EoE is the acronym for eosinophilic esophagitis. Once thought to be an uncommon condition, it is now recognized as one of the most common reasons for feeding problems in infants and for dysphagia (difficulty swallowing) and food impaction in adults.
Until the early 1990s EoE was lumped in with the GERD diagnosis (gastroesophageal reflux disease). But in the ‘90s researchers started to recognize that EoE was a different critter. The clinical symptoms were different from classic GERD, and the patients tend not to respond to acid suppression therapy, or anti-reflux surgery.
In children EoE causes feeding problems, vomiting and abdominal pain. In adolescents and adults it causes discomfort with swallowing and food impaction episodes. The reason for these symptoms is inflammation in the esophagus caused by the presence of the white blood cell – eosinophil (as opposed to acid-related inflammation in GERD).
The eosinophil can be seen on biopsies taken from the esophagus during upper endoscopy. It is believed the eosinophils infiltrate the esophagus in response to either or both allergens and altered microbiome. The allergens can be either food allergies or airborne. It may sound weird, but part of the self-cleaning process of our sinuses is to filter allergens, wrap them in mucus and then send them out of the body via swallowing them. As these aero allergens pass through the esophagus they can elicit the eosinophil response.
Treatment consists of two main approaches. First is to identify and then avoid food and airborne allergens. Second is topical corticosteroids. These can be administered either by swallowing the spray from a steroid asthma inhaler, or by viscous preparation of a liquid asthma steroidal normally used in a nebulizer.