How to Recognize Signs of Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by inflammation of the esophagus due to an infiltration of eosinophils, a type of white blood cell. Recognizing the signs and symptoms of EoE is crucial for early diagnosis and effective management. In this article we'll look at common signs of eosinophilic esophagitis, and review treatment options.
1. Difficulty Swallowing (Dysphagia)
Dysphagia is the most common symptom in adults with EoE and is often the primary reason patients seek medical attention. This difficulty swallowing can manifest in several ways:
- Feeling like food gets "stuck" in the throat or chest.
- Needing to chew food excessively before swallowing.
- Having to drink large amounts of liquids to wash down food.
- Taking longer to eat than others at the table.
2. Food Impaction
Food impaction occurs when food becomes lodged in the esophagus, leading to a complete obstruction. This is more than just food getting "stuck," it's a medical emergency that can require endoscopic removal. Nearly 50% of adults with EoE report experiencing at least one episode of food impaction in their lifetime.
During these episodes, patients may:
- Be unable to swallow saliva.
- Experience intense chest pain.
- Feel panic or anxiety.
- Attempt to vomit to dislodge the food.
Food impaction represents an advanced stage of the disease and is often the event that leads to diagnosis in adult patients.
3. Chest Pain and Discomfort
Chest pain in EoE is typically described as non-cardiac in nature and can be:
- Burning or pressure-like in quality.
- Located in the mid to lower chest area.
- Worsened by eating.
- Unresponsive to antacid medications.
This symptom can be particularly troubling as it may mimic heart-related chest pain, leading to extensive cardiac evaluations before the true cause is identified.
4. Heartburn and Acid Reflux Symptoms
Many EoE patients experience symptoms that resemble gastroesophageal reflux disease (GERD), including:
- Heartburn or burning sensation in the chest.
- Regurgitation of food or sour liquid.
- Sensation of a lump in the throat (globus sensation).
5. Vomiting and Regurgitation
Vomiting is a prominent symptom in children with EoE but can occur in adults as well. This may present as:
- Regurgitation of undigested food.
- Frequent vomiting during or after meals.
- Nausea accompanied by retching.
These symptoms can be particularly distressing and may lead to nutritional deficiencies if persistent over time.
6. Chronic Cough and Throat Clearing
Some patients with EoE develop upper respiratory symptoms that are actually related to their esophageal condition:
- Persistent dry cough that worsens after eating.
- Frequent throat clearing.
- Hoarseness or change in voice quality.
- Sensation of postnasal drip.
These symptoms result from the inflammatory process extending to the upper esophagus and pharyngeal area or from micro-aspiration events.
7. Poor Response to Conventional GERD Treatment
A hallmark feature that should raise suspicion for EoE is the persistence of symptoms despite appropriate therapy for GERD. Patients who continue to experience reflux symptoms, dysphagia and chest pain despite 8-12 weeks of high-dose proton pump inhibitor therapy should be evaluated for EoE.
8. Atopic Conditions
There is a strong association between EoE and other allergic conditions. The presence of the following conditions should increase suspicion for EoE in patients with digestive symptoms:
- Asthma.
- Allergic rhinitis.
- Atopic dermatitis.
- Food allergies.
- Seasonal allergies.
The prevalence of these conditions in EoE patients is significantly higher than in the general population, suggesting a shared allergic pathway.
Treatment Options for Eosinophilic Esophagitis
For those diagnosed with EoE, several treatment approaches are available:
- Dietary therapy. Elimination diets removing common allergens like dairy, wheat, eggs, soy, nuts and seafood have shown effectiveness in many patients. An empiric six-food elimination diet or targeted elimination based on allergy testing are common approaches.
- Medication. Topical corticosteroids such as fluticasone propionate or budesonide can reduce inflammation when swallowed rather than inhaled. Proton pump inhibitors may help a subset of patients with PPI-responsive EoE.
- Endoscopic dilation. For patients with significant narrowing of the esophagus, endoscopic dilation can provide relief from dysphagia symptoms.
- Biologic therapies. Newer targeted treatments focusing on specific inflammatory pathways are emerging with promising results in clinical trials.
- Lifestyle modifications. Careful chewing, eating slowly and avoiding trigger foods can help manage symptoms.
Early diagnosis and treatment of EoE are essential to prevent complications such as esophageal strictures, fibrosis and permanent remodeling of the esophagus. If you experience persistent symptoms of dysphagia, heartburn unresponsive to standard therapy or recurrent food impactions, consult a gastroenterologist for proper evaluation.