Eosinophilic Esophagitis

Eosinophilic esophagitis

Eosinophilic esophagitis is an inflammatory condition in which the wall of the esophagus (swallowing tube) becomes filled with a large number of a particular type of white blood cell called eosinophils. These cells, which are manufactured in the bone marrow, seem to be particularly active in the type of inflammation caused by allergic reactions. We now believe that EE is a type of esophagitis caused by allergy, similar to asthma or hay fever. Although we do not know what the allergen(s) are, EE seems to be more common among patients with other allergic conditions. The hallmark of all  of these conditions is the presence of an excess of eosinophils in the tissue just beneath the lining of whatever organ is involved.

The main symptom among adults with EE is dysphagia ( trouble swallowing solid food), with a sensation (and sometimes a reality)of food sticking in the esophagus after it is swallowed. Less common symptoms are heartburn and chest pain, which can be confused with acid reflux (see GERD). Dysphagia is a symptom we take very seriously, and it almost always leads to an endoscopic exam. Biopsies (samples) obtained during the exam can establish the diagnosis of EE if an excess number of eosinophils is found.

The treatment of EE nowadays consists of attacking the inflammatory allergic response in the esophagus with medications called steroids. When inhaled, these steroids are used to reduce the inflammation of the airways in asthma, but when the same medication is swallowed( rather than inhaled) it topically (on the surface) treats the inflammation in the esophagus. Acid suppressive medications like NEXIUM are also used in EE to treat any associated acid reflux.