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Allergy Today Advice Article: What is Eosinophilic Oesophagitis (EoE)

EoE is an inflammation of the esophagus. This is the tube that sends food from the mouth to the stomach. The inflammation is caused by the large numbers of white blood cells called eosinophils found in the tissue of the esophagus, where normally there are no eosinophils. online-marketing-hIgeoQjS iE-unsplash-209

The inflammation can cause the esophagus to narrow to the point that food gets stuck. This is called food impaction and is a medical emergency.

Eosinophils are a type of white blood cell that cause allergic inflammation seen in allergic rhinitis and asthma. Most cases are seen in people with other allergies such as food allergy, allergic rhinitis (hay fever) and asthma. Eosinophils can accumulate in the esophagus in response to food and/or airborne allergens and can cause inflammation and damage to the tissue.

EoE is estimated to affect around one in 2,000 people (children and adults) in Australia and New Zealand.

Young children with EoE may refuse food or need food to be pureed, and not be growing normally. Older children may have recurring stomach pain, and trouble swallowing or vomiting. Teenagers and adults are most likely to have difficulty swallowing and severe acid reflux (heartburn) that does not respond to medications. EoE is considered to be a chronic condition and is not generally outgrown.

If EoE is suspected, children should be referred to a paediatric gastroenterologist for an endoscope. A tissue sample (biopsy) will be taken at the same time and examined to look for eosinophils. If EoE is diagnosed, ideally patients should be managed by gastroenterologists, and co-managed with clinical immunology/allergy specialists and specialist dietitians.

The main focus of treatment is to reduce or eliminate the eosinophils in the esophagus. This may involve a combination of medications, special diet, allergen avoidance and allergy treatment. Options need to be discussed with the patient and family, and tailored to the individual.

EoE is a complex disorder, and researchers internationally are investigating ways to make diagnosis easier than the invasive procedure currently required; into more effective medications; and better understanding of diet manipulation as part of treatment.
 

Penny Jorgensen, Allergy Advisor
Allergy New Zealand

References:

https://www.ausee.org/whatisegid.htm

https://www.allergy.org.au/patients/food-other-adverse-reactions/eosinophilic-oesophagitis

https://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis

https://www.niaid.nih.gov/clinical-trials/eosinophilic-esophagitis-studies