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Difficulty swallowing? It could be eosinophilic esophagitis (EoE)

If you often experience trouble swallowing that won’t go away, you may be living with eosinophilic esophagitis, or EoE. This newly recognized chronic immune condition wasn’t on the radar until the 1990s but by some estimates, it affects 1 in every 2,000 people.

Unless you’ve already been diagnosed with EoE, it’s probably not a condition you’ve heard of before. And even among those living with EoE, there are some common misconceptions. Here are a few things to know about EoE from the team at Baylor Scott & White Research Institute’s Center for Esophageal Research.

What is eosinophilic esophagitis, or EoE?

Eosinophilic esophagitis is an allergic condition that affects the esophagus and makes it difficult to swallow. As happens with conditions like asthma and eczema, EoE is triggered as a reaction by the immune system. As white blood cells build up in your esophagus, this causes inflammation and damage to the esophagus.

In the case of EoE, the trigger is often food-related but can be exacerbated by environmental conditions, as research has also shown that EoE can be more active in the spring and summer when environmental allergens are higher. EoE most commonly impacts children and young to early middle-aged adults.

Despite its prevalence, little was known about the condition prior to the 1990s. Fortunately, research in recent years is bringing many new insights to the discussion, improving diagnosis and treatment for people living with EoE.

Symptoms of EoE vary widely

First, how do you know if you have EoE? It’s important to know how to spot the signs. Many people live with the discomfort and difficulties of EoE for years before seeking medical help.

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The symptoms of EoE vary from person to person and may include:

  • Trouble swallowing
  • Chest pain or heartburn
  • Abdominal pain
  • Regurgitation
  • Vomiting
  • Food getting stuck in the throat
  • Poor weight gain and growth in infants and toddlers
  • Feeding problems in infants and toddlers
  • Poor appetite in older children

Common myths about EoE

If you’re one of the few who have heard of EoE or have already been diagnosed, let’s clear up a few misconceptions you may have heard.

Food allergy testing

Many people believe that food allergy testing is necessary to diagnose and monitor EoE since EoE is often triggered by foods. However, research has shown that food allergy testing is not an accurate method to diagnose and monitor EoE.

The best method to diagnose and monitor EoE is through an upper endoscopy procedure performed by a gastroenterologist.

Dietary changes

Many people with EoE modify their eating habits (e.g. slow eating) or avoid foods that worsen their symptoms in order to compensate for their EoE, and believe that this will be enough to keep their condition under control.

However, untreated EoE-related inflammation affecting the esophagus can be dangerous over time due to the possibility of causing significant esophageal scarring—to the point of developing intolerance to most solid foods. Merely avoiding foods that trigger symptoms is not sufficient either, since the foods that result in EoE-related inflammation do not correlate with symptoms.

So, what can you do? Consult with your healthcare provider to understand what more can be done to treat your EoE for longer-term maintenance.

EoE vs. GERD

EoE is often incorrectly associated with gastroesophageal reflux disease, or GERD, because acid-reducing medications commonly used to treat GERD can be effective in controlling EoE.

However, research shows that the mechanisms that make acid-reducing medication effective are different in EoE vs. GERD. That’s why 50% or more of EoE patients do not improve when using these same acid-reducing medications.

Instead, you should be evaluated by your doctor so you can discuss trying different and potentially more effective EoE treatments.

Symptom tracking

People often rely on experiencing overt symptoms, like food regurgitation, to track their treatment response. But ongoing EoE inflammation can be present despite a reduction in symptoms—and remember, that inflammation can be dangerous in the long term.

Consult with your doctor about how best to assess if your EoE is adequately managed or controlled to ensure you’re also measuring all the underlying responses.

Long-term treatment

Once EoE is under control, the duration of continued treatment can be a topic of confusion. Research has shown that EoE is a chronic condition, meaning it can come and go or “flare up” if treatment is stopped.

Most people do require long-term maintenance treatment to keep their EoE under control. That’s why it’s important to have a doctor and care team who will collaborate with you, listen to you and make sure you feel confident in your long-term health.

Think you might have eosinophilic esophagitis?

Please consult with your doctor if you have swallowing difficulties that may be related to EoE. Our team is among those heavily involved in research around this condition. The good news is, EoE often can be safely controlled so you can live well and without discomfort. The key is to get the expert care you need as soon as you notice something is off.

Click here to get care for digestive diseases like EoE.

About the author

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Chanakyaram "Shan" Reddy, MD, is a gastroenterologist on the medical staff at Baylor University Medical Center. Dr. Reddy’s clinical expertise includes GERD, eosinophilic esophagitis, esophageal motility disorders and Barrett’s esophagus.

Difficulty swallowing? It could be eosinophilic esophagitis (EoE)