What is eosinophilic esophagitis?
Eosinophilic esophagitis is a disease of the esophagus that has not been known for very long. It was not until the early 1990s that two doctors first described it independently of each other: Professors Stephen Attwood from England and Alex Straumann from Switzerland. Since then, there have been many cases of eosinophilic esophagitis throughout the industrialized world – and the trend is rising.
Eosinophilic esophagitis is probably an allergy-like, chronic inflammation of the esophagus. The immune system is misdirected and reacts excessively to a stimulus that is normally harmless. In addition to genetic factors, environmental factors probably also play a role.
Eosinophilic esophagitis gets its name from the fact that certain inflammatory cells are involved in the disease: eosinophilic granulocytes. This is a special type of white blood cell (leukocyte) that plays a decisive role in immune defense. And the word “esophagitis” is the medical term for inflammation of the food pipe (esophagus). Eosinophilic esophagitis is abbreviated as EoE.
The triggers of inflammation in the gullet are probably mostly proteins from food, such as animal dairy products or wheat. In children, EoE is noticeable when they refuse to eat, do not thrive properly or vomit. Symptoms in adults, on the other hand, are often difficulty swallowing or pain behind the breastbone. There are several treatment options, for example avoiding the triggering foods, anti-inflammatory medication or dilating the esophagus.
Eosinophilic esophagitis – frequency and age
Eosinophilic esophagitis has only recently been recognized as a disease in its own right. Medical professionals estimate that approximately one person in every 2,500 to 4,000 inhabitants lives with an EoE. However, the number of unreported cases is probably even higher because not every person affected by eosinophilic esophagitis receives a diagnosis.
The disease of the gullet can affect people of any age. It usually begins between the ages of ten and 40. It affects the male sex significantly more often than the female – this is most likely due to genetic causes. Around 75 percent of those affected are male. And in some families, eosinophilic esophagitis occurs more frequently. This also suggests that genes are involved.
Eosinophilic esophagitis: causes and risk factors
Scientists are still researching the causes of eosinophilic esophagitis. However, there is probably not “one” cause, but several factors must interact to cause EoE – hereditary factors and environmental factors.
In any case, no eosinophilic granulocytes are present in a healthy esophagus. External allergy triggers (allergens) presumably trigger the immune response. However, it is still unclear whether those affected absorb the allergen by mouth or inhale it. There is still a need for further research here.
Eosinophilic esophagitis: food, genes and existing allergies
The fact that boys and men suffer from the disease much more frequently than girls and women suggests that genes are involved in the disease. EoE also occurs more frequently in some families. Many patients (around 50 to 70 percent) also already suffer from an allergy, such as bronchial asthma, hay fever (pollen allergy) or a food allergy.
In most people with eosinophilic esophagitis, the esophagus reacts allergically to contact with components of proteins, for example:
- Dairy products containing animal milk
- Wheat: possibly gluten as a trigger, probably all cereals containing gluten
- less frequently: eggs, nuts, soy, seafood
EoE can therefore probably be regarded as a special form of food allergy.
Symptoms: Eosinophilic esophagitis causes swallowing difficulties
Eosinophilic esophagitis can manifest itself through various symptoms. However, the symptoms are different in children and adults. They also change with increasing age.
Eosinophilic esophagitis: symptoms in children
- Pain behind the breastbone
- Abdominal pain
- Heartburn
- Swallowing complaint
- Cough
- Burping
- Diarrhea
- Nausea, vomiting
- Reduced appetite
- Refusal of food
- Failure to thrive – the child does not grow properly and hardly gains any weight
Eosinophilic esophagitis: symptoms in adolescents and adults
- Swallowing disorders(dysphagia) when consuming dry, solid and fibrous foods, for example meat, salads, raw vegetables. The symptoms range from slight gagging when food passes through the esophagus to a narrowing or complete blockage of the esophagus (bolus obstruction). Even saliva, water and other liquids can then no longer pass through. The obstruction of the esophagus can last from a few minutes to several hours. As a result, those affected develop avoidance strategies: they avoid hasty eating and problematic foods. They eat slowly, chew well and drink a lot between meals.
- Reflux-like symptoms, for example belching, heartburn and burning, pressure-like pain behind the breastbone – they can occur during the swallowing process, but also independently of it.
- Sensation of a lump or tightness when swallowing.
Eosinophilic esophagitis: Diagnosis by the doctor
The diagnosis of eosinophilic esophagitis always begins with a discussion of the patient’s medical history (anamnesis). We ask you some questions, for example:
- What exactly are the symptoms?
- How long have they existed?
- How severe are the symptoms?
- Where exactly are they located?
- For swallowing disorders: Which foods do you have the biggest problems with?
- Do you have any known illnesses, for example an allergy? If yes: What type of allergy and how long has it existed? Around half of those affected by EoE already suffer from an allergic disease such as hay fever, bronchial asthma or a food allergy.
- Are there any illnesses in your family, for example eosinophilic esophagitis or allergic disease?
- Are you taking any medication, if so, what kind?
This is usually followed by a physical examination. Among other things, we scan the neck and chest for changes. In most cases, however, no abnormalities can be detected.
If eosinophilic esophagitis is suspected, further examinations should be carried out, in particular:
- Endoscopy: We examine the esophagus with a special instrument, the endoscope. It is equipped with a small camera and light source. This enables him to detect changes in the esophagus. Most frequently, small white deposits, inconspicuous reddish longitudinal furrows or rings can be observed on the mucous membrane.
- Tissue sample (biopsy): We take several tissue samples from suspicious areas of the esophagus as part of the endoscopy. Pathology specialists then examine the tissue under a microscope in the laboratory. Particular attention is paid here to the eosinophil granulocytes. The diagnosis of “eosinophilic esophagitis” can be made with a high degree of certainty when the density of these white blood cells reaches a certain level. Tissue samples are therefore highly informative in the diagnosis of the disease.
Nevertheless, the changes in the gullet are often very inconsistent and vary from person to person. In many cases, they are also only very mild and therefore easy to overlook – or they are completely absent. Therefore, the doctor performing the endoscopy should have experience with the clinical picture of EoE in order to interpret the conspicuous features correctly.
Eosinophilic esophagitis: prevention, early detection, prognosis
Eosinophilic esophagitis cannot be prevented according to current knowledge because the causes and risk factors have not yet been precisely clarified.
There are also no targeted measures for the early detection of EoE. Always visit us promptly if you suffer from symptoms, especially swallowing disorders or pain behind the breastbone. It can also be caused by other diseases, for example reflux disease.
Course and prognosis of eosinophilic esophagitis
Eosinophilic esophagitis is a chronic inflammation of the esophagus. Although it can be treated well, it cannot yet be cured. To do this, we need to know the causes more precisely and develop a therapy that addresses the root of the disease.
Without treatment, EoE can cause damage to the esophagus. The wall thickens, loses its elasticity and constricts the feeding tube. As a result, the esophagus no longer functions as it should. Normal food intake is becoming more and more of a problem. Finally, food particles can become trapped (bolus obstruction) – in this case a visit to hospital is unavoidable.
Sufficient and long-term treatment can mitigate these consequences or even prevent them altogether. To date, there is no evidence that eosinophilic esophagitis is associated with an increased risk of esophageal cancer.
Eosinophilic esophagitis: treatment with several strategies
The treatment of eosinophilic esophagitis is best in the hands of gastroenterology specialists who are well versed in the clinical picture. In the case of dietary therapy, we work closely with the nutritionist. It is based on several pillars, which are sometimes combined with each other. The most important drugs are those that reduce the inflammation in the esophagus and prevent consequential damage.