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Whilst not a complication of GORD, Eosinophilic Oesophagitis (EoE), also known as the "asthma of the esophagus", may be frequently misdiagnosed as such.

It is a relatively recently recognised condition leading to inflammation of the oesophagus, not diagnosed before the 1970's.

The symptoms are similar to GORD: Heartburn, chest and upper abdominal pains and swallowing difficulties.

Eosinophils are white blood cells which are not normally found in the oesophagus. They are part of the immune system. Whereas not much is known about the condition, it is probably a result of food allergies. EoE sufferers are frequently found to have other allergy conditions, like eczema, asthma or hay fever.

It is usually diagnosed by a failure of normal treatments for GORD and test for food allergies may be undertaken.

The following foods have been found to cause EoE and may need to be avoided; dairy products, eggs, wheat, seafood, nuts.

There is no medication to cure the condition yet. Currently it may be managed with corticosteroids with their inherent side effects.

A paper released in August 2015 by researchers at the D'Or institute in Rio De Janeiro, found a molecule known as macrophage migration inhibitory factor (MIF) was more prevalent in biopsies of patients with EoE and "the early administration of a drug that blocks the effect of MIF prevented the eosinophils accumulation in the esophagus and the development of esophagitis in treated mice" [o-v]

Thia proposed integrated care pathway for EoE was produced in UK in October 2024, Improving management of eosinophilic oesophagitis in adults in the UK.

Possible treatments

EoS Network (Eosinophilic Diseases Charity) reports on a 2022 study, "Fluticasone Propionate Orally Disintegrating Tablet (APT-1011) for Eosinophilic Esophagitis: Randomized Controlled Trial concluding "APT-1011 dosing regimens were superior for histologic and endoscopic responses, and for reduction in dysphagia frequency vs placebo. Based on the symptom improvement and assessment of adverse events together with the histologic response rate, 3 mg once daily at bedtime dose showed the most favorable risk-benefit profile."

In the discussion within the December 2022 paper, Assessment of the clinical and allergy profiles of PPI responsive and non-responsive eosinophilic esophagitis, it states, "there are no known predictors of PPI response in EoE. Therefore, in spite of the new guidelines, PPI still tends to be used as first-line therapy, given its low cost and wide availability. This may lead to delay in achieving disease remission for patients that are not responders, thus increasing the risk of EoE-related complications such as food impaction."

A 2024 discussion on Eosinophilic esophagitis in Medical News Today, explains how the drug Dupixent has improved treatment:
“In the case of EoE, when the body is exposed to certain allergens, an immune cascade occurs that results in trafficking and accumulation of specific immune cells called eosinophils in the esophagus. These cells contain molecules such as histamine that are released when the cells are activated and release of these molecules can cause additional inflammation, swelling, and edema and eventually an increase in connective tissue in the wall of the esophagus,”

The following was generated using AI.

It will be checked and edited as this page is completed.

Eosinophilic esophagitis (EOE) is a chronic and inflammatory condition of the esophagus that has garnered increasing attention in recent years due to its rising prevalence. While it shares some symptoms with acid reflux, EOE is a distinct disorder with its own set of diagnostic criteria, causes, and treatment strategies.

Understanding Eosinophilic Oesophagitis:

• Defining EOE: Eosinophilic esophagitis is characterized by an overabundance of white blood cells called eosinophils in the esophageal lining. These eosinophils can lead to inflammation, irritation, and damage to the esophagus over time.

• Symptoms: Common symptoms of EOE include difficulty swallowing, chest pain, heartburn, regurgitation, food impaction, and even food aversion. It's important to note that these symptoms can mimic those of gastroesophageal reflux disease (GERD), leading to initial misdiagnoses.

• Diagnosis: EOE is typically diagnosed through endoscopy and biopsy. During an endoscopy, a gastroenterologist examines the esophagus and takes tissue samples for analysis. Eosinophilic infiltration of the esophagus (usually more than 15 eosinophils per high-power field) is a key diagnostic criterion.

• Causes: The exact cause of EOE is still under investigation, but it is believed to be related to allergies and genetic factors. Certain allergens, such as pollen, foods, and aeroallergens, can trigger the condition in susceptible individuals.

• Treatment: Management of EOE often involves a combination of dietary modifications, medications, and lifestyle changes. The most common dietary approach is the elimination diet, where specific trigger foods are removed from the patient's diet. Steroid medications can help reduce inflammation, and proton pump inhibitors may also be used. In some cases, endoscopic dilation may be necessary to relieve esophageal strictures.

• Long-Term Outlook: EOE is a chronic condition that requires ongoing management. Patients often need regular follow-up appointments to monitor their condition and make necessary adjustments to their treatment plan.

Living with EOE:

Living with EOE can be challenging, but it is possible to maintain a good quality of life with proper management. Here are some tips for those diagnosed with EOE:

• Dietary Modifications: If you have EOE, working closely with a registered dietitian to identify trigger foods and create a personalized elimination diet can be immensely helpful in managing your symptoms.

• Medication Compliance: Adhering to your prescribed medications, whether they are steroids, proton pump inhibitors, or other drugs, is crucial for keeping inflammation under control.

• Lifestyle Adjustments: Avoiding allergens and irritants, such as tobacco and alcohol, and adopting a healthy lifestyle, including stress management and regular exercise, can help improve your overall well-being.

• Regular Follow-Up: Keep up with your healthcare appointments and communicate openly with your healthcare team. They can provide guidance and ensure that your treatment plan remains effective.

Conclusion:

Eosinophilic esophagitis is a complex and relatively new condition, but with the right diagnosis and management, individuals living with EOE can lead fulfilling lives. Understanding the causes, symptoms, and treatment options is essential for both patients and their healthcare providers.

Page updated 23 October 2023