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June is Dysphagia Awareness Month.
Eosinophilic esophagitis (EoE) is a disease that causes chronic inflammation of the esophagus. This inflammation leads to symptoms such as difficulty swallowing, chest pain, and food stasis (when food gets stuck in the esophagus). Although there is no cure for EoE, there are effective treatments to control symptoms and monitor the disorder. Without treatment, EoE often worsens.
EoE is becoming increasingly common and can affect people of all ages. We spoke with Evan S. Dellon, MD, MPH, gastroenterologist, professor of medicine and assistant professor of epidemiology at the University of North Carolina at Chapel Hill, to learn more about the symptoms of EoE, how to get help, and what treatment options are available.
Which EoE Symptoms Should Motivate You to See a Doctor?
In adults and adolescents, the most common symptom is difficulty swallowing or stuck food. It is important to note that it is not normal for food to slowly sink or get stuck. Many people who are diagnosed with EoE do not initially pay attention to this symptom. They may simply avoid certain foods or chew more carefully until a major problem arises. Don’t wait for that to happen. You should be examined if you are eating very slowly or have difficulty swallowing. Other gastrointestinal symptoms such as chest discomfort or heartburn are also associated with EoE.
Other medical conditions can cause food to slowly spoil or become stuck. If these symptoms occur along with asthma, eczema, or food allergies, it is more likely to be a sign of EoE.
Children with EoE have completely different symptoms. It can include abdominal pain, vomiting, poor development, failure to switch to foods with different textures, or avoiding certain foods. Many gastrointestinal diseases in children can cause these symptoms. But they could also be signs of EoE, especially if a child also has eczema, asthma or food allergies.
If you have EoE, why is it so important to be diagnosed?
We believe that EoE generally begins as an allergic inflammation. If left untreated, this inflammation can lead to scar tissue over time. The esophagus can then become narrow and rigid, leading to further symptoms and complications such as food debris buildup. A blockage in the esophagus can lead to perforation or rupture of the esophagus, a very serious problem. It doesn’t happen often, but it should be taken into account. Children who suffer from this disorder in severe form may be malnourished.
There are also impacts on quality of life. Anything that affects your diet will impact social events, family gatherings, work events and travel and can cause significant anxiety. Symptoms, effects on quality of life and possible complications are good reasons for an examination.
How are you diagnosed with EoE?
Diagnosis is made using an endoscopy to examine the esophagus. We do not have blood tests or other methods to diagnose EoE.
Endoscopy is a procedure with sedation. A lighted camera is inserted through the mouth into the esophagus and stomach. We try to recognize typical signs of EoE. The esophagus may appear inflamed. It may be covered with white spots, which is a sign of inflammation. There may be scar tissue in a ring shape or narrowing. We send a biopsy to a pathologist who examines the allergy cells, i.e. the eosinophils. If there are enough eosinophils present and we rule out the possibility that they are caused by other causes, we can officially diagnose EoE.
Why is it important to receive ongoing care when you have EoE?
EoE is a chronic disease that requires long-term treatment. If people receive a diagnosis but no treatment, many serious complications could arise over time. It is important to have a medical team and carry out treatment on time.
The severity of this disorder varies. The medical team will tailor treatment to each person’s situation. For example, someone who went to the emergency room with an impaction will need much longer follow-up than a person with mild symptoms. Ongoing care is different for each person, but it is very important to prevent flare-ups and problems from getting worse.
What types of healthcare providers should be part of your medical team if you have EoE?
Some people receive follow-up care primarily from gastrointestinal doctors. Some people turn primarily to allergists. Some people see both types of doctors on a multidisciplinary basis. Children may also need nutritional therapists and other providers of various specialties. We often work with dietitians and nutritionists.
How is EoE controlled?
There are two main categories of therapy: food restriction and medication.
We assume that in most patients EoE is a disorder triggered by certain foods. Unlike a typical food allergy with an immediate reaction, this is a condition in which eating certain foods over a long period of time triggers inflammation. Currently, allergy testing for EoE isn’t really accurate, so it’s a bit difficult. But we know most of the common food triggers: dairy, wheat, eggs, soy, nuts and shellfish. With the help of food restriction, food triggers can be identified and eliminated from the diet. It’s a good option, but it really depends on each patient.
Antacid medications like omeprazole (Prilosec) or lansoprazole (Prevacid) are usually the first medications we try. About 30 to 40% of people may respond well to these simple medications.
There is also a topical corticosteroid. We now have an approved medication, budesonide oral suspension (Eohilia), specifically designed to adhere to the esophagus. It may be effective in 50 to 60% of people or more.
Another option is dupilumab (Dupixent), a systemic medication. It is a weekly injection that blocks some of the allergic factors that cause EoE. It is usually reserved for people who do not respond well to other treatments. It could also be used for people being treated for asthma and eczema and EoE, as dupilumab is approved for all of these conditions.
Why is EoE control a lifelong process?
The vast majority of people can control EoE, but it is a chronic condition. If people don’t get treatment, they will eventually have problems. Not everyone will have complications, but we have no reliable way to know who is at risk of complications and who is not. It is therefore advisable to offer everyone individual treatment and regular check-ups.
New treatment methods are also being developed. Science is advancing rapidly in this area. Now when I see someone in the clinic, I can offer options that weren’t available a few years ago. There are also several awareness groups that educate and support patients.
If you experience these symptoms, don’t ignore them. It is becoming a much more common condition. Get examined.
This educational resource was created with support from Sanofi and Regeneron.
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