Dysphagia or swallowing difficulties can make it challenging to ingest food or beverages. Dysphagia can occur due to health conditions, including stroke, multiple sclerosis, mouth or throat cancer, and gastroesophageal reflux disease (GERD). Inflammatory conditions like eosinophilic esophagitis can also cause it.
Eosinophilic esophagitis (EoE) is a chronic immune disorder that causes inflammation in the esophagus — the tube that carries food from the mouth to the stomach. It can occur when white blood cells or immune cells called eosinophils react to food, allergens, or acid reflux (backflow of stomach acid) in the esophagus. Eosinophils multiply and accumulate in the esophageal lining in response to foreign particles. This causes the esophagus to become inflamed and constricted, leading to swallowing difficulties.
Eosinophilic esophagitis prevalence has increased over the past 20 years. Approximately five to 10 new cases of eosinophilic esophagitis per 100,000 people emerge every year. In Canada, EoE impacts about 15,000 people. It is more common in adults than children and affects men more than women.
What Are the Signs and Symptoms of Eosinophilic Esophagitis?
The primary symptom of eosinophilic esophagitis is inflammation in the esophagus. Other signs and symptoms in adults include the following:
- Swallowing difficulties
- Impaction or food getting stuck in the esophagus on swallowing
- Pain in the centre of the chest that does not resolve after taking antacids
- Regurgitation of backflow of undigested food
Children with eosinophilic esophagitis have similar symptoms. They also have difficulty feeding or eating, abdominal pain, and vomiting. EoE in children can lead to poor growth, malnutrition, weight loss, and failure to thrive.
How Is Eosinophilic Esophagitis Diagnosed?
If a patient shows symptoms of eosinophilic esophagitis, the following tests are recommended to diagnose the condition:
- Upper gastrointestinal endoscopy. This gastroenterology test examines the esophagus from the inside. It uses an endoscope — a long, narrow tube with a light and tiny camera — inserted into the esophagus through the mouth to inspect the esophageal lining for swelling or narrowing.
- Biopsy. During endoscopy, you can biopsy the esophagus by removing a small tissue sample, and examine it under a microscope to detect eosinophils.
- Esophageal sponge or cytosponge. The test involves swallowing a capsule with a string attached. Once your patient swallows the capsule, it dissolves in the stomach and releases a sponge called a cytosponge. Pull the sponge out of their mouth using the string to collect the esophageal tissue sample. This test acts as a substitute for endoscopy.
- Blood tests. You can recommend additional blood tests for your patients to confirm the diagnosis. These can include testing for allergens or allergy-causing substances in the body, eosinophil counts, or antibody levels.
What Does Eosinophilic Esophagitis Treatment Involve?
Eosinophilic esophagitis is a chronic illness that can relapse if patients are not careful. It requires ongoing treatment to manage the symptoms. Eosinophilic esophagitis treatment involves the following:
If your patient is diagnosed with eosinophilic esophagitis due to a food allergy, advise them to stop eating the particular food. Avoiding common allergenic foods such as gluten and dairy may reduce inflammation and other eosinophilic esophagitis symptoms.
You can prescribe the following medications to ease the symptoms:
- Proton pump inhibitors such as omeprazole or pantoprazole reduce stomach acid production.
- Topical steroids such as fluticasone or budesonide reduce inflammation.
- Monoclonal antibodies such as dupilumab reduce inflammation and allergic responses.
You can use dilation if a patient’s esophagus is severely constricted or narrowed. Dilating or stretching the esophagus makes swallowing easier and helps avoid continuous medication.
If your patient frequently experiences acid reflux or heartburn, you can suggest lifestyle changes to help reduce its frequency. Ask them to avoid foods or drinks that trigger heartburn and to maintain a healthy weight. Also, keeping their head elevated while sleeping can prevent acid reflux.
What Are the Current Findings on Eosinophilic Esophagitis?
Researchers are currently studying potential therapies to treat eosinophilic esophagitis.
Some studies show that monoclonal antibodies like RPC4046 and reslizumab help manage eosinophilic esophagitis symptoms. Researchers have found a new monoclonal antibody called AK002 that targets specific receptor molecules on eosinophils and improves symptoms of dysphagia. Another new antibody called CALY-002 can reduce the levels of pro-inflammatory molecules like interleukin 15, which may relieve eosinophilic esophagitis symptoms.
Theimmune-modulating, anti-inflammatory drug Fingolimod, commonly used to treat multiple sclerosis, is also under study for its potential use in eosinophilic esophagitis treatment. Additionally, experts are studying the accuracy and efficiency of diagnostic techniques such as the cytosponge to detect eosinophilic esophagitis without endoscopy.
With further research underway, novel diagnostic tools and targeted therapies can help detect the condition early and resolve symptoms without requiring continuous treatment.
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