Eosinophilic Esophagitis: An Emerging Allergic Disorder Affecting the Esophagus

Introduction to Eosinophilic Esophagitis
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by infiltration of eosinophils in the esophageal mucosa. It is also known as allergic eosinophilic esophagitis. The exact cause behind this condition is not known but it is considered as a type-1 hypersensitivity reaction that may be triggered by some foods, inhalant allergens or other environmental factors.

Symptoms of Eosinophilic Esophagitis

The classic and most common symptoms of EoE include dysphagia or difficulty in swallowing and food impaction. Apart from this, patients may also experience symptoms like abdominal pain, heartburn, chest pain, vomiting and weight loss. However, many patients may remain asymptomatic or may report symptoms commonly seen in gastroesophageal reflux disease (GERD) like acid reflux. The symptoms often worsen with time if left untreated.

Diagnosis of Eosinophilic Esophagitis

Eosinophilic Esophagitis is diagnosed by performing upper endoscopy along with biopsy of the esophagus. During endoscopy, esophageal mucosa may show signs of superficial furrows, ridging and narrowing of the lumen. However, endoscopic findings are not always diagnostic. Histological findings are crucial for diagnosis which show >15 eosinophils per high power field in one or more biopsy specimens from esophagus. Other potential causes of esophageal eosinophilia need to be ruled out.

Causes and Pathophysiology of Eosinophilic Esophagitis

EoE is considered as a chronic immune/antigen-mediated disease where certain food proteins or aeroallergens trigger an aberrant immune response in the esophagus. Such inciting agents are referred to as triggers. In atopic individuals, these triggers activate T-helper 2 (Th2) lymphocytes and mast cells leading to production of Th2 cytokines. This causes local eosinophilic inflammation and esophageal tissue remodeling. Genetic predisposition also plays a role in EoE as it commonly occurs in families.

Treatment of Eosinophilic Esophagitis

The goals of EoE treatment are symptom control and prevention of complications by suppressing esophageal inflammation. Treatment strategies depend on age of the patient and severity of the disease. The mainstay of treatment involves identification and elimination of dietary triggers through diet therapy. Topical corticosteroids are given to control inflammation. If needed, acid suppressants are added. Severe or resistant cases may require focused esophageal dilation or topical mitomycin-C application. Proton pump inhibitors alone are not effective for treatment of EoE.

Prognosis and Complications of EoE

If untreated, EoE can lead to complications like esophageal strictures, chest pain, dysphagia and food impaction requiring hospitalization. The prognosis is good with adherence to proper treatment which includes elimination diet and/or topical steroids. Complete resolution of symptoms is not always possible but long-term control can be achieved. Risk of acid reflux or Barrett's esophagus is not increased with EoE. Repeated dilation procedures may carry a small risk of perforation. With increasing awareness, proper diagnosis and management, long-term outcomes continue to improve.

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