Wellness

Eosinophilic Esophagitis – Causes and Symptom

eosinophilic-esophagitis

Eosinophilic esophagitis is an inflammatory disorder of the esophagus (food pipe, which joins mouth to stomach). It is characterized by infiltration of the esophagus wall by white blood cells called eosinophils. Children as well as adults are affected. It is more common in men than women, but the reason for it is unknown.

Causes Of Eosinophilic Esophagitis

Ehagitisops can be caused by acid reflux from the stomach (heartburn), fungal infection (for example Candida), viral infection (for example herpes simplex), radiation therapy (for example for lung cancer), and medications getting stuck in esophagus (like tetracycline). Eosinophilic esophagitis is a kind of esophagitis that is presumed to result from allergy because (1) eosinophils are generally mobilized in allergic reactions, (2) other allergic disorders like asthma, allergic rhinitis, atopic dermatitis and hay fever are found associated with eosinophilic esophagitis. However, the allergen(s) responsible has not been identified.

Signs and symptoms of Of Eosinophilic Esophagitis

Adult

  • Difficulty swallowing (dysphagia)
  • Food impaction
  • Chest pain that is often centrally located and does not respond to antacids
  • Persistent heartburn
  • Upper abdominal pain
  • No response to gastroesophageal reflux disease (GERD) medication
  • Backflow of undigested food (regurgitation)

Children

  • Difficulty feeding
  • Vomiting
  • Abdominal pain
  • Difficulty swallowing (dysphagia)
  • Food impaction
  • No response to GERD medication
  • Failure to thrive (poor growth, malnutrition and weight loss)

Diagnosis

Other causes of dysphagia like esophageal strictures, esophageal rings, disorder of muscles of esophagus (achalasia) and esophageal cancer have to be ruled out. Endoscopy can be confirmatory in determining the cause of dysphagia. Esophageal biopsy can reveal eosinophilic infiltration in the wall of esophagus, clinching the diagnosis of eosinophilic esophagitis. Often endoscopy may reveal a normal-looking esophagus, and so unless biopsy is taken and studied under the microscope, the diagnosis may be missed. Serum IgE concentration may be raised.

Treatment of Eosinophilic Esophagitis

Dietary modifications are not very effective, but elimination diets may be of benefit in some patients. The rationale for elimination diets is that eosinophilic esophagitis may due to allergy to a protein in the food. There is some evidence that elimination diets in children have relieved the esophagitis and reduced eosinophils in esophagus. Similar evidence is being gathered in adults. The allergen can be identified either by trial and error by varying the food intake, or by blood and skin tests to find the specific allergen and eliminating it from the diet. If eosinophilic esophagitis can be controlled with elimination diets then medications may be avoided. The drugs used in treatment of eosinophilic esophagitis are steroids like prednisolone, budesonide and fluticasone, and proton-pump inhibitors like pantoprazole, esomeprazole, rabeprazole, lansoprazole and omeprazole. Steroids reduce the inflammation and relieve dysphagia by reducing the swelling of esophagus.

Proton-pump inhibitors help relieve heartburn and inflammation. Anti-inflammatory medications like montelukast and sodium cromoglycate reduce the severity of allergic reaction. Esophageal dilatation is another modality of treatment to relieve dysphagia in patients with eosinophilic esophagitis. It involves gradual stretching of the esophageal wall to break any swelling.  It is usually safe and effective, but caution has to be exercised because tears or even esophageal perforation can occur.This treatment is reserved for cases not responding to elimination diets and medications.The prognosis is good in most of the patients. Eosinophilic esophagitis has come to light as a disease entity only recently, so much research needs to be done.

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