Eosinophilic Esophagitis FAQs

Q: What is eosinophilic esophagitis (EoE)?
A: Eosinophilic esophagitis (EoE) is caused by the infiltration of the lining of the esophagus with cells called eosinophils. Eosinophils are part of the white blood cells that circulate through the body. They are normally involved in certain immunological responses. In patients with EoE, there is an abnormal eosinophilic inflammation of the esophagus.

Q: What the symptoms of EoE?
A: In adults, the most common symptom is a sensation of food getting stuck in the throat. Often, patients have been suffering with these symptoms for months or years and have learned to compensate by chewing their food very carefully and drinking a lot of water with meals.
In young children, the symptoms are more diverse. They can include trouble swallowing, abdominal pain, fussiness, vomiting, bloating, chest tightness, food avoidance, and weight loss.

Q: How is EoE diagnosed?
A: After a patient demonstrates symptoms suggestive of EoE, a gastroenterologist performs an EGD with a biopsy of the esophagus. The diagnosis is made if the symptoms are consistent with EoE, the biopsy shows greater than 15 eosinophils/high power field, and reflux medications fail to reduce the amount of eosinophilic inflammation.

Q: What are some of the complications if EoE goes untreated?
A: In addition to the symptoms that lead to the diagnosis of EoE, untreated EoE can result in the formation of a circumferential stricture, which is a narrowing of the esophagus that eventually requires dilation.

Q: What causes EoE?
A: It is thought that certain foods are responsible for the development of EoE. This includes milk, wheat, egg, soy, peanut/nuts, and shellfish/fish. There is extensive literature evidence that empiric elimination of these foods from the diet improves symptoms and reduces the amount of eosinophilic inflammation.
There is some evidence to suggest that environmental allergens also contribute to EoE.

Q: How is eosinophilic esophagitis treated?
A: The treatment of EoE includes steroids and food elimination diets.
Oral steroids were the mainstay of treatment up until a few years ago. As one might imagine, there are potential side effects when using oral steroids because they enter the blood stream in relatively high concentrations and can affect other organ systems.
More recent studies have shown that inhaled steroids used for the treatment of asthma can be used for treatment of EoE. Instead of inhaling the steroids, the patient swallows them. The two most studied inhaled steroids are Flovent (fluticasone) and Pulmicort (budesonide). Flovent is sprayed into the back of the throat and swallowed. Pulmicort is often mixed in Splenda, not to sweeten it, but to make it viscous enough to effectively coat the esophagus. Patients should avoid eating or drinking for at least 1 or 2 hours after each dose. That prevents washing the steroid down before it has a chance to work. The treatment course is usually 8 weeks.
Another treatment option was often called a ‘6 food elimination diet’. The patient eliminates milk, egg, wheat, soy, shellfish/fish, and peanut/nuts from the diet for at least 3 months with a guidance of our dietitian.

Q: What happens after the treatment course?
A: At the end of the treatment course, patients will need a repeat EGD with biopsy to correlate improvement in symptoms with a decrease in the amount of eosinophilic inflammation.