Eosinophilic oesophagitis symptoms

Eosinophilic oesophagitis being diagnosed more often in both children and adults.It is the second most common cause of chronic oesophagitis, after gastro-oesophageal reflux.
It is more common in males.
It is an atopic disease (along with eczema, asthma, hay fever and migraine,) often co-existing with them.

Eosinophils are white blood cells involved in allergy, here present in oesophageal mucosa even enough to narrow its' lumen.

Children commonly get abdominal pain, vomiting and dysphagia. They also get gagging, regurgitation, chest pain, excessive saliva, reduced appetite, slowed growth, sleep difficulties, cough, noisy breathing, sinusitis or even pneumonia).

Adults get chest pain, heartburn, dysphagia (or even food actually stuck in the gullet.)

Affected individuals often eat very slowly, chew a lot and drink after each bite, especially eating rice and meat.

Testing for this type of oesophagitis

This depends on the appearance on endoscopy and the result of biopsies of the oesophageal mucosa.

Distinctive endoscopic features are linear furrows, mucosal rings and little white bumps. These are quite different to the appearance of reflux oesophagitis and the white mucosal patches of monilia oesophagitis.

A abnormal eosinophilic infiltrate has ≥15 eosinophils per high-powered field on microscopic examination of oesophageal mucosal biopsies.

Half the time, the blood count of eosinophils is also increased, and the IgE immunoglobulin increased even more often (but not useful in identifying which foods cause it.)

Treatment

An allergy elimination diet to eliminate the items responsible.

Measures to reduce one's overall tendency to allergies.

Cortisone to temporarily reduce the allergic reaction while one works on these jobs.

Dr. Jonathan Spergel¹ from the Children's Hospital of Philadelphia presented a study of 1025 children with this condition to the American Academy of Allergy, Asthma & Immunology in 2014. In 425 of those children a specific food was considered causative, as removing it from the diet stopped symptoms or reintroducing it into the diet caused symptoms to return. The most common triggers were cows milk, eggs, wheat, and soy. This study focused on patients who had naturally (apparently) outgrown their food allergies.

"Initially, they are getting anaphylactic shock to this food. Two to 4 years later, they come back with a different allergy. Now they are getting a swollen esophagus."

Others² have found 3/4 with food and inhalent allergies, but more would probably be found if food additives were checked as well.

To one page detailing how to do these jobs.
And another page with more detail

References

1. Quoted by Medscape on 15th March 1014.

2. Assa'ad A H et al, Pediatric patients with eosinophilic esophagitis: an 8-year follow-up. J Allergy Clin Immunol. 2007 Mar;119(3):731-8





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Mucosa is the name for the skin lining our intestines, which is covered with a protective layer of mucus (slime.)


Dysphagia is a feeling of food getting temporarily stuck or passing over an obstruction at the back of the throat or in the chest.

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