Eosinophilic Esophagitis – Diagnosis and Treatment
Diagnosis
Doctors diagnose eosinophilic esophagitis (EoE) by checking symptoms and running specific tests. Common signs include trouble swallowing, food getting stuck in the esophagus, and persistent heartburn that does not improve with usual treatments.
Doctors start by asking about symptoms and any allergy history. They often use an upper endoscopy to look inside the esophagus with a thin, flexible tube and camera.
The doctor looks for swelling, rings, narrow spots, furrows, and white patches that may show tissue damage or inflammation from EoE. Sometimes, the esophagus can look normal even if EoE is present.
During endoscopy, doctors take biopsies from different areas of the esophagus. They check these small tissue samples under a microscope for increased numbers of eosinophils, a type of white blood cell that builds up in EoE.
Finding 15 or more eosinophils in one high-power field gives strong evidence for EoE.
Other helpful tests include:
| Test | What it Shows |
|---|---|
| Blood tests | High eosinophil counts or allergy markers (like immunoglobulin E). |
| Esophageal sponge | Checks for inflammation by collecting tissue with a sponge on a string. |
Doctors may also use allergy testing to find triggers, since some cases of EoE link to reactions to certain foods or substances. These steps help identify EoE and separate it from other issues like GERD.
Treatment
Changes to Diet
Doctors often ask people with EoE to change their diets. Foods that commonly cause reactions include dairy, wheat, eggs, soy, and nuts.
Removing these foods, called an elimination diet, can reduce swelling and symptoms. Some people only need to cut out a few foods, while others may need to avoid more foods to feel better.
A table of foods often removed:
| Food Category | Examples |
|---|---|
| Dairy | Milk, cheese |
| Wheat | Bread, pasta |
| Eggs | Scrambled, baked |
| Soy | Soy milk, tofu |
| Nuts | Almonds, peanuts |
Health care providers may suggest reintroducing foods one at a time to see which ones cause symptoms. The goal is to build a healthy diet with the fewest symptoms.
Medicines That May Be Used
Doctors use several types of medication to manage eosinophilic esophagitis (EoE):
- Acid Blockers (Proton Pump Inhibitors): These reduce stomach acid and may help relieve EoE symptoms in some individuals, though not everyone responds to them.
- Swallowed Corticosteroids: These medications are taken as a spray or liquid and swallowed so they coat the esophagus. They help reduce inflammation with minimal systemic absorption, lowering the risk of side effects.
- Monoclonal Antibody Therapy: Administered by injection, this treatment blocks specific immune proteins that trigger inflammation. It may be prescribed for adults and children age 12 and older.
Doctors tailor medication plans based on symptom severity and how well the individual responds to treatment.
Esophageal Stretching
If the esophagus becomes very narrow, swallowing can become hard or painful. Doctors may perform endoscopic dilation to gently stretch and widen the esophagus.
This procedure helps if medicines or diet changes do not work enough. Dilation does not treat the root cause, but it can make eating easier.
Key facts about endoscopic dilation:
- Doctors usually do it as an outpatient procedure.
- It is generally safe, with mild risks like soreness or slight bleeding.
- The procedure can improve swallowing and help with daily life.
Lifestyle Tips
Simple changes in daily habits can help reduce symptoms like heartburn, chest pain, and discomfort. Eating smaller meals and choosing foods that do not trigger symptoms may help.
Keeping a healthy weight may prevent acid from backing up into the esophagus. Reducing exposure to triggers can help people with asthma, allergies, or atopic conditions.
Tips to manage at home:
- Keep a food journal to track which foods cause problems. Common triggers include fatty foods, chocolate, alcohol, coffee, garlic, onions, mint, and tomato-based dishes.
- Limit large meals and do not lie down right after eating.
- Raise the head of the bed by 6-9 inches using blocks or a wedge pillow. Gravity helps keep stomach acid down during sleep.
- Work towards a healthy weight. Extra weight increases pressure on the stomach and can make reflux, asthma, and allergic rhinitis worse.
- For people with atopic dermatitis, controlling humidity and using gentle skin care can also help.
| Common Triggers | Possible Symptoms |
|---|---|
| Fatty foods | Heartburn, chest pain |
| Chocolate | Acid reflux, discomfort |
| Alcohol | Irritation, allergic reactions |
| Caffeine | Heartburn, disrupted sleep |
People with food allergies or gastroesophageal reflux disease benefit from avoiding known triggers. Those with unexplained weight loss should talk to a healthcare provider for advice.
Getting Ready for Your Visit
Steps to Take Before Your Appointment
Preparing ahead makes a visit with a healthcare provider or gastroenterologist easier. Patients should check for special instructions, such as fasting or avoiding certain foods.
It helps to call the office before the visit to ask about any restrictions, stopping medications, or items to bring.
Bringing important medical records, past test results, and a list of all medicines, vitamins, and supplements is useful. Patients should gather results from any previous endoscopies or lab tests, especially if done at other clinics.
Recording symptoms is also important. Patients should list all symptoms they notice, even minor ones.
For example:
- Trouble swallowing
- Chest pain
- Food getting stuck
- Stomach discomfort
- Nausea or vomiting
- Problems with certain foods
Noting when symptoms began, how often they occur, and what makes them better or worse helps the provider. Writing down major life events—such as moving, stress, or recent illnesses—can also be helpful.
A complete medication list should include these columns:
| Name of Medication | Dose | How Often Taken | Reason for Use |
|---|---|---|---|
Filling out this list ahead of time can save time and prevent forgetting anything.
Patients may want to bring a trusted friend or family member to the visit. Having another person present can help remember instructions and ask questions.
This person may also provide extra information from a different view.
Preparing questions in advance helps people get the most out of the appointment. These might include:
- What are the likely causes of my symptoms?
- Which tests do I need?
- Will I need an endoscopy?
- Is my condition short-term or ongoing?
- What is the best treatment plan?
- Are there other treatment options?
- How should I manage other health problems with this condition?
- Are there diet or activity restrictions I need to follow?
- Should I see a specialist such as a gastroenterologist?
- What will be the cost of seeing specialists?
- Is there a generic or less expensive version of my medicine?
- Do I need any follow-up appointments?
People can write this list in a notebook or store it on a phone for easy access.
Questions the Provider May Ask
Health care providers, including gastroenterologists, often ask about specific symptoms and how they have changed over time. You can prepare for your visit by thinking about your answers to these questions.
Common questions include:
What symptoms do you have, and when did they start?
Are the symptoms constant, or do they come and go?
How strong or severe are your symptoms?
What actions or foods help relieve them?
What triggers or worsens your symptoms?
Do your symptoms cause waking at night or trouble sleeping?
Are your symptoms worse after eating or lying down?
Do you have difficulty swallowing solid foods or liquids?
Has food ever become stuck in your throat?
Do you experience regurgitation of food or a sour taste?
Do you have chest pain or stomach pain?
Have you had procedures like esophageal dilation?
Has your provider recommended treatments such as topical steroids or a restricted diet before?
Have you noticed changes in your weight, either gain or loss?
Do you have nausea, vomiting, or breathing issues?
Are your symptoms worse during certain times, such as allergy seasons?
Do you have a history of asthma, allergies, or chronic breathing problems?
Has anyone in your family had allergies or similar symptoms?
Have you used antacids or medications for reflux, and did they help?
For children, the provider may also ask if there are problems with feeding, slow growth, or poor weight gain.
If you bring clear and complete answers, you help the provider find the cause and develop a good plan. This preparation helps the visit go smoothly and ensures important topics are covered.
