Eosinophilic Esophagitis is a recently recognized problem of the esophagus where individuals have problems swallowing solid foods. They can have chest pains, sometimes heartburn and pain in the upper abdomen. Often in the past these individuals were thought to have atypical acid reflux symptoms or benign scarring (narrowing) in the esophagus that did not respond in a typical way to treatment.
With the recent recognition of this disease, there are many patients, previously diagnosed with other disorders, who now have the opportunity for better management because we have a clearer diagnosis.
Eosinophilic Esophagitis is a disorder where there is increased inflammation in the esophagus (the swallowing tube that passes food from the mouth to the stomach). Inflammation in the esophagus causes symptoms such as problems with swallowing and chest pain. The diagnosis is usually made by performing a gastroscopy which is done while the patient is sedated. Small biopsies are taken to confirm the diagnosis. Sometimes when there is scarring or narrowing in the esophagus due to chronic inflammation, the esophagus can be opened up. When this is performed the problem with swallowing often improves.
Treatment for Eosinophilic Esophagitis
Like any newly appreciated disorder, treatment is evolving as our understanding improves.
- Up to 75% of patients will actually improve by decreasing stomach acid, which has been the reason this condition has been confused with acid reflux in the past.
- Other patients respond well to steroids. A commonly used inhaler for asthma, Flovent, where 2 puffs of inhaler are taken and swallowed twice a day, often decreases symptoms significantly. (It is important not to inhale this medication, which was its original intent for treatment of asthma, but to just swallow it). It is also important that no food or water is ingested for 30 minutes after this, to allow the medication to remain in contact with the esophagus.
- Another steroid, Budesonide, 1-2 mg twice a day has also been shown to decrease symptoms.
- There is also evidence that this may be an allergic phenomenon. Individuals who eliminate certain foods from their diet such as milk, soy, eggs, wheat, peanuts/tree nuts and shellfish/fish, will often experience a significant decrease in symptoms; this is called the SFED Diet (Soy, Fish, Eggs and Dairy). Of these foods, dairy and wheat seem to be the most important. Individuals who improve on these “elimination diets” can then slowly re-introduce some of these foods such as eggs, soy and nuts to see which foods play more of a role. They are often able to introduce these foods and still have good control over their symptoms. It is important when using an elimination diet as therapy that this is done under the guidance of a dietitian.
In the majority of affected individuals, Eosinophilic Esophagitis seems to be a chronic problem. Medication that decreases stomach acid or medication with steroids in it is a better option for some individuals, yet others do better on a diet eliminating the foods that are associated with this.
Again, Eosinophilic Esophagitis is something that has only been recently recognized and as our understanding of these conditions improves, the treatment will also evolve and improve.