What is Eosinophilic Esophagitis?

Eosinophilic Esophagitis (EoE) is a chronic condition in which the immune system causes inflammation to the esophagus – the tube which carries food from the mouth to the stomach. In EoE, the lining of the esophagus has certain cells called “eosinophils” which cause inflammation and do not let the esophagus function properly. Eosinophils are allergy cells that normally are not seen in the esophagus. The exact cause of EoE is unknown, but it is thought to be related to allergies, in particular food allergies.

 

What are the common symptoms?

The symptoms of Eosinophilic Esophagitis can vary with age. Adults and teenagers usually develop symptoms of trouble swallowing as the most common symptom. It can begin with difficulty swallowing solid food or even the feeling as if food is getting stuck in the throat or chest.  Other people can experience chest or upper abdominal pain, and possibly chest burning known as heartburn. In children, it usually presents with different symptoms such as refusing to eat solid foods, nausea or vomiting, and also abdominal pain. Patients with Eosinophilic Esophagitis can have other allergic disorders such as asthma, hay fever, or eczema.

 

How is Eosinophilic Esophagitis diagnosed?

Eosinophilic Esophagitis can be challenging to diagnose at first because it can resemble other conditions. However, the best available test to check for this condition is an upper endoscopy with biopsy. An upper endoscopy is a procedure performed by a gastroenterologist during which a small flexible tube with a camera is introduced through the mouth and passed into the esophagus. The lining of the esophagus can be looked at and a small piece of tissue from the esophagus is removed (biopsy).  The sample of the tissue obtained is then sent to a pathologist to view under a microscope and determine if you have Eosinophilic Esophagitis. At times, blood tests can show elevated levels of eosinophils, but this alone does not make the diagnosis.

 

How is Eosinophilic Esophagitis treated?

The treatment of Eosinophilic Esophagitis involves diet changes and medications which help control symptoms. As an initial approach, certain foods that commonly cause allergy are avoided in order to improve symptoms. These may include milk, egg, soy, peanuts, shellfish, and wheat. Patients can be sent to an experienced dietician to help with learning how to shop and substitute foods. Otherwise, patients can be referred to an allergist for further testing to determine food allergies.

There are also different medications used to treat Eosinophilic Esophagitis. One common medication is called “Proton Pump Inhibitor” (PPI), which is commonly used to treat acid reflux. This medication blocks acid, which can trigger symptoms or contribute to the inflammation. Other medicines used include steroids, which help reduce inflammation and therefore improve symptoms.  In some patients with EoE, inflammation may progress and cause narrowing of the esophagus which is known as an esophageal stricture. This is treated by performing an upper endoscopy and widening the esophagus, called dilation. Eosinophilic Esophagitis has become more commonly recognized and visiting your doctor can lead to its discovery.

Investigative Overview: Esophageal Cancer

Esophageal cancer can occur when normal cells seen in the esophagus become abnormal and begin to replicate out of control. The esophagus is the muscular tube which helps move food from the mouth to the stomach. Esophageal cancer is not very common in the United States, but can occur often in men over the age of 50. There are two main types of cancer: Squamous Cell Carcinoma and Adenocarcinoma. Certain risk factors have been shown to increase the risk of esophageal cancer, which include smoking, alcohol consumption, obesity and gastric reflux.

What are the symptoms?

Early stages of esophageal cancer may not produce any symptoms. However, once symptoms develop people can frequently experience difficulty swallowing (especially solid food), weight loss, pain or burning in the chest and hoarseness. Although these symptoms can be seen with esophageal cancer, there are other conditions which can also cause these symptoms. Therefore, you should be seen by your doctor for further evaluation.

How is esophageal cancer diagnosed?

Barium Swallow

The patient is given Barium to swallow and X-rays are taken as it goes down the esophagus. This can help detect abnormal lining in the esophagus or even abnormal growth.

