Have Trouble Swallowing? It Could Be Allergies

Eosinophilic esophagitis (e-o-sin-o-FILL-ik uh-sof-uh-JIE-tis), or EoE, is a relatively new diagnosis for a chronic, allergic inflammatory condition of the esophagus. Because the symptoms of EoE can mimic those of gastroesophageal reflux disease (GERD), it can go undiagnosed.

Patients with EoE have a large number of eosinophils (a type of white blood cells) in the tissue of the esophagus. Eosinophils are common in the digestive tract, but an excessive buildup of these cells in the esophagus may be caused by a reaction to foods, allergens or acid reflux. According to the American Academy of Allergy, Asthma & Immunology, the majority of patients with EoE have a family history of allergies or asthma. EoE can occur at any age, and it is more common in males than females.

Symptoms:

There are a variety of symptoms that patients with EoE might experience including:

• difficulty swallowing
• food getting stuck in the esophagus
• persistent heartburn
• abdominal or chest pain
• nausea and vomiting

Children with EoE may also experience difficulty with feeding, malnutrition and weight loss.

Diagnosis:

The symptoms that most tend to indicate a diagnosis of EoE are patients having difficulty swallowing and getting food stuck in their throat. Some patients have to go to the emergency room to have the food physically removed from their esophagus.

Testing for this disease requires an endoscopy, which is an outpatient procedure performed by a physician who uses an endoscope to examine the inside of the upper digestive system. During the endoscopy, a biopsy of the tissue of the esophagus is taken and a diagnosis of EoE is made by both a gastroenterologist and a pathologist.

Since EoE is more common in people with allergies, those diagnosed are referred for allergy testing. An allergist will perform skin or food patch testing to determine if their diagnosis of EoE is caused by a food allergy.

Treatment:

If the cause of EoE is determined to be an allergy to a particular food or foods, it’s important to work with a nutritionist and an allergist to help eliminate those foods from your diet. Quite often, simply eliminating the offending food can result in a resolution of the symptoms within two to three months’ time.

Medications such as proton pump inhibitors (PPI’s) – common brand names include Prilosec and Nexium – or swallowed inhaled corticosteroids (such as Flovent or Pulmicort) may be prescribed.

There has been a rise in the number of people diagnosed with eosinophilic esophagitis over the past 10 years. Some research suggests this increased incidence is related to a rise in the number of patients diagnosed with asthma and allergies. If you suspect you may have this condition, contact your doctor’s office to determine the best plan to diagnose your condition.

About Dr. Lynda Kabbash

Dr Lynda Kabbash joined Harvard Vanguard in 1999. She received her medical degree from McGill University and residency training in Internal Medicine and Allergy and Immunology at the Montreal General Hospital and Royal Victoria Hospital. She is a Fellow of the Royal College of Physicians and Surgeons of Canada, certified in Internal Medicine and Allergy and Clinical Immunology. She is also a Fellow of the American Academy of Asthma, Allergy and Immunology. Dr Kabbash is involved in the Norfolk District Medical Society, Massachusetts Medical Society and the American Medical Association. She has served on the Board of Trustees at Cotting School in Lexington until one year ago.

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