Eosinophilic Esophagitis

About eosinophilic esophagitis

Eosinophilic esophagitis (EoE) is a disorder of the esophagus that can affect patients of any age, and typically presents with difficulty swallowing, food getting stuck and sometimes chest pain or an abnormal sensation in the chest and upper abdomen. The eosinophil is a specialized type of immune cell that plays an important role in many allergic disorders, and EoE results from an abnormal accumulation of eosinophils in the lining of the esophagus.

What causes eosinophilic esophagitis?

Understanding what causes EoE is an area of active investigation. A number of important genetic factors have been identified that may interact with environmental and dietary factors to cause the disease. 

How is eosinophilic esophagitis diagnosed?

It is critical to first be sure of the diagnosis. Acid reflux (GERD) is a common disorder that can also lead to increased eosinophils in the esophagus. Because the treatment of GERD and EoE are very different, the first step is often a period of acid suppression followed by an endoscopy with biopsies. The presence of eosinophils despite acid suppression, especially in the context of swallowing symptoms, strongly supports the diagnosis of EoE.

How is eosinophilic esophagitis treated?

The mainstays of treatment for eosinophilic esophagitis include dietary changes and medications that suppress the eosinophils, as well as additional experimental therapies, which sometimes are used for related disorders such as asthma.  We individualize treatment approaches for each patient based on their disease, the results of allergy testing and their initial response to therapy.

Diet: The Division of Gastroenterology at Mass General works closely with the Mass General Food Allergy Center to employ state-of-the-art diagnostic testing for common environmental and dietary allergens. Dietary treatment of EoE can involve removing confirmed or suspected allergens from the diet, or sometimes instituting a broad elimination diet with the careful reintroduction of specific food groups. We work closely with specialized nutritionists to help guide patients and successfully implement appropriate dietary changes.

Medications: Steroids that exert a local effect on the esophagus can be very effective at reducing the eosinophil numbers and controlling the symptoms of EoE. Using a steroid inhaler, but swallowing rather than inhaling the medication, can coat the esophagus and often leads to improvement without the risks and side effects of systemic steroids.

Experimental therapies: Additional medications that target other aspects of eosinophil function and allergic processes are sometimes also used. These include antihistamines, inhibitors of molecules called leukotrienes, medications that stabilize mast cells (a closely related type of immune cell), and molecules that target circulating substances such as interleukin-5 (IL-5).  

How do I make an appointment with an EoE specialist?

How can I participate in a clinical trial?

What areas of EoE research are being pursued at the Gut-2-Health Center?