Upper Endoscopy

This is when a thin tube with a light at the end of it is introduced through the mouth and into the esophagus while you are asleep. This can directly look at the lining of the esophagus and can take samples of tissue from the esophagus, called a biopsy. The tissue is then looked at under the microscope by a pathologist and can diagnose the tissue as cancerous. If indeed cancer is diagnosed, further evaluation must be performed to determine if the cancer has spread to other areas from where it originally started. This process is called cancer staging and is important to determine the appropriate treatment required.

How can it be treated?

Esophageal cancer usually requires more than one modality of treatment. Surgery can be used to remove the part of the esophagus where cancer cells are located. The remainder of the esophagus is then connected to the stomach so that food can be digested appropriately.  Another way to treat it is using Radiation Therapy, which consists of high-energy radiation used to shrink and eliminate cancer cells. The last way to treat esophageal cancer is using Chemotherapy, which uses medicines to eliminate cancer cells. Often by using a combination of these different treatment regimens, esophageal cancer can be cured. If the cancer cannot be cured, there are other treatment options used to help improve symptoms. These consist of using a laser beam or electric current to help eliminate cancer cells or performing a procedure to help widen the part of esophagus which is blocked. After treatment, it is important to have regular follow-up visits with your doctor to make sure you remain cancer free.

What is Celiac Disease?

Celiac disease is a condition in which a protein found in certain foods – gluten – causes the immune system to damage the small intestine. The small intestine is responsible for absorbing food and nutrients. However, when the lining of the small intestine is damaged this can cause problems with absorbing nutrients which is referred to as malabsorption. Gluten is found in wheat, barley, rye and several condiments, sauces and spreads. It is not clear what exactly causes celiac disease, but there is a combination of environmental and genetic factors. Celiac disease can affect both male and females of any age. Although there is no cure for celiac disease, avoiding gluten can stop the damage to the lining of the small intestine.

What are the common symptoms?

The symptoms of celiac disease can vary from person to person. Some people may have no symptoms, yet exhibit signs of malabsorption detected on blood tests. Others can develop a variety of gastrointestinal complaints. The most common symptoms experienced are abdominal discomfort, diarrhea, bloating, weight loss and decreased energy. There can also be other signs and symptoms of vitamin and nutrient deficiencies that can cause anemia, bone loss, nervous system disorders and skin rash. Children with celiac disease can have a poor appetite, slow growth and have difficulty gaining weight.

How is Celiac Disease Diagnosed?

Celiac disease can be difficult to diagnose because its signs and symptoms can resemble other conditions. However, there are blood tests available which can help make the diagnosis. These blood tests look for proteins (antibodies) that can become elevated in people with celiac disease. It is important to continue eating gluten while being tested because avoiding it can cause these proteins to become normal. If the blood test is positive for celiac disease, the diagnosis is confirmed by obtaining a sample of the small intestine. The sample (known as a biopsy) is obtained by performing an upper endoscopy and the sample is viewed under a microscope to see if there has been any damage to the lining of the small intestine. An upper endoscopy is a procedure performed by a gastroenterologist during which a small flexible tube with a camera is introduced through the mouth and a small piece of tissue from the small intestine is removed.

How is Celiac Disease Treated?

The cornerstone of treatment for celiac disease is elimination of gluten from the diet.  This can be overwhelming initially because many foods that we eat and even condiments that we cook with contain gluten. Therefore, consulting with an experienced dietician can help you learn how to eat, shop and prepare a gluten-free diet.  Most patients will notice an improvement in their symptoms within two weeks. Rarely, patients fail to have improvement in symptoms despite adherence to a gluten-free diet. This is considered refractory celiac disease and requires medications which suppress the immune system (like steroids). It is important to remain on a strict gluten-free diet despite feeling well to prevent nutritional deficiencies and certain types of gastrointestinal cancer. Families should be aware of their increased risk of developing celiac disease and anyone with symptoms should be tested. Various local and national support groups help increase awareness and make living a gluten-free lifestyle achievable.