Difficulty Swallowing? Eosinophilic Esophagitis Could Be the Reason

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By Kheng-Jim Lim, MD

Eosinophilic esophagitis — also known as EoE — is a chronic medical condition causing inflammation in the esophagus that can lead to swallowing difficulties and ultimately food getting stuck in your throat.

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And while EoE is relatively uncommon, cases are on the rise, especially among men in their 20s and 30s.

If you experience symptoms of EoE, don’t wait until it becomes an emergency to seek medical care. With the proper diagnosis and treatment, EoE can be successfully managed and treated so you lead a symptom-free life.

Penn Medicine Princeton Medical Center’s Center for Digestive Health offers comprehensive gastrointestinal healthcare services, including specialized care for diseases of the esophagus.

Understanding EOE

Eosinophilic esophagitis occurs when the immune system overreacts and sends an abundance of eosinophils (a type of white blood cell) to the esophagus. The pooling of these blood cells causes inflammation that keeps the esophagus from contracting properly.

Though the exact cause is unknown, eosinophilic esophagitis is believed to be triggered by food allergies. It may also be associated with acid reflux.

The condition affects an estimated 1 in 2,000 people in the United States, according to the American Partnership of Eosinophilic Disorders, and can occur in children as well as adults.

However, it is more prevalent among young men.

In addition, people who have other allergic diseases, such as rhinitis, asthma or eczema, are at greater risk for developing EoE, as are people who have family members with the condition.

Symptoms

Common symptoms of EoE include:

  • Difficulty swallowing.
  • Food impaction, food getting stuck in the esophagus.
  • Upper abdominal pain.
  • Nausea and vomiting.
  • Reflux pain that is often centrally located and may not respond to antacids.

Trouble swallowing is typically one of the first signs of EoE. Yet in many instances, people wait until food gets stuck in the esophagus, which often leads to an emergency room visit.

If you experience difficulty swallowing or other signs of EoE, see your primary care physician, who may refer you to a gastroenterologist for testing and diagnosis.

If left untreated, the chronic inflammation caused by EoE can lead to scarring and narrowing of the esophagus that would require a dilation procedure.

Diagnostic Testing

The diagnostic process for EoE 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 to test for excessive white blood cells.

Once a diagnosis is confirmed, the gastroenterologist may refer you to an allergist who can conduct further testing to help identify the specific food trigger.

Treatment

The primary goal of treatment for EoE is to reduce inflammation and improve symptoms.

Treatment may include:

  • Dietary modifications. This first-line treatment includes dietary changes such as the six-food elimination diet, which removes dairy, wheat, soy, eggs, nuts and seafood from the diet. The goal is to remove potentially allergenic food and reintroduce them one at a time to identify the cause of the allergic reaction. Some patients may benefit from elemental diets that consist of amino acid- based formulas, which provide complete nutrition without triggering allergic reactions.
  • Medications. There are several medications that may be used to help reduce symptoms of EoE, including proton pump inhibitors, steroids, and a monoclonal antibody called dupilumab. Proton pump inhibitors that are acid suppressors that may relieve reflux symptoms and in some patients help to improve EoE.
  • Steroids, such as budesonide/fluticason, are effective in reducing inflammation in the esophagus. These medications, which are typically used to treat asthma and have not been approved by the Food and Drug Administration (FDA) for the treatment of EoE, are usually administered through an inhaler or a nebulizer.
  • Dupilumab is an injectable medicine that works to block inflammatory pathways, decrease the allergic response and prevent inflammation of the esophagus. The FDA approved dupilumab as a treatment for EoE in May 2022.
  • Esophageal dilation. Patients with EoE who experience difficulty swallowing due to esophageal narrowing may be candidates for esophageal dilation. Esophageal dilation involves the use of an endoscope and dilating balloon or plastic dilators to stretch the esophagus, which can improve symptoms.
  • 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 for EoE depends on the patient’s symptoms, the severity of inflammation, and the presence of other medical conditions. Treatment plans are customized for each individual, and patients should be monitored closely for symptoms and adverse effects.

At the Center for Digestive Health, gastroenterologists, allergists, and nutritionists work together to create a comprehensive treatment plan that’s tailored to meet each patient’s unique needs.

Eosinophilic esophagitis can be an uncomfortable and frustrating condition. Paying attention to the warning signs and seeking prompt medical care can help you swallow easier — and avoid a trip to the emergency room.

To schedule a consultation with a Center for Digestive Health provider or for more information, call (609)-853-6390 or visit princetonhcs.org/EOE.

Kheng-Jim Lim, MD, is board certified in gastroenterology and internal medicine and a
member of the Medical Staff at Penn Medicine Princeton Health.

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