Eosinophilic Esophagitis: Trouble Swallowing, Stuck Food and Reflux That Won't Settle

What it involves

MedlinePlus explains that eosinophilic esophagitis, or EoE, is a chronic disease of the esophagus, the tube that carries food and liquids to the stomach. White blood cells called eosinophils build up in the esophagus, causing damage and inflammation that lead to pain, trouble swallowing and food getting stuck.

Who this is for

• Adults with trouble swallowing solid foods or food that gets stuck in the throat or chest.
• Patients whose heartburn or reflux does not get better with acid-reducing medicine.
• People with allergic conditions such as hay fever, eczema, asthma or food allergies.
• Anyone with a family member who has eosinophilic esophagitis and new swallowing trouble.

What to expect

• Questions about which foods stick, how long this has gone on, reflux symptoms and allergies
• An exam that includes your throat, neck and belly and a review of your medicines
• Blood work, which the practice offers, to check for other conditions
• A referral to a gastroenterologist for the upper endoscopy and biopsy that diagnose EoE

Go to the ER if food is stuck and you cannot breathe

Call 911 or go to the ER if food is stuck and you cannot swallow your own saliva, if you are drooling, or if you have trouble breathing, wheezing, a swollen tongue or throat, or hives after eating, which can be a severe allergic reaction. Chest pain with sweating, or pain spreading to the arm or jaw, can be a heart problem rather than the esophagus, and the chest pain guide explains which pain needs 911. The anaphylaxis guide lists the warning signs of a severe allergic reaction.

How it differs from ordinary reflux

MedlinePlus notes that EoE is rare but is being diagnosed more often because it is newly recognized, and that some people who think they have reflux may actually have EoE. A telltale sign is reflux that does not get better with medicines. The acid reflux guide covers the common condition first, and the difficulty swallowing guide describes the many other causes of swallowing trouble, including narrowing, rings and spasm.

Why it happens and who is at risk

Researchers are not certain about the exact cause. MedlinePlus says they think it is an immune system or allergic reaction to foods or to substances in the environment such as dust mites, animal dander, pollen and molds, and that genes may play a role. It can affect anyone but is more common in males, in people with other allergic diseases such as hay fever, eczema, asthma and food allergies, and in people with family members who have it. The food allergy guide and the asthma guide describe two related conditions.

How it is diagnosed

Your provider takes a thorough history, because other conditions have the same symptoms. MedlinePlus says the diagnosis is made with an upper GI endoscopy, in which a flexible tube with a camera looks at the esophagus, and with a biopsy, where small tissue samples are checked for a high number of eosinophils. The biopsy is the only way to diagnose EoE. Blood tests may check for other conditions or specific allergies. The practice offers blood work, and endoscopy is arranged by referral.

Treatment: medicines and diet

There is no cure, but MedlinePlus says treatment can manage symptoms and prevent further damage. It lists steroids that are usually swallowed in liquid or inhaled form, acid suppressors called proton pump inhibitors and monoclonal antibodies for adults and children over 12. Diet choices include an elimination diet, which removes common allergy foods for several weeks and adds them back one at a time, and an elemental diet. If the esophagus narrows, a procedure to stretch it may be needed. These are specialist decisions.

When to be seen

Book a visit when swallowing trouble lasts more than a couple of weeks, when food sticks more than once, when heartburn continues despite medicine, or when you are losing weight or avoiding foods because of the problem. The unintentional weight loss guide explains why weight loss needs a visit. Wear and bleeding in the stomach lining are covered in the peptic ulcer guide. Bring a note of which foods stick and any known allergies.

Sources

• MedlinePlus: Eosinophilic Esophagitis