you test positive for food allergies, you may be told to avoid those foods. Or you may avoid all foods that are known to trigger this problem. Common foods to avoid include seafood, eggs, nuts, soy, wheat, and dairy. Allergy testing may discover specific foods to avoid.

Proton pump inhibitors can help control symptoms, but they don't help the problem causing symptoms.

Your provider may prescribe topical steroids taken orally or inhaled. You also may take oral steroids for a short time. Topical steroids don't have the same side effects as oral steroids.

If you develop narrowing or strictures, a procedure to open up or dilate the area may be needed.

You and your provider will work together to find a treatment plan that works best for you.

Support Groups

Support groups such as American Partnership for Eosinophilic Disorders can help you understand more about eosinophilic esophagitis. You can also learn ways to manage your condition and cope with the disease.

Outlook (Prognosis)

Eosinophilic esophagitis is long-term (chronic) disease that comes and goes over a person's lifetime.

Possible Complications

Possible complications may include:

  • Narrowing of the esophagus (a stricture)
  • Food getting stuck in the esophagus (common in both children and adults)
  • Severe swelling and irritation of the esophagus

When to Contact a Medical Professional

Contact your provider if you have symptoms of eosinophilic esophagitis.

References

Chen JW, Kao JY. Eosinophilic esophagitis: update on management and controversies. BMJ. 2017;359:j4482. PMID: 29133286 pubmed.ncbi.nlm.nih.gov/29133286/.

Falk GW, Katzka DA. Diseases of the esophagus. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 129.

Groetch M, Venter C, Skypala I, et al; Eosinophilic Gastrointestinal Disorders Committee of the American Academy of Allergy, Asthma and Immunology. Dietary therapy and nutrition management of eosinophilic esophagitis: a work group report of the American Academy of Allergy, Asthma, and Immunology. J Allergy Clin Immunol Pract. 2017;5(2):312-324.e29. PMID: 28283156 pubmed.ncbi.nlm.nih.gov/28283156/.

Khan S. Eosinophilic esophagitis, pill esophagitis, and infective esophagitis. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 350.

  • Esophagus - illustration

    The esophagus connects the nose and mouth with the stomach. The epiglottis folds over the trachea when a swallow occurs, to prevent the swallowed substance from being inhaled into the lungs. When a person is unable to swallow because of illness or coma, a tube may be inserted either through the mouth or nose, past the epiglottis, into the esophagus and into the stomach. Nutrients will be passed through the tube directly into the stomach.

    Esophagus

    illustration

  • Allergy skin prick or scratch test - illustration

    One of the most common methods of allergy testing is the scratch test or skin prick test. The test involves placing a small amount of the suspected allergy-causing substance (allergen) on the skin (usually the forearm, upper arm, or the back), and then scratching or pricking the skin so that the allergen is introduced under the skin surface. The skin is observed closely for signs of a reaction, which usually includes swelling and redness of the site. With this test, several suspected allergens can be tested at the same time, and results are usually obtained within about 20 minutes.

    Allergy skin prick or scratch test

    illustration

  • Intradermal allergy test reactions - illustration

    Intradermal allergy testing is another method of skin testing to help determine whether an individual is allergic to a specific allergen. The test involves injection of a small amount of the suspected allergen under the surface of the skin. After about 20 minutes the area is examined for a reaction at the site. A typical reaction looks like a small hive with swelling and redness. The intradermal test is more sensitive than the skin prick test and can usually provide more consistent results.

    Intradermal allergy test reactions

    illustration

  • Esophagus - illustration

    The esophagus connects the nose and mouth with the stomach. The epiglottis folds over the trachea when a swallow occurs, to prevent the swallowed substance from being inhaled into the lungs. When a person is unable to swallow because of illness or coma, a tube may be inserted either through the mouth or nose, past the epiglottis, into the esophagus and into the stomach. Nutrients will be passed through the tube directly into the stomach.

    Esophagus

    illustration

  • Allergy skin prick or scratch test - illustration

    One of the most common methods of allergy testing is the scratch test or skin prick test. The test involves placing a small amount of the suspected allergy-causing substance (allergen) on the skin (usually the forearm, upper arm, or the back), and then scratching or pricking the skin so that the allergen is introduced under the skin surface. The skin is observed closely for signs of a reaction, which usually includes swelling and redness of the site. With this test, several suspected allergens can be tested at the same time, and results are usually obtained within about 20 minutes.

    Allergy skin prick or scratch test

    illustration

  • Intradermal allergy test reactions - illustration

    Intradermal allergy testing is another method of skin testing to help determine whether an individual is allergic to a specific allergen. The test involves injection of a small amount of the suspected allergen under the surface of the skin. After about 20 minutes the area is examined for a reaction at the site. A typical reaction looks like a small hive with swelling and redness. The intradermal test is more sensitive than the skin prick test and can usually provide more consistent results.

    Intradermal allergy test reactions

    illustration

 

Review Date: 4/11/2020

Reviewed By: Michael M. Phillips, MD, Clinical Professor of Medicine, The George Washington University School of Medicine, Washington, DC. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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