A chronic inflammatory condition of the esophagus can cause symptoms that resemble acid reflux, but eosinophilic esophagitis, or EoE, is a different condition that can become more serious if left untreated.
Nikki Sommer, a nurse practitioner with Key West Surgical Group, Inc. and Med Spa, joined Good Morning Keys on Keys Talk 96.9/102.5FM this morning for Medical Matters.
EoE is an immune-mediated inflammatory disease in which eosinophils, a type of white blood cell involved in allergic and immune responses, accumulate in the lining of the esophagus.
The esophagus is the muscular tube that carries food from the mouth to the stomach. Chronic inflammation caused by EoE can eventually result in scarring and fibrosis, causing the esophagus to narrow and develop rings or strictures.
“It is actually considered a chronic immune-mediated inflammatory disease,” Sommer said.
Although EoE is associated with allergies, it is not the same as a traditional food allergy.
Certain foods can trigger an immune response in the esophagus that develops over time rather than causing an immediate reaction such as hives, swelling or difficulty breathing. Environmental allergies can also play a role.
People with EoE frequently have other allergic conditions, including asthma, eczema, seasonal allergies, allergic rhinitis or food allergies.
For adults, one of the most important symptoms to watch for is difficulty swallowing, medically known as dysphagia.
Sommer said people may notice that foods such as meat or bread do not go down easily, or that they need to drink water with nearly every bite.
Some patients describe feeling as though food has stopped halfway down the esophagus.
Another serious symptom is food impaction, when food becomes lodged in the esophagus. Sommer said some people do not discover they have EoE until they end up in an emergency department because food has become completely stuck.
EoE can also cause heartburn, chest discomfort, upper abdominal discomfort, reflux-like symptoms and regurgitation, which can make it difficult to distinguish from gastroesophageal reflux disease, or GERD.
In some cases, patients may have both conditions.
Sommer said patients may also unconsciously change their eating habits to compensate for swallowing difficulties. They may cut food into unusually small pieces, chew for a long time, eat more slowly, avoid foods such as steak or bread, drink liquids after nearly every bite or stop eating certain foods altogether.
“They won’t describe it as difficulty swallowing,” Sommer said. “They might say, ‘I don’t want to eat steak anymore. I don’t want to eat this specific food anymore because it doesn’t agree with me.'”
EoE can affect children as well, although symptoms may be harder to recognize.
Parents may notice poor appetite, refusal to eat certain foods, vomiting, abdominal pain, difficulty transitioning to solid foods, taking an unusually long time to finish meals, poor weight gain or weight loss.
Older children and teenagers may be more likely to describe trouble swallowing or the sensation that food is getting stuck.
Because EoE can resemble GERD, determining the correct diagnosis is important.
Sommer said doctors have historically used a trial of proton pump inhibitor medications, including medications such as omeprazole, Prilosec and Nexium, when patients present with reflux-like symptoms.
However, diagnosis of EoE now relies on the overall clinical picture and findings from an upper endoscopy, along with biopsies.
During an upper endoscopy, also known as an EGD, a gastroenterologist uses a small flexible camera to examine the esophagus. Possible findings can include rings, furrows, white spots or exudates, narrowed areas and strictures.
Sommer emphasized that the esophagus can also appear completely normal during an endoscopy in someone who has EoE.
“That’s why biopsies are essential,” she said.
Small tissue samples are taken from different areas of the esophagus and examined under a microscope. Sommer said one diagnostic criterion is finding at least 15 eosinophils per high-power microscopic field in conjunction with symptoms of esophageal dysfunction.
Early diagnosis is important because EoE is a chronic condition that can progress.
“Chronic inflammation can eventually lead to fibrosis and scar tissue,” Sommer said. “So the esophagus will narrow.”
As the esophagus becomes narrower, patients can develop increasingly difficult swallowing and a greater risk of food becoming impacted.
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