Diagnosis and Treatment of EoE

Recently a condition known as eosinophilic esophagitis (EoE), which is characterized by a buildup of inflammatory white blood cells (eosinophils) in the esophagus, has seen increased attention as it becomes more common and leads to potentially serious symptoms, including food impaction and dysphagia, or trouble swallowing.

The condition affects men about three times more often than women but occurs in people of all ages and ethnicities. Factors that may increase the risk of EoE include allergies and a family history of the condition.

Clinical awareness of EoE and similar conditions has led to research and discussion regarding diagnosis and treatment, some of which has been conflicting and even controversial.

Diagnosis of EoE

Diagnostic guidelines for EoE include an endoscopy, a biopsy to measure the amount of eosinophils in the esophagus, PPI therapy, and/or blood tests. However, EoE shares many symptoms with gastroesophageal reflux disease (GERD).

This makes the diagnosis of EoE more complex because physicians must first rule out GERD, and the conditions can co-exist or even cause each other, according to researchers at the University of North Carolina School of Medicine.

Patients should also undergo allergy testing if EoE is suspected because food allergies may be the root problem or make the symptoms significantly worse. In fact, many pediatric patients see significant relief just from eliminating food allergens.

Treatment of EoE

Many patients see positive results from PPI because it inhibits acid production in the stomach and acts as an anti-inflammatory, but the medication may not be appropriate for everyone.

For example, treating children with PPI may result in long-term complications. However, recent studies suggest that food elimination can ease symptoms in children.

Research from Sotiria General Hospital in Athens, Greece suggests that dietary changes can have a measurable effect on EoE symptoms. In a study based on 35 child participants, 26 out of 27 who followed a food elimination diet saw improvements in symptoms and were able to lower dependence on medication. The most common food allergens were milk and eggs. In biopsies, the presence of eosinophils dropped below the threshold for clinical diagnosis of EoE for all patients who followed the diet.

Another study from the International Society for Diseases of the Esophagus that came out this year further suggests that the elimination of cow’s milk can be an effective measure against EoE in children. The study authors compared the effectiveness of a swallowed fluticasone regimen to a simple elimination of cow’s milk over a six- to eight-week trial period. Study participants were 2 to 18 years old. The researchers found that esophageal eosinophil counts decreased below the diagnosis threshold in 64 percent of patients who eliminated milk and 80 percent of patients on fluticasone.

In cases where eliminating certain foods was not effective, patients may see success with a swallowed steroid like fluticasone in conjunction with PPI therapy. Research is currently underway on new drugs that may treat EoE, as well as new ways in which PPIs can play a role in treatment.

When dealing with a chronic gastrointestinal illness, it’s important to consult with your doctors often. Make regular appointments with your gastroenterologist so they can stay up to date on any changes in your condition and you can learn about new treatments or complementary therapies.  

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