Introduction
Eosinophilic oesophagitis, sometimes abbreviated to 'EoE', is a condition where the oesophagus (or ‘food pipe’) becomes chronically inflamed. This in turn can cause other conditions, including dysphagia and reflux. It was first detected in the 1960s as being distinct from GORD (which has similar symptoms), but unlike GORD sufferers, sufferers of EoE showed normal pH levels and did not respond to medication to reduce stomach acid levels.
Causes
The condition is related to a type of white blood cell known as an eosinophil being present in large numbers in the lining of the oesophagus. Eosinophils are associated with allergic reactions such as hay fever (allergic rhinitis) and asthma. Eosinophilic oesophagitis can cause permanent scarring of the oesophagus, which is why it is important that it is correctly diagnosed and treated.
Symptoms
The following symptoms may indicate the possibility of EoE…
- Choking on food, or food regurgitation.
- Severe acid reflux that does not respond to normal treatment to reduce stomach acid.
- Food becoming ‘stuck’ in the oesophagus.
- Chest pain.
- Presence of hay fever and/or asthma.
- Presence of allergic reaction (confirmed via positive skin prick tests) to certain food groups (especially dairy, wheat, meat, soy, egg).
Children and young adults are more prone to the condition that other age groups - children may have difficulty eating or may vomit frequently. Teenagers and younger adults may have difficulty swallowing, or have reflux and/or chest pain.
Although many people do suffer from milder forms of reflux/heartburn and from occasional vomiting, the majority will not have the condition.
Tests / Diagnosis
If symptoms indicate that eosinophilic oesophagitis is a possible diagnosis, a gastroscopy is normally recommended to allow examination of the oesophagus and taking of tissue samples. Blood tests are also sometimes done to determine if levels of eosinophils in the blood are higher than normal.
Where the condition has caused a narrowing of the oesophagus, an endoscopic surgical procedure known as 'dilation' may be needed to slightly widen the oesophagus to allow food to pass through more easily. If the condition is traced to a reaction to foods, then an elimination diet may be recommended.
Alternatively, similar medications to those used for hay fever and asthma may be effective, such as topical asthma steroid 'puffers' which are swallowed rather than inhaled or tablets.