Eosinophils are not normally found in the
esophagus although small amounts may be found in other areas of the
digestive system. Eosinophilic esophagitis (EE) occurs when
large numbers of eosinophils are in the esophagus. There are a
multitude of things that can actually cause the unnatural production
of eosinophils in the esophagus. Issues such as food allergies, GERD
and inflammatory bowel disease can cause the present of eosinophils
in the esophagus.
EE is thought to be the most common type of EGID. It's most
common in children and young adults but can affect people of all
ages. Usually those with EE have other allergic type diseases
such as hay fever or excema and it may be genetic.
SYMPTOMS OF EOSINOPHILIC ESOPHAGITIS
Many of the symptoms of eosinophilic esophagitis are similar to
those of reflux or GERD, so it can sometimes be misdiagnosed as
such. Reflux that does not respond to typical reflux
treatments may even be a symptom of eosinophilic esophagitis.
Other symptoms can include:
- Nausea and Vomiting
- Food stuck in throat
- Dysphagia (difficulty swallowing)
- Poor appetite
- Failure to thrive or malnutrition
- Sleeping problems
- Failure to thrive (poor growth or weight
loss)
- Stomach or chest pain
DIAGNOSING EOSINOPHILIC ESOPHAGITIS
Eosinophilic esophagitis is confirmed by a scope (upper
endoscopy). A scope is used as it gives the gastroenterologist
the ability to see the esophagus, stomach and duodenum (first part
of the small bowel) as well as tissue samples for review under a
microscope. If EE is not visible during the exam, they will be
found under a microscope. Sometimes a blood sample will show higher than normal levels of eosinophils in the blood as well.
Once it's diagnosed, allergy testing (specifically skin prick
testing) is useful in determining the best treatment.
DOES EOSINOPHILIC ESOPHAGITIS NEED TREATMENT?
In adults, the condition lasts for many years if not indefinitely. Treatment is recommended to reduce the risk of permanent scarring that may results from untreated inflammation and uncontrolled acid reflux. So far, there is no evidence that this condition increases the risk of cancer. Babies with severe reflux often outgrow the problem, but whether older children do so is currently unclear.
TREATMENT FOR EOSINOPHILIC ESOPHAGITIS
Symptoms in infants often resolve in the first few years of life, particularly when only 1 or 2 foods is involved. Unfortunately, when symptoms arise in older children and adults, they usually last for many years. Follow up studies so far indicate that they may never resolve completely n patients of this age.
Medication
- Medication to reduce acid production will reduce acid reflux and the scarring that can result
- Topical asthma steroid puffers can reduce inflammation in the oesophagus. These are "swallowed" instead of inhaled, are low dose, poorly absorbed, and extremely unlikely to cause cortisone/steroidtablet-like
side-effects. They help reduce inflammation and the scarring
that can result from untreated disease
- Montelukast (Singulair) is an asthma tablet that reduce inflammation by blocking the effects of inflammatory chemicals release by white cells known as "leucotrienes"
- Other medicines are also being studied. Swallowed cortisone tablets with the property of being poorly absorpbed (like budesonide) have been helpful in some studies, but are not available currently in Australia.
Dilatation of the Esophagus
Some times if the esophagus is very narrow, you might need an endoscopy and a procedure known as "dilatation" to open up the esophagus to allow food to pass more easily.
Diet manipulation
In recent reported studies, some groups claimed that a combination of skin prick testing and food patch testing with staple foods, will identify potential food allergens. If avoided, they claim that improvement is seen in around 3 out of 4 patients. The general approach is to avoid the foods for which there is evidence of sensitization. If improvement in symptoms occur, foods are introduced one food at a time, starting with the foods that are least likely to cause problems. It is important to note that:
- the diagnosis of EES should always be confirmed first, and
- that dietary manipulation should be temporary and supervised by a skilled dietitian to avoid the risk of malnutrition.
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