What Is Eosinophilic Esophagitis?
What Is Eosinophilic Esophagitis?
Eosinophilic esophagitis symptoms
Eosinophilic esophagitis treatment
What Is Eosinophilic Esophagitis?
Eosinophilic esophagitis is known as a chronic immune or allergic medical condition. It is essentially a condition of inflammation that affects the esophagus. The esophagus is a tube that sends food from the mouth to the stomach region. This medical condition is known to affect both children and adults. Also, men are more likely to develop this condition than women. One of the major symptoms seen in adults suffering from eosinophilic esophagitis is problems while swallowing food, especially solid items. This symptom is also termed dysphagia. In this particular medical condition, there are a large number of white blood cells, which are also known as eosinophils. They are found in the esophagus tissues. In normal circumstances, there is no presence of eosinophils in the esophagus.
There has been an increase in the number of reported cases of eosinophilic esophagitis, which is seen by allergists and gastroenterologists. This medical condition is known to be a chronic condition.
The symptoms of eosinophilic esophagitis vary depending on the age of the person. In the case of infants and toddlers, one may notice them straight away refusing to take in any food or not growing properly. In the case of children who are attending school, they would complain of recurring pain in the abdomen, vomiting, and difficulty swallowing any food items. When it comes to teenagers as well as adults, they would also have difficulty swallowing mostly dry or dense, solid food items. The esophagus in eosinophilic esophagitis tends to become narrow to such an extent that the food gets stuck in there; this is known as food impaction, and in such cases, this is considered a medical emergency.
The less common symptoms seen in eosinophilic esophagitis are pain in the chest and instances of heartburn. When it comes to children, a few of the most common symptoms are pain in the abdomen, coughing continuously, vomiting, failing to thrive, and nausea.
Medications have been known to reduce the amount of eosinophils present in the esophagus and, at the same time, also improve the symptoms experienced by the individual. Corticosteroids are very helpful can be used for treating eosinophilic esophagitis. Taking in small doses of corticosteroids have been found to be a common form of treatment. However, during the initial phase, there may be a recommendation to take in higher doses so as to get the inflammation under control, but at the same time, one should not forget that higher doses are also linked with an increased risk of developing certain side effects. Hence, once the eosinophilic esophagitis is controlled to such a level, the dose of corticosteroids can then be reduced so as to maintain this balance.
The medicines or drugs which have been primarily used to treat eosinophilic esophagitis are proton pump inhibitors such as Prilosec, Protonix, Zegarid, Aciphex, and Nexium, and the fluticasone propionate such as flovent. The proton pump inhibitors are known to be helpful in reducing the amount of acid that is being produced and, at the same time, they have also been used to diagnose as well as treat this medical condition. It has been seen that some patients have shown a positive response to the use of proton pump inhibitors, and also, there has been a significant reduction in the presence of eosinophils as well as inflammation when the doctor has performed a biopsy or endoscopy. But, at the same time, one should note that proton pump inhibitors have a tendency to improve the symptoms of eosinophilic esophagitis without actually making the inflammation any better. There has to be careful monitoring from the side of the doctor to keep a tab on the improvement of the eosinophilic esophagitis. Also, researchers are continuously studying newer forms of treatment to get this medical condition treated.
If an individual has been diagnosed with any specific food allergies after undergoing a prick skin test, the doctor may ask one to refrain from consuming those food items. In certain individuals, this has been found to help a great deal. The elimination of major food allergens from the daily diet of the individual before carrying out any food allergy testing is also one of the accepted forms of getting eosinophilic esophagitis treated. The food items that are mostly excluded are dairy items, soy, eggs, fish, peanuts, and wheat. This diet has shown to be very effective in getting eosinophilic esophagitis under control. But at times, it may become difficult to follow them diligently, especially without the involvement of a dietician.
One of the other forms of treatment of eosinophilic esophagitis is by carrying out gentle esophageal dilation. The goal with this is to provide relief from the symptoms of dysphagia. For decades, it has been seen that gastroenterologists have treated various patients suffering from dysphagia caused due to eosinophilic esophagitis in a similar manner as those patients with dysphagia caused due to esophageal strictures. The process of esophageal dilation would involve a physical form of stretching the strictures or fracturing of the strictures, thereby allowing the passage to become free to take in solid food items. The doctor can perform the process of stretching or fracturing of the strictures or the rings by using an endoscope. Long as well as flexible dilators of varied diameters are inserted through the mouth, or it can also be done with balloons which are inserted inside the esophagus through a channel present in the endoscope. These balloons are positioned at such a level of the ring or the stricture, and then they are inflated back so as to break the ring or the stricture. This particular process of esophageal dilation is known to be an effective as well as safe treatment method. Also, doctors have observed that certain patients with eosinophilic esophagitis have developed tears in the lining of the esophagus, which can lead to severe pain in the chest after the dilation. There have been quite rare cases of esophageal perforations reported. This esophageal perforation, which is known to be a tear through the entire wall of the esophagus, is said to cause severe complications that can also lead to infections forming in the chest. Hence, even though the doctors may still go in for using the dilation to treat the dysphagia caused by eosinophilic esophagitis, they are now more likely to go in for smaller dilators and also apply less force than they would have while treating the esophageal ring or strictures. Doctors also prefer to commonly use medications to treat this condition and only use the dilation route when the medications method does not show much of a positive effect.
Changes in Diet
One of the leading theories when talking about the cause of eosinophilic esophagitis is that it mostly represents the allergy side to certain proteins found in food items. There has been enough evidence collected in children to indicate that various diets which can eliminate the allergy-inducing food are known to be the result of the reversal of the esophagitis as well as a reduction in the number of eosinophils. There has been similar evidence collected in adults as well. Doctors are also going in for elimination diets, and there are multiple ways in which the elimination diet can be attempted:
- Firstly, carry out skin and blood tests to check for the specific food items that can cause the allergy and then eliminate it from the diet.
- Secondly, eliminate all the major groups of food items such as soy, milk, peanuts, wheat, and seafood.
- Lastly, individuals can also be placed on a liquid diet.