Eosinophilic oesophagitis is a condition where a specific type of white blood cell, called eosinophils, builds up in the lining of the oesophagus. This accumulation leads to inflammation, which can cause damage to the oesophagus and affect its ability to function properly. Symptoms often include:
- Difficulty swallowing (dysphagia)
- Food impaction (food getting stuck)
- Heartburn and chest pain
Why Does Eosinophilic Oesophagitis Happen?
The exact cause of eosinophilic oesophagitis is not entirely understood, but several factors may contribute:
- Allergic reactions: It is thought to be triggered by an allergic reaction to certain foods or environmental allergens, such as dust mites, pollen, and pet dander. In some cases, food allergies, particularly to dairy, eggs, wheat, soy, and nuts, are identified as triggers.
- Genetic predisposition: There may be a genetic component, as eosinophilic oesophagitis is more common in individuals with a family history of allergic conditions.
- Immune system response: The immune system’s abnormal response to these allergens causes an inflammatory reaction, leading to the recruitment of eosinophils to the oesophagus.
When Does Eosinophilic Oesophagitis Occur?
Eosinophilic oesophagitis can occur at any age but is most commonly diagnosed in:
- Children: It often presents in childhood, especially between the ages of 3 and 10, and can sometimes be mistaken for gastro-oesophageal reflux disease (GORD).
- Adults: It may also develop later in life, particularly when food allergies or environmental sensitivities become more pronounced.
- Geographical variations: It is more common in Western countries, possibly due to differences in diet and environmental allergens.
How to Treat Eosinophilic Oesophagitis
Treatment for eosinophilic oesophagitis focuses on reducing inflammation and managing symptoms:
- Dietary changes:
- Elimination diet: Identifying and removing specific trigger foods from the diet can be effective in reducing symptoms. This may involve food trials or an elimination diet supervised by a dietitian.
- Six-food elimination diet: Often, removing common allergens such as dairy, eggs, wheat, soy, peanuts, and tree nuts can be helpful.
- Elemental diet: For more severe cases, an elemental diet, consisting of amino acid-based formulas, can be used to allow the oesophagus to heal without allergens.
- Medications:
- Topical steroids: These are commonly prescribed to reduce inflammation in the oesophagus. Fluticasone and budesonide are examples of topical steroids that can be used.
- Systemic corticosteroids: In more severe cases, systemic corticosteroids may be required to quickly reduce inflammation. These are usually used for a limited period due to potential side effects.
- PPI therapy: Proton pump inhibitors (PPIs) can help control heartburn symptoms and reduce the risk of food getting stuck.
- Endoscopic treatments:
- Dilation: In some cases, if the oesophagus is narrowed due to inflammation and scarring, endoscopic dilation (stretching of the oesophagus) may be performed to relieve symptoms of food impaction.
- Biopsy: Regular biopsies of the oesophagus may be taken to monitor eosinophil levels and assess treatment effectiveness.
- Ongoing management:
- Regular monitoring: Follow-up visits with a healthcare provider are necessary to monitor symptoms and adjust treatment as needed.
- Symptom management: Understanding individual triggers and avoiding them can help reduce symptoms over time.
- Education: Educating patients and their families about managing food allergies and sensitivities is crucial for long-term management of eosinophilic oesophagitis.
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