Eosinophilic esophagitis is a chronic condition that occurs when the immune system overreacts and sends an overabundance of white blood cells to the esophagus. The pooling of these blood cells causes inflammation that keeps the esophagus from contracting properly. It is triggered by a food allergy, seasonal allergies, or when acid flows backward from the stomach to the esophagus (also known as acid reflux).
The condition can occur in adults and children, however it’s most common in men in their 20s or 30s.
Common symptoms include:
- Dysphagia (difficulty swallowing)
- Food impaction (food getting stuck in the esophagus)
- Acid reflux pain that is often centrally located and may not respond to antacids
- Gastroesophageal reflux disease-like symptoms/refractory heartburn
- Upper abdominal pain
If left untreated, the chronic inflammation caused by EoE can lead to scarring and permanent narrowing of the esophagus due to formation of excessive fibrous tissue.
Diagnostic Testing
If you experience symptoms of EoE, your primary care physician may refer you to a gastroenterologist for testing and a complete diagnosis. The diagnostic process usually begins with an upper endoscopy, a procedure in which a flexible tube with a camera lens is inserted into your esophagus to look for inflammation and take a small tissue sample for testing excessive white blood cells.
Once a diagnosis is confirmed, your gastroenterologist may refer you to an allergist who can conduct skin and/or blood tests to determine whether your allergic reaction is triggered by food or environmental allergens like pollen, animal dander, dust mites, or mold.
Treatment at The Center for Digestive Health
At the Center for Digestive Health at Princeton Medical Center, the Eosinophilic Esophagitis Program is co-led by Kheng-Jim Lim, MD and Neha Sirohi, MD. A team of gastroenterologists, allergists, and nutritionists work together to create a comprehensive treatment plan that’s tailored to meet each patient’s unique needs.
The primary goal of treatment for EoE is to reduce inflammation and improve symptoms. Treatment plan options include:
- Dietary modification: Dietary therapy is the first-line treatment for EoE. Elimination diets, such as the six-food elimination diet (dairy, wheat, soy, eggs, nuts, and seafood/shellfish), remove allergenic foods from the patient's diet, and reintroduce them one at a time to identify the offending food(s). Some patients may benefit from elemental diets that consist of amino acid-based formulas, which provide complete nutrition without triggering allergic reactions.
- Medications: Medications that reduce inflammation, such as proton pump inhibitors (PPIs), may help reduce EoE symptoms. Corticosteroids, such as budesonide, are also effective in reducing inflammation in the esophagus. These medications are usually administered through an inhaler or a nebulizer. (The FDA has not approved use of corticosteroids for the treatment of eosinophilic esophagitis. Discuss this, and other treatment options, with your physician.)
- Esophageal dilation: Patients with EoE may experience difficulty swallowing due to esophageal narrowing. Esophageal dilation involves the use of an endoscope to stretch the esophagus, which can improve symptoms.
- Allergen immunotherapy: Allergen immunotherapy involves exposure to small amounts of allergens to desensitize the immune system. This therapy may be helpful for patients with EoE who have identified specific allergens.
- Psychological support: Patients with EoE may experience anxiety and depression due to the chronic nature of the condition and the restrictive dietary modifications. Psychological support, such as counseling or support groups, can help patients cope with the emotional impact of the condition.
Treatment plans for EoE will depend on the patient's symptoms, the severity of inflammation, and the presence of other medical conditions. Treatment plans are customized for each individualized, and patients should be monitored closely for symptoms and adverse effects.
Please contact our office to schedule a consultation with one of our providers to determine which treatment option will best meet your specific needs.
Center for Digestive Health
Penn Medicine Princeton Medical Center
5 Plainsboro Road, Suite 450
Plainsboro, New Jersey 08536
609.853.6390