Jay W. Marks, MD
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Eosinophilic esophagitis facts
- Eosinophilic esophagitis is an inflammatory condition of the esophagus that affects both children and adults, and men more than women.
- Eosinophilic gastroenteritis may be due allergy to an as yet unknown food allergen.
- The major symptom in adults with eosinophilic esophagitis is dysphagia (problems swallowing) for solid food.
- Eosinophilic esophagitis stiffens the esophagus so that solid foods have difficulty passing through the esophagus and into the stomach. Eosinophil deposition in esophagus can be in form of ridges or rings which can impede the passage of food.
- Other common causes of dysphagia for solid food are esophageal strictures and Schatzki rings.
- The diagnosis of eosinophilic esophagitis usually is made during an endoscopy (EGD), performed for the evaluation of dysphagia. The diagnosis is confirmed by biopsy of the esophagus.
- The treatment of eosinophilic esophagitis is with proton pump inhibitors and swallowed fluticasone propionate or budesonide.
- Gentle esophageal dilatation is used when meditations fail to relieve dysphagia.
What is eosinophilic esophagitis?
Eosinophilic esophagitis is an inflammatory condition in which the wall of the esophagus becomes filled with large numbers of eosinophils, a type of white blood cell.
What causes eosinophilic esophagitis?
The esophagus is a muscular tube that propels swallowed food from the mouth into the stomach. Esophagitis refers to inflammation of the esophagus that has several causes.
- The most common cause of esophagitis is acid reflux, which most frequently results in heartburn. Acid reflux can also cause ulcers in the inner lining of the esophagus.
- Other less common causes of esophagitis include viruses (such as herpes simplex), fungi (such as Candida), medications that become stuck in the esophagus (such as the antibiotic, tetracycline), and radiation therapy (such as during treatment of lung cancer).
Doctors believe that eosinophilic esophagitis is a type of esophagitis that is caused by an allergen for two reasons.
- First, eosinophils are prominent in other diseases associated with allergies such as asthma, hay fever, allergic rhinitis, and atopic dermatitis.
- Second, people with eosinophilic esophagitis are more likely to suffer from these other allergic diseases.
Nevertheless, the exact substance that causes the allergic reaction in eosinophilic esophagitis is not known. The hallmark of eosinophilic esophagitis is the presence of large numbers of eosinophils in the tissue just beneath the inner lining of the esophagus.
Eosinophils are white blood cells (leukocytes) manufactured in the bone marrow and are one of the many types of cells that actively promote inflammation. They are particularly active in the type of inflammation caused by allergic reactions. Thus, large number of eosinophils can accumulate in tissues such as the esophagus, the stomach, the small intestine, and sometimes in the blood when individuals are exposed to an allergen. As previously mentioned, the allergen(s) that causes eosinophilic esophagitis is not known. It is not even known whether the allergen is inhaled or ingested.
Eosinophilic esophagitis affects both children and adults. For unknown reasons, men are more commonly affected than women, and it is most commonly found among young boys and men.
This article primarily deals with the diagnosis and management of swallowing problems (dysphagia), the most common complication in adults with eosinophilic esophagitis.
What are the symptoms of eosinophilic esophagitis?
The major symptom in adults with eosinophilic esophagitis is difficulty in swallowing solid food (dysphagia). Specifically, the food becomes stuck in the esophagus after it is swallowed.
Less common symptoms include heartburn and chest pain.
In children, the most common symptoms are
How does eosinophilic esophagitis cause dysphagia?
Eosinophilic esophagitis decreases the ability of the esophagus to stretch and accommodate mouthfuls of swallowed food probably as a result of the presence of so many eosinophils but also, perhaps as a result of some scaring that occurs in the wall of the esophagus. As a result, solid foods (particularly solid meats) have difficulty passing through the esophagus. When solid food sticks in the esophagus, it causes an uncomfortable sensation in the chest. The sticking of food in the esophagus is referred to as dysphagia. If the solid food then passes into the stomach, the discomfort subsides, and the individual can resume eating. If the solid food does not pass into the stomach, individuals often must regurgitate the food by inducing vomiting before they can resume eating. Rarely, the solid food becomes impacted, that is, it can neither pass into the stomach nor be regurgitated. The impacted solid food causes chest pain that can mimic a heart attack, and also causes repeated spitting up of saliva that cannot be swallowed because of the obstruction in the esophagus. Individuals with impacted food are unable to eat or drink. To relieve the obstruction, a doctor usually will have to insert a flexible endoscope through the mouth and into the esophagus to remove the impacted food.
How eosinophilic esophagitis causes symptoms of abdominal pain, vomiting, and failure to thrive in children is not clear.
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What are the other causes of dysphagia for solid food?
The most common causes of dysphagia for solid food are esophageal strictures and Schatzki (lower esophageal) rings. Esophageal strictures are narrowings of the esophagus that result from inflammation and scarring, most commonly from chronic acid reflux. Strictures usually are located in the lower esophagus near the entrance of the esophagus into the stomach where the acid reflux is most severe. Schatzki rings are thin webs of tissue of unclear cause that can narrow the lumen (center) of the esophagus through which food passes. They also are located in the lower esophagus.
A less common cause of dysphagia for sol >