Eosinophilic Esophagitis: Symptoms, Causes & Treatment
التهاب المريء اليوزيني
Eosinophilic esophagitis is a chronic immune disease in which a type of immune cell (eosinophils) accumulates in the esophageal lining, often as an allergic reaction to foods. It causes difficulty swallowing, food impaction, chest pain, and heartburn that does not improve with acid medications. It is managed with dietary modification, medications, and esophageal dilation when needed.
What is Eosinophilic Esophagitis?
Eosinophilic esophagitis is a chronic disease affecting the esophagus, in which a large number of immune cells known as eosinophils (a type of white blood cell linked to allergy) accumulate in the esophageal lining, causing chronic inflammation. It is thought in many cases to be a chronic allergic reaction to some foods (such as milk, wheat, and eggs) or environmental allergens.
This inflammation makes the esophagus stiff, narrow, and less flexible, so characteristic symptoms appear that differ by age: in adults and adolescents the most prominent are difficulty swallowing solid food and food impaction in the esophagus (a distinctive symptom that may require emergency intervention), chest pain, and heartburn that does not improve with usual acid medications. In young children it may appear as food refusal, vomiting, abdominal pain, and poor growth. Affected people often have a history of allergy, asthma, or eczema.
It is important to distinguish this disease from gastroesophageal reflux, because despite some symptom overlap, eosinophilic esophagitis does not respond to acid medications alone and has a different immune cause. It is diagnosed by esophageal endoscopy and biopsies showing eosinophil accumulation. There is no definitive cure, but it is well controllable through three axes: dietary modification by removing allergens (often under a dietitian's and allergist's supervision), medications (acid suppressants, swallowed topical steroids, and modern biologic therapies), and endoscopic esophageal dilation when there is narrowing. Early detection prevents esophageal narrowing and its complications.
Symptoms
- Difficulty swallowing solid food and food impaction in the esophagus.
- Chest pain and heartburn not improving with acid medications.
- In children: food refusal, vomiting, abdominal pain, poor growth.
Causes
- A chronic immune (often allergic) reaction to foods or environmental allergens.
- Accumulation of eosinophils in the esophageal lining.
- A link to a history of allergy, asthma, and eczema.
Diagnosis
- Esophageal endoscopy and biopsies showing eosinophil accumulation (the basis of diagnosis).
- Assessing food and environmental allergy.
- Distinguishing it from gastroesophageal reflux.
Treatment
Dietary modification
- Removing allergenic foods (often under a dietitian's and allergist's supervision) then reintroducing them to identify the trigger.
Medications
- Acid suppressants, swallowed topical steroids, and modern biologic therapies.
Dilation
- Endoscopic esophageal dilation when there is narrowing causing food impaction.
This content is educational and does not replace consulting a gastroenterologist.
Complications
- Esophageal narrowing and recurrent food impaction.
- Esophageal tear, rarely, with severe impaction.
- Poor growth in children and impact on quality of life.
Prevention
- There is no proven prevention, but identifying and avoiding allergens reduces flares.
- Adhering to treatment and follow-up to prevent narrowing.
- Early detection with persistent difficulty swallowing.
When to see a doctor
See a doctor for persistent difficulty swallowing or heartburn and chest pain that do not improve with acid medications, or food refusal and poor growth in a child. Go to the emergency department immediately for food impaction in the esophagus and inability to swallow or clear saliva. Book an appointment with a gastroenterologist on ClinicsJo.