AAIQ   The Association of Allergists and Immunologists of Québec

Eosinophilic esophagitis

What is eosinophilic esophagitis?

The esophagus is the organ that brings food from the mouth to the stomach. Eosinophilic esophagitis is a disease where the esophagus becomes inflamed in association with the presence of many particular cells, eosinophils, within the lining of the esophagus itself. Eosinophils are white blood cells found in many allergic diseases. For example, these cells are often present in the lungs of people suffering from asthma. Certain people actually describe eosinophilic esophagitis as "asthma of the esophagus".

What are the symptoms of eosinophilic esophagitis?

Difficulty swallowing with a sensation of blocking when swallowing, sometimes accompanied by a true obstruction with food is often described. Other symptoms may include burning in the stomach, abdominal pain and vomiting. Young children may also have difficulty with feeding.

Who are those most likely to suffer from eosinophilic esophagitis?

Studies show that this disease mostly affects young men in their twenties and thirties, although many other cases have been described in young children and older people. Many patients have additional allergic diseases (asthma, rhinoconjunctivitis, food allergies).

What are the possible causes of eosinophilic esophagitis?

The causes of this disease are not clear. According to certain studies, allergies, in particular food allergies, play a role.

How does one diagnose eosinophilic esophagitis?

Because eosinophils can only be seen under the microscope, a diagnosis can only be made after examining biopsied tissue from the esophagus of someone with appropriate symptoms, and who doesn't typically respond to treatments for other diseases, such as gastro-esophageal reflux. Generally, a trial of a medication in the class of proton pump inhibitors (eg: omeprazole, pantoprazole, esomeprazole, lansoprazole…) should take place for at least 2 months. The biopsy is done using an endoscope (a camera is positioned in the esophagus and small samples of tissue can be biopsied).

What is the treatment of an eosinophilic esophagitis?

Since the symptoms of an eosinophilic esophagitis are often confounded with those of gasto-esophageal reflux, certain people are first treated with medications called proton-pump inhibitors (ex: Pantoloc™, Prevacid™). Since eosinophils are also found in asthma, the doctor will sometimes prescribe medicines that appear destined to treat asthmatics, such as inhaled cortisone (ex: Flovent™). But in this case, since he or she is treating the esophagus, the patient doesn't inhale the medicine - he swallows it. He must also be careful not to eat or drink immediately after taking the medicine. Sometimes, the doctor can identify specific food allergies in these patients using allergy skin tests. In this case, an elimination diet may be recommended. It is also possible that the doctor recommends from the very start to avoid certain foods without allergy tests. All forms of diets undertaken in this manner must be under supervision, so as not to cause nutritional deficiencies. Other medications for this disease are currently being studied.

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Nha Uyen Nguyen-Luu, MD FRCPC
(translation: Andrew Moore, MD FRCPC)