Frequently asked Eosinophilic Esophagitis (EoE) Questions
Written by: Milli Gupta
Updated: September 18th, 2023
What causes eosinophilic esophagitis (EoE)? How is it diagnosed? Can EoE be cured? We’ve compiled a list of all your frequently asked questions on this condition to help you understand it better. Read through the questions or skip to find the answers you are looking for below!
First things first, what is eosinophilic esophagitis?
Eosinophilic esophagitis (EoE) is a chronic condition that affects the function of the esophagus the tube that connects the mouth to the stomach. it is a common cause of esophageal dysphagia (difficulty swallowing) and food impactions (when food becomes stuck in the esophagus). In many situations people may have to go to their local emergency to assist with removal of the food.
What can eosinophilic esophagitis feel like?
This depends on the age of the individual. For children over 12 years of age, the most common presentation is difficulty swallowing (also known as dysphagia). Recurrent and chronic (long term) dysphagia is commonly seen in this condition.
Other signs and symptoms can include:
- Sensation of reflux
- Chest pressure
- Painful swallowing (odynophagia) when eating
Individuals may develop sudden food obstruction or impaction, which can feel like choking. Many seek medical attention in the emergency department for this situation, and often removal of the food from the esophagus is needed to relieve the sensation. Individuals with EoE may have anxiety around eating due to fear of choking. In some instances, anxiety and hypervigilance can persist even after confirmed healing of the esophagus with treatment.
On the other hand, some individuals don’t describe having difficulty with foods. This may be that they have developed ways to manage the difficulties of swallowing certain textures of foods by adjusting how they eat or drink. They may also have food aversions. It is common to see a 4-10 year gap between start of symptoms and time to diagnosis by a doctor.1 Delayed diagnosis results in delayed treatment and increases the risk of developing esophageal fibrosis (scarring in the esophagus that causes narrowing).1 It can be challenging to differentiate EoE from eating disorders, and because of this, it is important to seek a health care professional to help differentiate between these two. EoE can be present in those with either difficulties swallowing, or those that have behaviours that compensate for textures of food.
IMPACT is an acronym to describe how a person can modify their behaviour of eating/drinking to overcome challenges with food.2
- Imbibe fluids with meals to lubricate foods
- Modifying foods (cutting up foods into small bites)
- Prolonged mealtime
- Avoidance of hard textured foods
- Chewing excessively
- Turning away pills 2
How common is Eosinophilic Esophagitis?
Eosinophilic esophagitis (EoE) is a chronic condition that emerged as a disease entity in the 1990s. It is common in all age groups with the highest affected ages of 5-14 years, and 20-45 year3. Men are 3-4 times more likely than women to have this condition. Incidence and prevalence are both rising across the world, but most publications are from white majority populations, therefore non-white majority populations are under reported in the literature. EoE does not reduce life span, so prevalence is expected to rise for the foreseeable future.3 In Calgary, Alberta Canada4, prevalence has increased from 10.7 to 33.7 persons/100,000, and incidence rose from 2.1 to 10.7 cases/100,000 from 2004-2008. This is the last reported data for adult Canadians to date. Other countries in Europe and North America have shown a steady rise in rates of incidence and prevalence.
What causes Eosinophilic Esophagitis?
Research into how one develops EoE is still being studied. It is believed to be triggered by abnormal type 2 immune response to food and likely aeroallergens (airborne susbstances or inhalants such as pollens, spores, and other particles that cause allergic disorders) 5,2. Type 2 immune system response refers to the type of immune system activation occurring in the body. Type 2 immune response is seen in allergic disorders like asthma. But the development of this disorder is not simply an allergic reaction. It is a complex interaction between genetics and antigen triggers in the environment. 6 Details on the exact ways in which EoE develops, and why some people develop severe disease is still being studied. 6
Atopic (allergic disorders) conditions are common to see in those with EoE. More than 75% of people with EoE have food allergies, atopic dermatitis, allergic rhinitis, nasal polyps, and/or asthma 7. Therefore, individuals with a personal history of atopy, frequent dysphagia and/or altered eating habits should talk to their doctor about being evaluated for the diagnosis of EoE.
How is Eosinophilic Esophagitis diagnosed?
Diagnosis requires the right clinical history (outlined above) and biopsies from a gastroscopy (also known as scope) showing high eosinophil counts. The findings on biopsies can be related to other conditions like gastroesophageal reflux disease (GERD), which is why It’s important to be seen by a gastroenterologist, who will assist in figuring out if the person has EoE, GERD or another swallowing disorder. If an individual has had a history of food impactions but never had a scope, its important they seek out referral to gastroenterology because more than 75% of people will have an identifiable cause.8
Can Eosinophilic Esophagitis be cured?
There is no cure known at this time for EoE. However, we know that consistent and regular therapy reduces the risk of narrowing and inflammation in the esophagus. It is also important to note that taking treatment for a few months and then stopping can cause some individuals to redevelop inflammation. The development of inflammation can result in repeat symptoms and difficulties with food. Depending on how serious the EoE condition is, some people can redevelop strictures or scars in their esophagus that can result in food obstruction. Therefore, most experts recommend that if someone has a previous history of food impactions, have required repeated dilations or are unable to access emergency services in case of food impaction, they should remain on long term treatment.9
Can Eosinophilic Esophagitis cause cancer?
At this time there are no publications that show a direct link between eosinophilic esophagitis and esophageal cancer 10.
Learn more about Eosinophilic Esophagitis here.
Funding for this initiative was provided by Sanofi-Aventis Canada Inc
References
- Schoepfer AM, Safroneeva E, Bussmann C, Kuchen T, Portmann S, Simon HU, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology [Internet]. 2013;145(6):1230-1236.e2. Available from: http://dx.doi.org/10.1053/j.gastro.2013.08.015
- Hirano I, Furuta GT. Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis. Gastroenterology. 2020.
- Arias Á, Lucendo AJ. Epidemiology and risk factors for eosinophilic esophagitis: lessons for clinicians. Expert Review of Gastroenterology and Hepatology. 2020
- A.A.N. Syed, C.N. Andrews, E. Shaffer, P. Belletruti, M. Stewart, S.J. Urbanski. The rising incidence of eosinophilic oesophagitis is associated with increasing biopsy rates: A population-based study. Aliment Pharmacol Ther. 2012
- Straumann A, Bauer M, Fischer B, Blaser K, Simon HU. Idiopathic eosinophilic esophagitis is associated with a TH2-type allergic inflammatory response. J Allergy Clin Immunol. 2001;
- O’Shea KM, Aceves SS, Dellon ES, Gupta SK, Spergel JM, Furuta GT, et al. Pathophysiology of Eosinophilic Esophagitis. Gastroenterology. 2018;154(2):333–45.
- Van Rhijn BD, Bredenoord AJ. Management of eosinophilic esophagitis based on pathophysiological evidence. J Clin Gastroenterol. 2017;51(8):659–68.
- Birk M, Bauerfeind P, Deprez PH, Häfner M, Hartmann D, Hassan C, et al. Removal of foreign bodies in the upper gastrointestinal tract in adults: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline. Endoscopy. 2016;48(5):489–96.
- Straumann and Katzka. Diagnosis and Treatment of Eosinophilic Esophagitis. Gastro 2018 Jan 154 (2):346-359.
- Syed A, Maradey-Romero C, Fass R. The relationship between eosinophilic esophagitis and esophageal cancer. Dis Esoph 2017; 30(7): 1-5
