Eosinophilic Esophagitis (EoE)
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What is eosinophilic esophagitis (EoE)?
EoE is a common cause of difficulty swallowing, or dysphagia, in adults. It is thought to be an allergic condition, related to food or other environmental allergens, which causes inflammation and scarring that can affect both esophageal structure and function. In some way, it can be thought of as an asthma-like condition in the esophagus.
What causes EoE?
It is believed that one or more allergens (usually food) cause a low-level inflammatory response which, over time, leads to scar tissue formation. The scarring impairs the motility, or movement pattern, in the esophagus, and also can narrow the caliber of the esophagus, affecting how food travels down it.
What are the symptoms of EoE?
Typical symptoms include an intermittent sensation of food sticking inside the chest, chest pain or heartburn. In severe cases, food can get stuck in the esophagus requiring an endoscopy to remove the trapped food.
How is EoE diagnosed?
Diagnosing EoE requires that a patient undergo an upper endoscopy to look at the lining of the esophagus and to take biopsies to determine the density of eosinophils present in the esophageal lining. The esophagus typically has a ring-like appearance with cracks that travel down the length of it. The accepted threshold for the number of eosinophils in a biopsy specimen is at least 15 per high-powered microscopic field.
What are the treatment options for EoE?
Several potential treatment options exist, including proton pump inhibitors (PPIs) and topical steroids. Specific food elimination diets may also be used to identify the causative food(s), avoidance of which can improve inflammation and symptoms. Additionally, if a narrowing is seen in the esophagus, a balloon can be passed through the endoscope to dilate, or stretch open, the narrowed area(s) to provide more-immediate relief of symptoms.