Eosinophilic Esophagitis(EOE)

Eosinophilic Esophagitis(EOE) is a condition where eosinophils (allergic/inflammatory cells) appear in the esophagus of patients. These cells are normally found in the eyes and nose especially in patients with allergies, in the lungs in patients with asthma, on the skin in patients with atopic dermatitis(eczema) and in the gastrointestinal tract from the stomach down to the lower intestines. These cell can also appear in patient that are healthy without any atopic disease. Eosinophils are not normal when found in the esophagus. The etiology(cause) of EOE is currently unknown.

EOE will occasionally run in families and can present in pediatrics as well as adults. Children will often experience recurrent nausea and vomiting, abdominal pains and feeding problems especially refusing to eat solid foods. Adolescents and adults usually present with a history of dysphagia(trouble swallowing) especially solid foods. They will also report food getting stuck, heartburn as well as abdominal or chest pains.

This condition can be diagnosed by Gastroenterologist(GI specialist) after endoscopy where biopsies of esophageal inflamed tissue reveal eosinophils.

Treatment involves a very strict diet and medications. EOE patients should avoid 4 common foods: eggs/milk/soy and gluten(barley/oats/rye and wheat). There are some reports that show that peanuts/tree nuts and shellfish may also promote eosinophils in certain patients. An initial diet avoiding all these foods can be very challenging, but lead to significant improvement in patient’s symptoms. A repeat endoscopy should reveal decreasing eosinophils if patient’s comply with this diet. Nuts and shellfish may be added back into the diet slowly after several months of improvement if the re-introduction does not result in increasing symptoms and/or increasing eosinophils on repeat biopsies.

Medications include proton pump inhibitors(PIP’s) such as: Prilosec (Omeprazole), Prevacid (Lansoprazole), Nexium( Esomeprazole), Aciphex( Rabeprazole), Dexilant (Dexlansoprazole), Protonix (pantoprazole) and Zegerid(Omeprazole/sodium bicarbonate). PPI’s are usually given to patients with gastroesophageal reflux qd(daily), however in EOE these meds are started bid(2x/day). Inhaled corticosteroids are also used. Flovent 220 and more recently budesonide are also swallowed bid, not inhaled. These meds provide topical anti-inflammatory effects.

Complications include anemia,weight loss and fatigue from poor caloric content as well as gastrointestinal strictures just to name a few. The differential diagnoses includes true food allergies, food protein-induced enterocolitis syndrome(FPIES),celiac disease and many other GI diagnoses. Your primary care, allergist and gastroenterologist should all work together with these patients and their families to provide a better outcome.

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