Eosinophilic oesophagitis
What is Eosinophilic oesophagitis
Eosinophlic oesophagitis (EoE) a chronic allergic disorder characterised by inflammation or swelling of the oesophagus, the tube that connects the mouth to the stomach. Inflammation leads to symptoms such as heartburn, abdominal pain, and a feeling of food getting stuck. EoE develops when a certain type of white blood cell called the eosinophil triggers an allergic response in the oesophagus, usually due to a particular food allergen.
Untreated, inflammation can ultimately leads to narrowing and scarring of the oesophagus, and lead to strictures.
Causes
The cause of EoE is usually an autoimmune response to allergens in the diet of people with a genetic susceptibility. Environmental factors may play a role, all be it unclear.
An estimated 1 in 100 adults and 1 in 10,000 children are estimated to have this condition.
It can be associated with other allergic conditions such as asthma or allergic rhinitis.
Diagnosis
Diagnosis requires an upper endoscopy with biopsies that show eosinophils in the lining of the oesophagus. The appearance of the oesophagus can be normal, so biopsies are essential.
Treatment
Dietary, medication and endoscopic treatments are available for treatment of EoE –
- Dietary modification can be effective if the main allergens that are triggering swelling in the oesophagus can be identified. A six food elimination diet involves avoiding the six food types that are most commonly associated with EoE (milk, wheat, eggs, soy, nuts and seafood) and reintroducing them one by one to assess response. A targeted elimination diet based on allergy testing (skin prick or patch testing) is less effective. Close support from a dietitian can be very useful.
- Medications such as proton pump inhibitors (PPIs), and swallowed steroids (Fluticasone, Budesonide) can be used and are generally very well tolerated.
- Endoscopy with dilatation of narrowed, scarred areas within the oesophagus can widen the oesophagus and relieve food impaction symptoms. Risks include a small but significant chance of perforation (tearing a hole in the oesophagus) during the procedure.
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