Eosinophilic Esophagitis

Infants and children may refuse to eat and have vomiting, weight loss, and abdominal pain, chest pain, or a combination.

Adults who have a stricture (usually those who have had esophagitis for a long time) often have difficulty swallowing Difficulty Swallowing Some people have difficulty swallowing (dysphagia). In dysphagia, foods and/or liquids do not move normally from the throat (pharynx) to the stomach. People feel as though food or liquids become... read more (dysphagia) and may have food lodged in their esophagus (called esophageal food impaction). People may have symptoms similar to those of gastroesophageal reflux disease Gastroesophageal Reflux Disease (GERD) In gastroesophageal reflux disease, stomach contents, including acid and bile, flow backward from the stomach into the esophagus, causing inflammation in the esophagus and pain in the bottom... read more (GERD), particularly heartburn (a burning pain behind the breastbone).

People often also have other allergic disorders, such as asthma Asthma Asthma is a condition in which the airways narrow—usually reversibly—in response to certain stimuli. Coughing, wheezing, and shortness of breath that occur in response to specific triggers are... read more or eczema Atopic Dermatitis (Eczema) Atopic dermatitis (commonly referred to as eczema) is chronic, itchy inflammation of the upper layers of the skin that often develops in people who have hay fever or asthma and in people who... read more .

Doctors suspect the diagnosis of eosinophilic esophagitis in people of any age who have other allergic disorders and difficulty swallowing solid foods. The diagnosis is also suspected in people who have symptoms of GERD that do not go away with typical treatment.

To diagnose the disorder, doctors look in the esophagus with a flexible tube (endoscopy Endoscopy Endoscopy is an examination of internal structures using a flexible viewing tube (endoscope). In addition to examinations, doctors can use endoscopy to do biopsies and give treatment. Endoscopes... read more ). During the endoscopy, doctors take tissue samples to analyze under a microscope (called a biopsy).

Sometimes, doctors also do a barium swallow X-Ray Studies of the Digestive Tract X-rays often are used to evaluate digestive problems. Standard x-rays ( plain x-rays) can show some blockages or paralysis of the digestive tract, or abnormal air patterns in the abdominal cavity... read more . In this test, people are given barium in a liquid before x-rays are taken. The barium outlines the esophagus, making abnormalities easier to see.

Doctors may also do tests for food allergies Diagnosis A food allergy is an allergic reaction to a particular food. Food allergies are commonly triggered by certain nuts, peanuts, shellfish, fish, milk, eggs, wheat, and soybeans. Symptoms vary by... read more to identify possible triggers, but they are of little benefit.

Adults are given proton pump inhibitors (PPIs), which are drugs that reduce production of stomach acid and can reduce symptoms. In children, changes in diet are often effective, but PPIs are typically used if changes to the diet have not helped.

If PPIs do not help, people are given topical corticosteroids (such as fluticasone and budesonide) that are swallowed to coat the esophagus can help reduce inflammation. People may use a fluticasone 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 in liquid form also can be mixed with a sugar substitute or thickener (such as cornstarch) and swallowed. People may rinse out their mouth afterwards to help avoid a fungal infection of the mouth (thrush Candidiasis (Yeast Infection) Candidiasis is infection with the yeast Candida. Candidiasis tends to occur in moist areas of the skin. This skin infection may cause rashes, scaling, itching, and swelling. Doctors examine... read more ).

Doctors may instruct people to change their diet. People can follow a diet that eliminates wheat, dairy, fish/shellfish, peanuts/tree nuts, eggs, and soy (see elimination diet Diagnosis ). This diet is the most often recommended diet for eosinophilic esophagitis and is better and simpler than eliminating foods based on the results of skin and blood allergy tests. Variations of this diet, where only two or four foods are eliminated, can be tried. The elemental diet, in which people get most of their nutrition in a liquid form usually composed of amino acids, fats, sugars, vitamins, and minerals, is successful in both adults and children but is often not practical in adults.

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

Injection and infusion therapies that target the eosinophil pathway in the body are being studied for eosinophilic esophagitis.