Is this Reflux? Or Eosinophilic Esophagitis?

Heartburn. Chest pain. Trouble swallowing. All symptoms of reflux.

But a growing number of people are realizing that there’s something else behind their reflux-like symptoms: an allergic/immune condition known as eosinophilic esophagitis (EoE).

Reflux or Eosinophilic Esophagitis

(derneuemann / pixabay)

EoE wasn’t officially recognized until 1993, and while it affects only about 5 out of every 10,000 people, it is on the rise, with a rapidly increasing number of people being diagnosed with the condition around the world.

EoE affects the esophagus, which is the tube that passes from the throat to the stomach. White blood cells gather in the esophagus in response to allergens. These cells, known as eosinophils, cause the esophagus to become inflamed.

This inflammation leads to the following symptoms:

  • Difficulty swallowing
  • Reflux that does not improve with medication
  • Pain in the chest and stomach
  • Heartburn
  • Vomiting
  • Food getting stuck in the esophagus

While EoE is most common in white males in their 30s, it can affect anyone, including children. Kids with EoE will often reject food, leading them to fall behind in weight gain and growth. They could also miss important feeding milestones, such as learning to chew and swallow solid foods, that could affect their nutrition and habits as they grow.

If left untreated, scar tissue can develop in the esophagus. This thickens and narrows the esophagus, which leads to food getting trapped there (also known as food impaction).

How is it diagnosed?

If you suspect that you have eosinophilic esophagitis, talk to your doctor. They can review your medical history. If you have allergies, asthma, and/or eczema, you are at greater risk for EoE.

Your doctor can perform an upper gastrointestinal endoscopy (or refer you out for one). During this procedure, your doctor will run an endoscope (a flexible tube with a camera) into your esophagus. With this technology, they will be able to look at the lining of your esophagus. They will be looking for rings or white spots. They will also be looking to see if your esophagus narrows due to inflammation or scar tissue.

Your doctor may also take small samples of your esophagus tissue and perform a biopsy. They will be looking for large concentrations of eosinophils in the tissue indicating the allergic reaction that leads to EoE.

And finally, your doctor may perform an allergy test to see what is triggering your allergic reactions. Intradermal allergy tests are generally considered the gold standard. With this type of test, a small amount of allergen is injected under the skin, and the resulting skin bumps or “wheals” are measured. Blood tests can also help determine allergies with varying degrees of accuracy.

What allergies cause EOE?

While it would make sense that people with food allergies develop EoE (since the esophagus is directly exposed to trigger foods), researchers think the source doesn’t stop there. They believe there is also a connection between EoE and environmental allergens (pollen, dust, pet dander, and mold).

What is currently done to treat EOE?

No cure has been found for this increasingly common condition. Doctors generally treat it with steroids, which help manage the inflammation of the esophagus. Unfortunately, steroids come with a host of side effects, especially with ongoing use. Acid suppressors can also help calm the reflux symptoms and reduce inflammation, but long-term use is not recommended.

Elimination diets are also used to prevent symptoms of EoE. People with the condition can remove foods from their diet to see if their EoE worsens or improves without this food. Bear in mind that it can take the body several weeks to heal after it is no longer exposed to certain allergens, so an elimination diet may not provide quick answers.

If no foods are clear “smoking guns,” a food allergy test can provide a starting place for knowing which foods to eliminate. Unfortunately, food allergy tests can give false positives and negatives, so they may not provide a fully accurate picture.

What treatments are on the horizon?

Allergy treatment is a promising approach to EoE because it affects the root of the condition, not just its symptoms. While allergy shots are the most popular method of allergy treatment, they don’t work for food allergies. In contrast, sublingual immunotherapy (SLIT) is a food allergy treatment program that has been shown to be both safe and effective for food and environmental allergies.

With sublingual immunotherapy, antigen is dispensed under the tongue in the form of liquid droplets that are absorbed into the bloodstream by special cells in the mouth. It operates on the same premise as shots in that it gradually desensitizes the body to things that once triggered reactions. However, sublingual immunotherapy is safer than shots, so it can be taken in the comfort of home (rather than having to go to the doctor’s office regularly for shots).

Many AllergyEasy patients have experienced relief from their EoE with the help of sublingual immunotherapy drops. Talk to your sublingual immunotherapy doctor for more details.

While the medical community originally thought of EoE as a chronic condition, there is increasing evidence that if the allergies that cause it are treated, people can be free of the inconvenience, sickness, and pain of living with EoE.

About The Author

Stuart H. Agren, M.D.

Stuart H. Agren, M.D. completed his undergraduate studies at the University of Utah and went on to earn his Doctor of Medicine from Tulane University School of Medicine in 1974. He completed additional training at L.D.S. Hospital in Salt Lake City, Utah and then established his private medical practice starting in 1975. Dr. Agren completed a mini-residency in Industrial Medicine at the Robert Johnson School of Medicine at Rutgers University and also completed training to become a certified Medical Review Officer.

Dr. Agren was the Medical Director at TRW and McDonnell Douglas in Mesa, Arizona and at Stauffer Chemical and Kennecott Copper in Salt Lake City, Utah. He also served as an adjunct faculty member at Arizona State University.

In his private medical practice, Dr. Agren specialized in family practice and allergy. In his work as a private practice allergist, he was one of the first doctors in the country to prescribe sublingual immunotherapy to his patients as an alternative to subcutaneous immunotherapy (allergy shots). He has also been a trailblazer in the field of food allergy treatment and research, developing a program to treat multiple food allergies simultaneously using sublingual immunotherapy. Dr. Agren has been featured on local CBS, NBC, and ABC news affiliates and won the peer-nominated “Top Doc” award from Phoenix Magazine.

After 20 years in private practice, Dr. Agren became the Founder and President of AllergyEasy, which helps primary care physicians around the country offer allergy testing and sublingual immunotherapy treatment to their patients. Over 200 physicians in over 32 states use the AllergyEasy program to help their patients overcome environmental and food allergies and asthma.