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Dr. Mansfield
Eosinophilic esophagitis, or EoE, is a disease in which a large number of a special type of white blood cell, called eosinophils, cause inflammation in the esophagus. Dr. Malone, what can you tell us about this condition?

Dr. Malone
Well, Dr. Mansfield, inflammation caused by eosinophils can cause many different types of changes in the esophagus, both on the surface and with the function of the deeper muscle layers. These changes can result in stiffening or narrowing of the esophagus, which can cause difficulty with swallowing, called dysphagia, or food getting stuck in the esophagus. In fact, dysphagia and food lodged in the esophagus are the most common symptoms of EoE, and can become a medical emergency if the food does not pass. Other, less common symptoms include heartburn and chest pain.

Currently, the only way to diagnose EoE is by performing an upper GI endoscopy with biopsy. During endoscopy with biopsy, a thin, flexible tube with a camera is passed through the esophagus, and tiny pieces of tissue are taken from the lining of the esophagus, also called the mucosa. These are then inspected under a microscope.

The cause of EoE is unknown, but some research suggests that this condition is associated with an allergic reaction to environmental and food allergens. A majority of patients with EoE have a history of allergic conditions, such as allergic rhinitis, asthma, eczema, or food allergy. For this reason, dietary changes may be recommended. However, primary treatment for EoE is a daily proton pump inhibitor, or PPI, medication, usually continued for life. A topical allergy medication may be added to the treatment regimen to be used intermittently if symptoms remain.