There’s a relatively new form of food allergy with a growing number of diagnoses, called eosinophilic esophagitis (EoE). Doctors only started diagnosing EoE about ten to fifteen years ago, and since then the number of cases has risen to a startling degree. No one can say why this uncomfortable condition is on the rise, but experts are fighting to learn more about what causes it and how to treat it.
What Is Eosinophilic Esophagitis?
EoE is a condition that causes the esophagus, the tube connecting the mouth and stomach through which we swallow food, to become inflamed. White blood cells called eosinophils build up in the esophagus and cause the inflammation. These cells are a part of the immune system, and their build up in the esophagus is most often triggered by a food allergen. The result is swelling and difficulty swallowing. Repeated inflammation in the esophagus leads to scar tissue and the build-up of fibrous material, further constricting the throat.
Although the bouts of EoE are most often triggered by food allergens, experts still don’t fully understand what causes the condition. It seems to be related to both food and pollen allergies, and people with these kinds of allergies are more likely to experience EoE. Other risk factors for having EoE include asthma, a family history of the condition and living in a dry or a cold climate. At one time, EoE was thought to be related to gastroesophageal reflux disease (GERD), as acid reflux can sometimes trigger swelling in the esophagus.
Not Just for Kids
As with food allergies, the increase in the number of cases of EoE is being seen among children, but adults have the condition too. Young children with EoE may be difficult to feed and fail to thrive as a result. Young and older children may experience abdominal pain, vomiting, difficulty swallowing and food impaction in the throat. Adults with EoE also struggle to swallow and may have food impaction. Adults also get chest pain and persistent heartburn with EoE. For adults, EoE may be mistaken for heartburn or GERD, but the symptoms don’t respond to over the counter medications.
EoE Is on the Rise
Initially, doctors put the increase in EoE diagnoses down to better awareness. With more doctors aware of EoE and taking more throat biopsies to test for it, the number of diagnoses definitely went up, and yet the growing number of cases cannot be explained that easily. As with food allergies, there seem to be other factors at play. The increasing prevalence of EoE parallels the rising number of cases of allergies and asthma, in children especially. Exactly why all of these conditions are becoming more common is not understood.
Diagnosis and Treatment for EoE
Because this condition is fairly new, or at least only recently recognized, diagnosis and treatment can be tricky. Not all doctors are on the same page when it comes to making a diagnosis or suggesting a treatment. It’s easy to misdiagnose EoE. It presents similar symptoms to GERD, infection, cancer, benign tumors and esophageal spasms. Not all doctors immediately think of EoE as a possible diagnosis for the symptoms patients have. The only way to really confirm EoE is to use an endoscope to take tissue samples from the esophagus in order to count the number of eosinophils present. Some doctors prefer to eliminate other possibilities, like GERD, before subjecting a patient to a biopsy.
As with food allergies, treating EoE is not simple or straightforward. There are a number of different strategies that can be tried with no real cure. Because EoE is related to pollen and food allergens, avoidance is one important strategy. Many patients will be asked to go through an elimination diet as a first step to find out which foods trigger the attacks of EoE. If the allergen is discovered, the patient can simply avoid it. One of the eight foods that are responsible for 90 percent of food allergies in the U.S. is usually the culprit: milk, peanuts, tree nuts, eggs, fish, shellfish, soy or wheat.
Medications can also help to treat the symptoms of EoE. Adults may be given acid blockers, while both kids and adults can sometimes benefit from an inhaler. Inhalers use steroids to reduce inflammation in the throat. In reducing the inflammation, steroids don’t treat the condition, but they do allow the throat time to heal before it becomes inflamed again.
Because EoE has not been recognized for very long, researchers have a lot of work to do to catch up with the growing number of cases being diagnosed. Patients suffering with EoE need less invasive diagnostic techniques and better treatments. Doctors and medical researchers are hard at work coming up with answers to the many questions about EoE.