Nikki Sommer, a nurse practitioner with Key West Surgical Group, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
What some people dismiss as heartburn or difficulty swallowing could be a sign of a chronic inflammatory condition known as eosinophilic esophagitis, or EOE. The condition can mimic acid reflux but requires different considerations for diagnosis and treatment.
EOE causes inflammation of the esophagus, the muscular tube that carries food from the mouth to the stomach. Sommer said the condition is related to allergic and immune responses, although it does not necessarily produce the same outward symptoms as a traditional food allergy.
“It can mimic it,” Sommer said of acid reflux. “It can present itself as acid reflux.”
People with EOE may experience heartburn, chest or upper abdominal discomfort and reflux-like symptoms. However, Sommer said patients can also adapt to swallowing difficulties without realizing that something may be wrong.
She said people may begin chewing food longer, cutting it into smaller pieces or routinely drinking water with every bite to help food go down.
“Most likely, that’s not it. There is something else going on,” Sommer said.
EOE is generally diagnosed through an upper endoscopy and biopsies. Treatment depends on the individual and can include dietary changes, medications, biologic therapy and, when necessary, esophageal dilation.
Sommer said current treatment recommendations from the American College of Gastroenterology include several options, beginning with proton pump inhibitors, or PPIs. Medications such as omeprazole, esomeprazole and pantoprazole reduce acid production and may help decrease inflammation.
Another treatment option is a swallowed topical corticosteroid, such as budesonide or fluticasone. Sommer explained that these medications are used to coat the esophagus and reduce inflammation locally.
Dietary treatment can also play an important role. A six-food elimination diet, which removes several common food triggers, may help identify foods contributing to inflammation.
Sommer cautioned, however, that patients should work with medical professionals, including a dietitian when appropriate, rather than assuming that symptoms disappearing means the inflammation is gone.
“Symptoms don’t always correlate perfectly with what’s happening microscopically,” she said.
As a result, repeat endoscopies and biopsies may be necessary to determine whether treatment is actually controlling the disease.
For patients who do not respond adequately to other treatments, biologic therapy may be considered. Sommer discussed Dupixent, a biologic medication that targets specific inflammatory pathways involved in EOE.
Another potential complication of chronic EOE is narrowing of the esophagus, known as a stricture. In those cases, an esophageal dilation may be performed to widen the narrowed area and make swallowing easier.
One of the most serious symptoms to watch for is food becoming lodged in the esophagus.
Sommer said chronic inflammation can cause the esophagus to become so narrow that food becomes stuck. If a person is unable to get the food down, an urgent medical evaluation may be necessary.
A food impaction can require an emergency endoscopy to remove the obstruction.
People should not attempt to force additional food or large amounts of liquid down in an effort to push an obstruction through, according to the discussion.
Sommer emphasized that EOE is a chronic condition. Even after symptoms improve and inflammation is brought under control, ongoing treatment and monitoring may be necessary.
“It is considered a chronic disease,” Sommer said. “The idea is to get it under control, get the inflammation under control, understanding what could be causing the symptoms.”
She compared long-term management of EOE to other chronic conditions that require continued monitoring.
Sommer also noted that people with asthma, eczema, seasonal allergies or food allergies may have an increased likelihood of experiencing the inflammatory processes associated with EOE.
The primary takeaway, she said, is that swallowing should not routinely be difficult.
If someone regularly feels that food is getting stuck, has to cut food into unusually small pieces, needs water to wash down every bite or has developed other persistent swallowing problems, Sommer said those symptoms should not simply be accepted as normal.
The condition can be treated, but determining whether EOE is responsible requires proper medical evaluation.
For more information on how Key West Surgical Group can help, click here: https://www.keywestsurgicalgroup.com/