Over the last few years, I have seen an increase number of young patients being diagnosed with eosinophilic esophagitis (EoE) in our practice. All of them have presented with varying severity of dysphagia (feeling of food getting stuck) – ranging from temporary self resolving episodes to complete obstruction needing emergent endoscopic removal of the food.
Our understanding of EoE is still in its infancy stage since the diagnosis first came in to existence about 2 decades ago. However, rapid advances are being made to help us develop better treatment.
As the name suggests, esophagus is invaded with eosinophils, these cells are hallmark of allergic reaction. I like to compare it to smoldering case of mild Asthma, which has a similar pathophysiology. The inner lying of the esophagus over years looses its supple character and becomes ‘crepe’ like. This change is seen as rings and furrows during EGD, and eventually lead to stricture formation.
3 years ago, Mr. A and his entire family instead of driving to San Antonio for kids vacation, ended up in ER with food stuck in his esophagus. As I approached to meet Mr. A for the first time, the little eyes of his kids watched me curiously because the trip to Seaworld was now dependent on me.
Without wasting much time, Mr. A went for EGD – upper endoscopy. As expected, his esophagus showed telltale signs of EoE -rings and furrows.
The food was removed successfully with forceps and roth net (like a small fishing net). He did well, and the family continued their trip to San Antonio. It has been almost 3 years, Mr. A was treated with omeprazole to decrease acid reflux, and fluticasone spray which was swallowed. There is a subset of patients, whose disease responds well to antacid therapy and they do not warrant steroid ingestion, However, Mr A needd fluticasone for an intensive phase and was eventually tapered off. He has done remarkably well. His last EGD has revealed a supple esophagus with no biopsy evidence of EoE.
As we learn more about EoE, I believe the role of dietary factors would come to light. Already some physicians have tried various diets with success. One such diet which holds promise is the one in which the 6 most allergenic foods (Empiric Elimination Diets) are removed - dairy, egg, wheat, soy, peanut, tree nuts and fish. These diets have been shown to be very helpful in treating EoE, although they can be very difficult to follow. Foods are typically added back one at a time with follow up endoscopies to make sure that EoE remains in control.
We know that EoE is a complex disorder – still our understanding of the disease is evolving, and the treatments offered though effective and do not have a well defined end point. It’s important for patients to listen to their gastroenterologist for advice on managing EoE and figuring out when endoscopies are needed to check to see if the condition is getting better or worse.
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- Clear Lake Office (Wesbter)
1015 Medical Center Blvd
Suite 1300, Webster, TX 77598
Phone: (281) 557-2527
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7111 Medical Center Drive
Texas City, TX 77591
If you have any questions please do not hesitate to call my office 281-557-2527, and I would be more than happy to call you back and talk to you for free. I believe this is the least I can do to better the lives of people who are trying to find the right answers.