Causes

The cause of EoE is usually an autoimmune response to allergens in the diet of people with a genetic susceptibility. Environmental factors may play a role, all be it unclear.

An estimated 1 in 100 adults and 1 in 10,000 children are estimated to have this condition.

It can be associated with other allergic conditions such as asthma or allergic rhinitis.

Diagnosis

Diagnosis requires an upper endoscopy with biopsies that show eosinophils in the lining of the oesophagus.  The appearance of the oesophagus can be normal, so biopsies are essential.

Treatment

Dietary, medication and endoscopic treatments are available for treatment of EoE –

• Dietary modification can be effective if the main allergens that are triggering swelling in the oesophagus can be identified. A six food elimination diet involves avoiding the six food types that are most commonly associated with EoE (milk, wheat, eggs, soy, nuts and seafood) and reintroducing them one by one to assess response. A targeted elimination diet based on allergy testing (skin prick or patch testing) is less effective. Close support from a dietitian can be very useful.
• Medications such as proton pump inhibitors (PPIs), and swallowed steroids (Fluticasone, Budesonide) can be used and are generally very well tolerated.
• Endoscopy with dilatation of narrowed, scarred areas within the oesophagus can widen the oesophagus and relieve food impaction symptoms. Risks include a small but significant chance of perforation (tearing a hole in the oesophagus) during the procedure.