Two of my friends have eosinophilic esophagitis. They both described to me that if they eat too quickly, take too big of a bite, or do not chew their food well, that the food may become stuck in their esophagus. When they go out for lunch and order something such as a big burger and fries, one will joke with the other, “You know we are both going to choke on this”. However, joking aside, it can be a stressful, painful, and uncomfortable condition. A couple of Thanksgivings ago, one of my friends ended up spending most of the night upstairs trying to pass, either down or up, whatever food got lodged in his throat. This was compounded by the esophagus spasming and constricting and the onset of acid reflux. After an increase in incidents, he went to his doctor for an endoscopy and biopsy and they determined that he had eosinophilic esophagitis. With an endoscopic dilation and a prescription of oral steroids, he has improved greatly. Although, he still needs to be mindful of how he eats and at times he will add in oral steroids back for a week or two. My other friend has learned that when she gets the feeling of food stuck in her throat, the food will pass down if she stands up and moves around. There have been times when instead the whole food bolus comes out, more of a regurgitation than a vomiting. She did not respond to the oral steroids after her endoscopy and biopsy and she was referred to an allergist, since eosinophilic esophagitis is caused by food and/or environmental allergens, as well as acid reflux. Her allergy and blood tests came back negative and she was diagnosed with non-IgG eosinophilic esophagitis. It was recommended that she go on an elimination diet with weekly endoscopies to determine what food was causing it. Not excited about the prospect of weekly endoscopies, she passed on the recommendation and has instead worked on managing how she eats.
What is it Eosinophilic esophagitis?
It is a chronic immune condition of the esophagus. Eosinophils, not normally found in the esophagus, are white blood cells that are part of our immune system and protect us from viruses, bacteria, and parasites. They also cause inflammation in response to allergies and asthma. With eosinophilic esophagitis, high levels of eosinophils are present in the lining of the esophagus in response to food or environmental allergens or acid reflux resulting in inflammation and scarring of the esophagus. This can cause the formation of structures, furrows, or rings, which narrow the esophagus, leading to dysphagia, or difficulty swallowing, and food impaction.
Eosinophilic esophagitis is a relatively new condition. There were cases of this in the past, however its incidence has risen in the past twenty years along with the increase in allergies. It has been found that those with eosinophilic esophagitis are more likely to have allergies or asthma and there tends to be increases of problems in the fall and spring when seasonal allergies are on the rise. Men are more likely to have this condition but it is also seen in women and children. In adults, the symptoms are dysphagia, food impaction, chest pain, heartburn, upper abdominal pain, and regurgitation. Infants, toddlers, and children tend not to have dysphagia, which begins in the teenage years. Infants and toddlers instead can be irritable and have difficulty feeding and gaining weight. Children may suffer from abdominal pain, regurgitation, vomiting, and reflux.
An endoscopy and a biopsy are needed to diagnose the patient. A biopsy is important since some patients have a normal looking esophagus. Blood tests may also be given to look at the eosinophil count and to determine if the patient has allergies. Allergists may use a skin prick test or skin patch test to find what the patient is allergic to and if those assays are negative, they may recommend such as in the case with my friend, an elimination diet.
When food becomes stuck, the patient should avoid further food or drink until the food passes. Most of the time, the food will go down and if not the food should be regurgitated. In an extremely bad case, the patient should go to the hospital where a doctor can help remove the food with a flexible endoscope. If it is determined that the patient has an allergy, it is recommended that the patient avoid or limit their exposure to it. Proton pump inhibitors, which reduces gastric acid production in the stomach and is used to treat acid reflux is a possible treatment as well as oral steroids, which have been shown to reduce inflammation and the number of eosinophils. And as mentioned above with my friend, an endoscopic dilation, which stretches open the esophagus is used if it has become too narrow. Currently, new drugs are being tested and considered as alternative or additional treatments.
There is still much to learn about this condition, including the specific allergens causing it but research has increased since the 1990s. Three practice guidelines have been published between 2008 and 2014 and since 2007, the number of publications has doubled on this topic.
Do you suffer from eosinophilic esophagitis? How do you manage your symptoms?
1. Dellon, E.S. and Liacouras, C.A. (2014) Advances in Clinical Management of Eosinophilic Esophagitis. Gastroeneterology. 147(6): 1238-1254
2. Philpott, H. et. al. (2015) Eosinophilic esophagitis: A clinicopathologic review. Pharmacology & Therapeutics. 146: 12-22
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