Eosinophilic Esophagitis
Information about the causes, symptoms, and most effective treatments for inflammation of the esophagus caused by an accumulation of white blood cells.
Symptoms and Causes
Eosinophilic esophagitis is a chronic condition in which the esophagus becomes inflamed due to the accumulation of eosinophils, a type of white blood cell. It is a disorder of the immune system, which reacts disproportionately to certain foods or allergens.
Currently, numerous studies are underway to better understand this disease, as it has only been recognized since the 1990s. Therefore, some diagnostic methods and treatments are still being developed.
Although it is a chronic disease, the prognosis is good if it is detected early and treated appropriately. Management should focus on the specific cause of eosinophilic esophagitis, while also preventing potential complications.
Symptoms
The symptoms of eosinophilic esophagitis vary depending on the patient’s age:
- Adults:
- Dysphagia: difficulty swallowing solid foods.
- Food impaction: the sensation that food is getting stuck.
- Regurgitation.
- Reflux.
- Pain in the center of the chest.
- Infants:
- Crying during feedings.
- Feeding refusal.
- Weight loss or very slow weight gain.
- Children:
- Dysphagia.
- Abdominal pain.
- Vomiting.
- Refusal of a wide variety of foods.
- Growth delay.
- In some cases, malnutrition.
Causes
Eosinophilic esophagitis occurs when the immune system overreacts to certain foods in a way similar to an allergic reaction. When these substances are detected, white blood cells move to the esophagus to defend the body, causing eosinophils to accumulate. This buildup leads to inflammation of the tissue lining the inside of the esophagus and interferes with normal muscle movement.
Risk Factors
The risk of developing eosinophilic esophagitis increases in the following cases:
- Age: although it can occur in anyone, it is more common in children.
- Sex: it is more frequent in males.
- Genetic predisposition: people with relatives who have the disease are more likely to develop it.
- Food allergies: the most common are allergies to wheat, eggs, milk, nuts, or shellfish.
- Environmental allergies.
- Asthma.
- Gastroesophageal reflux.
- Excessive use of antibiotics or antacids.
Complications
The most common complications of eosinophilic esophagitis include:
- Esophageal narrowing: inflammation can cause scarring in the lining of the esophagus, making swallowing difficult and causing food to become stuck.
- Tissue tears.
- Ulcers.
- Esophageal perforation (rare).
Contrary to what many patients believe, eosinophilic esophagitis is not directly related to any type of cancer. There is also no evidence that it is caused by stress.
Prevention
It is difficult to prevent eosinophilic esophagitis, but maintaining a balanced diet and avoiding foods that may trigger allergies can reduce the risk of developing it.
Which specialist treats eosinophilic esophagitis?
Eosinophilic esophagitis is diagnosed and treated by specialists in the digestive system, usually in coordination with allergology specialists.
Diagnosis
After evaluating the patient’s symptoms and medical history, several tests are performed to diagnose eosinophilic esophagitis. The most important include:
- Blood test: checks for the presence of allergens and immunoglobulins, and measures eosinophil count.
- Endoscopy: a flexible tube is inserted through the mouth into the esophagus to observe the inner tissue. Concentric rings, longitudinal furrows, stiffness, narrowing, or white exudates are signs of the disease.
- Biopsy: to confirm the diagnosis, a tissue sample is taken during the same endoscopy and analyzed in the laboratory to determine the number of eosinophils present.
Treatment
Treatment for eosinophilic esophagitis is personalized for each patient and usually combines several approaches. The most common include:
- Dietary changes: avoiding foods that cause allergies helps reduce symptoms and improve quality of life.
- Medications: prescribed to reduce inflammation and acid levels in the esophagus, relieve symptoms, and promote tissue healing.
- Proton pump inhibitors: treat gastroesophageal reflux and have anti-inflammatory properties.
- Corticosteroids: taken in liquid form so that as they pass through the esophagus, they coat the tissue and enter the bloodstream. They are effective anti-inflammatory agents that, due to their method of administration, do not cause systemic side effects.
- Monoclonal antibodies: used in patients who do not respond adequately to other treatments. They work by blocking the proteins responsible for triggering allergic reactions.
- Esophageal dilation: used in patients with esophageal narrowing to widen the passageway. It is performed through an X-ray-guided endoscopy using one of two techniques:
- Inflatable balloon: inserted deflated through the mouth and then inflated in the esophagus, where it is held in place for a while to stretch the tissue.
- Plastic dilators: progressively wider tubes are passed through the esophagus until the desired size is reached.
