What Triggers Eosinophilic Esophagitis?

Eosinophils are a type of white blood cell that becomes active due to an immune or allergic response.

Eosinophilic esophagitis causes problems with the esophagus, which is a muscular tube that connects the mouth to the stomach. Eosinophils are a type of white blood cell that becomes active due to an immune or allergic response. In eosinophilic esophagitis, eosinophils are found in the linings of the esophagus, which leads to inflammatory reactions.

Symptoms of eosinophilic esophagitis depend on a person's age.

Symptoms of eosinophilic esophagitis in adults and teenagers include:

• Difficulty swallowing (most common symptom)
• Trouble swallowing solid foods
• Pain with swallowing
• Feeling as if the food gets stuck on the way down
• Chest pain 
• Upper abdominal pain
• Heartburn that doesn't improve after taking heartburn medicines
• Throat clearing
• Choking
• Gagging
• Vomiting or regurgitation
• Hoarseness
• Sinus infections

Symptoms of eosinophilic esophagitis in children include:

• Feeding problems, such as the refusal of food
• Nausea 
• Vomiting
• Regurgitation or spitting up
• Stomach or abdominal pain
• Weight loss
• Anemia
• Failure to thrive
• Heartburn
• Diarrhea

Eosinophilic esophagitis is typically caused by an allergic reaction, usually to certain foods or environmental allergens. 

Risk factors for eosinophilic esophagitis include: 

• Family history which may suggest a genetic predisposition
• Allergies – food or environmental
• Asthma
• Atopic dermatitis
• Chronic respiratory disease
• Living in a cold or dry climate
• Season – more common in spring and fall, possibly due to allergens 
• Male gender

The most common test used to diagnose eosinophilic esophagitis is an upper endoscopy. During the endoscopy a biopsy of the esophagus tissue may need to be performed. This biopsy shows an increase in eosinophils in the tissues of the esophagus leading to the diagnosis of eosinophilic esophagitis.

Other tests used to diagnose eosinophilic esophagitis include:

• Esophageal manometry (checking the pressure in the esophagus)
• Blood tests, such as:
  • Complete blood count (CBC)
  • Eosinophil counts 
  • Total immunoglobulin E levels
  • Allergy testing

Treatment for eosinophilic esophagitis usually involves medication and dietary changes. There is no cure. 

Medications used to treat eosinophilic esophagitis include:

• Proton pump inhibitors (PPIs) for acid reflux
• Antacids
• Steroids to help reduce inflammation, usually in liquid form

Patients may need to consult a nutritionist to make necessary dietary changes and also ensure they get proper nutrition. When symptoms improve, patients usually can add foods back into the diet. Dietary changes used to treat eosinophilic esophagitis include:

• Avoid foods that trigger eosinophilic esophagitis symptoms
• Avoid foods you are allergic to
• Follow a liquid diet
• Elimination diet
  • Eliminating or severely restricting the foods to which you are allergic or which trigger symptoms
• Elemental diet
  • Getting all nutrients from amino acid formulas and eliminating all other possible allergens
  • May require a feeding tube

In some cases, eosinophilic esophagitis can lead to an esophageal stricture, which is a narrowing of the esophagus. If medications do not resolve this problem, patients may need a procedure called dilation to widen the esophagus. Dilation is performed during an endoscopy.

For frequent heartburn, lifestyle changes may help relieve symptoms:

• Avoid foods that trigger heartburn
  • Fatty or fried foods
  • Spicy foods
  • Alcohol
  • Chocolate
  • Garlic and online
  • Caffeine
  • Tomato-based foods
• Avoid eating close to bedtime and do not lay down right after eating
• Lose weight 
• Don’t smoke
• Raise the head of the bed for sleeping 

If eosinophilic esophagitis is not treated, complications may include:

• Esophageal stricture (narrowing of the esophagus), which makes it difficult to swallow
• Tearing of esophageal tissue, which can occur during an endoscopy or when people gag or wretch trying to clear food stuck in the esophagus.

Avoiding known allergens may prevent inflammation. 

Proper treatments can manage symptoms and prevent further damage to the esophagus.