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Eosinophilic Esophagitis

By Michael C. DiMarino, MD, Division of Gastroenterology and Hepatology, Department of Medicine, Thomas Jefferson University

Eosinophilic esophagitis is an inflammatory disorder in which the wall of the esophagus becomes filled with large numbers of eosinophils, a type of white blood cell.

Eosinophilic esophagitis can begin at any time between infancy and young adulthood. It occasionally occurs in older adults and is more common among males.

This disorder may be caused by an allergic reaction to certain foods in people who have genetic risk factors. The allergic reaction causes inflammation that irritates the esophagus and can eventually lead to chronic narrowing (stricture) of the esophagus (see Complications).

Symptoms

People may have symptoms similar to those of gastroesophageal reflux disease (GERD—see Gastroesophageal Reflux (GERD)), particularly heartburn. Infants and children may refuse to eat and have vomiting and abdominal or chest pain. People who have a stricture (usually adults who have had esophagitis for a long time) may have food lodged in their esophagus. People may also have other allergic disorders, such as asthma.

Diagnosis

Doctors suspect the diagnosis in people with symptoms of GERD that do not go away with typical treatment (see Gastroesophageal Reflux (GERD) : Treatment) and in adults who have food lodged in their esophagus. To diagnose the disorder, doctors look in the esophagus with a flexible tube (endoscopy—see Endoscopy). During the endoscopy, doctors take tissue samples to analyze under a microscope (called a biopsy).

Doctors also test for food allergies to identify possible triggers (see Food Allergy : Diagnosis). Skin tests and a radioallergosorbent test (RAST) may also be done (see Skin testing).

Treatment

Doctors typically instruct people to change their diet. Any food allergies identified through allergy testing are eliminated from the diet, or people can follow an elimination diet created by their doctor (see Diagnosis).

Corticosteroids (such as fluticasone and budesonide) that are swallowed to coat the esophagus can help reduce inflammation. People may use a fluticasone or budesonide inhaler and puff the drug into their mouth without inhaling and then swallow it. This way the drug coats the esophagus and does not enter the lungs. Budesonide also can be mixed with a sugar substitute and a liquid and swallowed. People may rinse out their mouth afterwards to help avoid a fungal infection of the mouth (thrush—see Candidiasis).

If people have narrowing of the esophagus, doctors inflate a balloon in the esophagus to dilate it. Doctors often do several dilations using progressively larger balloons to prevent the esophagus from tearing.

Drugs Mentioned In This Article

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    Select Brand Names
  • CUTIVATE, FLONASE
  • PULMICORT, RHINOCORT

* This is the Consumer Version. *