The oesophagus is the gullet, or food pipe, that connects the mouth to the stomach. Inflammation of the oesophagus is known as oesophagitis. Commonly, the inflammation is caused by acid leaking up from the stomach (a condition known as acid reflux). In some people, however, it can be caused by a condition known as eosinophilic oesophagitis. In eosinophilic oesophagitis, particular types of white blood cells (called eosinophils) gather in large numbers in the lining of the oesophagus, causing inflammation. It occurs in children and in adults. The condition can be controlled by making changes to your diet and/or taking steroids. Occasionally, an operation to stretch the oesophagus through a telescope (endoscope) may be needed.
Understanding the oesophagus and stomach
When we eat, food passes down the gullet (oesophagus) into the stomach. Cells in the lining of the stomach make acid and other chemicals which help to digest food. Stomach cells also make mucus which protects them from damage from the acid. The cells lining the oesophagus are different and have little protection from acid.
There is a circular band of muscle (a sphincter) at the junction between the oesophagus and stomach. This relaxes to allow food down but then normally tightens up and stops food and acid leaking up (refluxing) into the oesophagus. In effect, the sphincter acts like a valve.
What is eosinophilic oesophagitis?
Oesophagitis means inflammation of the gullet or oesophagus. In eosinophilic oesophagitis (EO) lots of white cells called eosinophils can be seen in the oesophageal lining. EO is thought to occur due to a combination of genetic makeup and the body's response to the environment. If you have EO you may be allergic to certain foods, although tests do not always identify the specific foods causing the problem. You are also more likely to have other allergies such as asthma or hay fever.
What are the symptoms of eosinophilic oesophagitis?
The symptoms of eosinophilic oesophagitis (EO) vary depending on whether you are an adult, a teenager or a child. If you are an adult you may notice difficulty in swallowing (dysphagia) and have the feeling that food is sticking in the gullet. If you are a teenager you may start being sick (vomiting) and have chest or stomach pain. These symptoms are similar to those of people who have acid reflux (also known as gastro-oesophageal reflux disease). If your child has EO, you may notice that they refuse food and fail to gain weight.
Who does eosinophilic oesophagitis affect?
Most people with eosinophilic oesophagitis (EO) are white men between the ages of 30-50 years. However, the condition can occur in all ages and in both sexes. Men are three times more likely than women to be affected. It occurs in about 4 people in 10,000.
How is eosinophilic oesophagitis diagnosed?
If you are suspected of having eosinophilic oesophagitis (EO), you will need to have a gastroscopy (endoscopy). This involves putting a thin flexible telescope called an endoscope through the mouth and down into the gullet (oesophagus). The endoscope has a tiny light and video camera at the end. These help the doctor to take a film and see inside your oesophagus. An instrument can also be passed down the endoscope to take a small sample of the lining of the oesophagus (a biopsy). Your symptoms, the appearance of the lining of your oesophagus and the biopsy report will all help the doctor to diagnose EO.
If your child is suspected of having EO, endoscopy can be performed using a smaller tube.
Sometimes, blood tests and/or skin prick tests are used to help identify specific foods that might be causing the condition. These are more commonly used in children than in adults.
What are the treatments for eosinophilic oesophagitis?
You may be advised to alter your diet, either as the main treatment for your eosinophilic oesophagitis (EO) or in addition to other treatment. Dietary manipulation may involve cutting out certain foods to which you may be allergic.
Sometimes food allergy tests may be able to identify which foods to avoid but these tests do not always provide the answer. If your allergy tests are not helpful, you may be advised to avoid the types of food which are well known to cause allergic reactions. Common foods that can do this include nuts, seafood, milk, egg, wheat and soya products. A dietician and/or an allergy specialist may be involved in giving you advice about what changes to your diet you need to make,
Usually you need to avoid these foods for about six weeks and then gradually reintroduce them one by one. Another approach, most commonly used in children, is to try a specially made-up mixture of basic food chemicals called amino acids. This mixture needs to be taken instead of food for about six weeks. Your child may not like the taste of the mixture and it may be difficult to persevere with this treatment. However, it is particularly useful if your child has a severe form of EO which is difficult to control.
Steroids such as fluticasone are often recommended, with or without dietary manipulation. They are usually prescribed in the form of an inhaler. It is the same type of inhaler as that used by patients with asthma. However, you will be asked to spray the inhaler into your mouth without breathing in and to swallow the powder without water. You should not eat food or drink liquids for half an hour after spraying the medicine. Another type of steroid called budesonide is also available in liquid form. The liquid form is not specially made for people with EO but comes in small plastic containers called budesonide respules which are used by asthma patients. This can be mixed with a sweetener called sucralose, or with honey or chocolate syrup. This is a particularly useful option for children who have problems with the inhaler method.
You may need to have treatment using an endoscope if dietary manipulation or steroids do not work. You may also need endoscopy if you develop a complication of EO such as narrowing of the oesophagus.
Does eosinophilic oesophagitis get better?
Eosinophilic oesophagitis (EO) can be controlled in most cases by dietary manipulation and/or steroid medicine. However, you or your child may find that the condition returns as soon as treatment is stopped. Treatment may therefore need to be continued long-term to keep the condition under control.
Further reading and references
Murali AR, Gupta A, Attar BM, et al; Topical steroids in eosinophilic esophagitis: Systematic review and meta-analysis of placebo-controlled randomized clinical trials. J Gastroenterol Hepatol. 2016 Jun31(6):1111-9. doi: 10.1111/jgh.13281.
Furuta GT, Katzka DA; Eosinophilic Esophagitis. N Engl J Med. 2015 Oct 22373(17):1640-8. doi: 10.1056/NEJMra1502863.
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