Eosinophilic oesophagitis (EoE)
Eosinophilic oesophagitis, also known as oesophageal asthma, is a rare disorder that affects about one in 3,000 people in the UK. It causes chronic inflammation of the tissue in the food pipe (oesophagus). For some people, it’s severe and painful, while for others, it’s mild and causes only slight discomfort.
Overview | Symptoms | Urgent care | Diagnosis | Causes | Risk factors | Treatment | Video FAQs
Symptoms of eosinophilic oesophagitis can vary by person and age. On this page, we’ll discuss EoE in adults. Though, infants and children can also get EoE.
Symptoms
One of the identifying symptoms of EoE is difficulty swallowing. People with other conditions, such as GORD, might also struggle to eat and have similar symptoms. Due to this, your doctor may perform tests for or believe you have GORD initially. Our blog can explain more alternative causes: Throat pain and trouble swallowing? Find out why
Symptoms include:
- Difficulty swallowing
- Heartburn or reflux
- Feeling tired/ fatigue
- Feeling or being sick
- Weight loss and malnutrition
- Bringing food back up (regurgitation)
- Food stuck in the oesophagus (impaction)
- Centrally-located chest pain that does not respond to antacids
Some people instinctively change the way they eat to cope with these symptoms. For example, you may chew your food excessively, take longer than others to finish your meal, favour soft foods, or drink a lot while eating.
The condition can also prevent individuals from enjoying social interactions, such as eating a meal with other people.
When to seek emergency help
If food becomes stuck in the oesophagus, it can lead to serious situations in which your oesophagus may become completely obstructed. If you experience difficulty breathing, noisy breathing, or choking, seek emergency help.
Book an appointment with our specialist if you have a persistent feeling of something stuck in your throat.
Diagnosis
When you visit our specialist (a gastroenterologist), we’ll ask you some questions regarding your symptoms. We’ll need to know what symptoms you experience and how frequent and severe they are. Our gastroenterologist will also ask about your and your family’s medical history.
If we suspect EoE, we may perform a barium swallow test or an upper endoscopy (gastroscopy). We might also perform blood tests.
Barium swallow involves you swallowing barium sulphate before we take a series of X-rays. We call this an oesophagogram.
Upper endoscopy involves examining your upper digestive tract with an endoscope passed through your mouth. An endoscope is a thin, flexible tube that has a light and a camera attached to it. We may also take a biopsy (a small tissue sample). The endoscopy findings will inform our treatment recommendations.
Visit our blog to learn more: How does a private endoscopy for eosinophilic oesophagitis (EoE) work?
Causes
EoE is brought about by having too many eosinophils (white blood cells) in the tissues of the food pipe. Why this happens in some people is not fully understood. However, scientists believe it’s linked to the body’s immune response to certain foods or environmental allergens.
As a result, we often find EoE in people with allergy-related conditions, such as asthma, eczema, and rhinitis. Another reason may be that a generic disorder causes an overabundance of white blood cells.
Some people with EoE experience oesophageal strictures (narrowing in the food pipe), further limiting their swallowing ability.
Risk factors
If you have a family history of EoE, you may have a higher risk of it. While you can be any age to experience EoE, people between 30 and 50 years are more likely to receive a diagnosis. Men also tend to be diagnosed with EoE more than women.
We associate the following factors with EoE as well:
- Caucasian race
- Climate – dry or cold
- Season – higher pollen levels
- A lack of early exposure to microbes
- Atopy (Genetically more likely to develop allergic diseases)
Gut barrier function (The barrier between your gut and bloodstream)
Treatment
Our gastroenterologist may recommend a combination of lifestyle changes and medications for EoE, depending on how severe your symptoms are. We run through these treatment options below.
Dr Sami is an expert in his field in this and is one of the co-authors of the UK guidelines on EoE.
Lifestyle changes
Diet can be a big part of treating EoE. Changing your diet can help you identify which foods, if any, may be triggering your EoE. We call this an elimination diet. We may recommend a two, four or six-food elimination diet, where you remove the most common allergens from your diet.
Common allergens
- Dairy products, such as milk
- Fish/shellfish
- Wheat
- Eggs
- Soya
- Nuts
This process can take a few months, and you may not see an immediate improvement after removing certain foods. You may be reacting to environmental allergies instead of food.
Environmental allergens
- Animals
- Dust mites
- Moulds
- Pollen
Endoscopic dilatation
If you have oesophageal narrowing, we can use endoscopic dilatation to widen your oesophagus. Endoscopic dilatation involves using an endoscope (thin, flexible tube) to insert a dilating device at the place of the narrowing. We then use the device to slowly stretch the narrowing.
It could take a few sessions to widen your oesophagus sufficiently. You may also need follow-up procedures if you get oesophageal narrowing again.
Dr Sami is the lead author of the UK oesophageal dilatation guidelines and one of the key opinion leaders in this field.
Medications
To control the inflammation and prevent narrowing in your oesophagus, we may recommend proton pump inhibitors (PPIs) and topical steroids.
Proton Pump Inhibitors
If acid reflux inflames your eosinophilic oesophagitis, we may prescribe a PPI. This drug works on the cells that line the stomach, reducing acid production. It can also help reduce the number of eosinophils in your oesophagus.
Swallowed Budesonide (weak steroid)
Jorveza is the first licenced drug to treat EoE. The active substance in Jorveza is a weak corticosteroid called budesonide. Corticosteroids work by attaching to receptors of immune cells. This decreases the release of substances involved in the inflammation process. This treatment has the highest success rate compared to others.
Learn more about these treatment methods in our blog: How do we treat EoE? We also discuss endoscopic dilatation, a treatment for oesophageal narrowing.
Endoscopy
If you experience food impaction, you may need an endoscopy to remove the food bolus. Food impaction can cause chest and neck pain and cause you to bring your food back up (regurgitation). Depending on the size of your food bolus and your symptoms, you may need an endoscopy as an emergency procedure.
Book an appointment
If you experience difficulty swallowing, visit our gastroenterologist to receive testing for EoE.
Our specialists complete a thorough consultation and assessment before recommending appropriate tests. Your test results and associated symptoms will help our experts form a tailored treatment plan for you.
Book a consultation today to get started.
