What is EoE?
Eosinophilic Oesophagitis (EoE) is an allergic disease affecting the oesophagus, the muscular tube that connects the mouth to the stomach. In EoE, allergy cells (called eosinophils) cause the lining of the oesophagus to become abnormal. This happens because of an allergy to food/s and/or allergens in the air (e.g. pollens and grasses).
EoE is more common in people with other allergies such as hay fever (allergic rhinitis), eczema and asthma. EoE is estimated to affect around 1 in 1000 people (children and adults) and appears to be becoming more common.
Signs and Symptoms of EoE
The symptoms of EoE are different from one person to the next, but commonly include:
- Eating issues – slow to eat, needing soft or pureed foods, needing to drink when eating, fussiness or avoidance of certain foods
- Poor appetite, not wanting to eat
- Poor weight gain
- Difficulty swallowing or food sticking while trying to swallow
- Nausea, persistent gagging or retching and/or unexplained vomiting
- Abdominal (stomach) or chest pain
Diagnosis of EoE
EoE is usually suspected based on symptoms, but diagnosis requires a gastroenterologist to perform an endoscopy and biopsy. An endoscopy involves a tube with a light and camera attached being inserted into the oesophagus to look at the inside of the oesophagus. The patient is sedated or under general anaesthetic for this procedure. Tissue samples are taken during the endoscopy and reviewed by a pathologist to assess the number of eosinophils present in the oesophagus. Eosinophils are a type of white blood cell and high numbers indicate high levels of inflammation.
Most people with EoE are managed by a gastroenterologist, an allergy specialist and a food allergy dietitian.
Treatment options EoE
There is currently no cure for EoE. The goal of treatment is to improve symptoms through the elimination or reduction of eosinophils in the oesophagus. Current treatment options include medications and/or a specialised diet.
The Management Plan for Eosinophilic Oesophagitis (EoE) provides guidance about ongoing treatment and management of EoE.
A small number of patients may also need to undergo a procedure to help stretch open the narrowed oesophagus. This makes swallowing easier and helps prevent food from getting stuck when eating. This procedure is done under a general anaesthetic.
The Action Plan for Eosinophilic Oesophagitis is for the emergency treatment of food impaction and food bolus obstruction (FBO), due to EoE.
The ASCIA Action and Management Plans for EoE are medical documents that should be completed and signed by the patient’s allergy specialist or gastroenterologist.
Medication Treatments
- Antacid/Proton Pump Inhibitor medication that reduce acid production, used in the treatment of reflux can also be effective for some patients with EoE.
- Swallowed corticosteroid medication given in a way that allows the steroid to coat the lining of the oesophagus can reduce eosinophils and inflammation. These are usually taken as sprays that are swallowed, or liquid preparations usually mixed with an artificial sweetener/honey/pureed fruit and swallowed.
Dietary Treatment
For many people with EoE, symptoms can be triggered by food/s. The most common food triggers are cow’s milk (dairy), wheat, egg and soy.
Identifying EoE food triggers can be very challenging and allergy testing methods are not always useful. Symptoms are not always a reliable guide to control, so an endoscopy and biopsy are needed to monitor the response to dietary treatment.
Changes to the diet including removing a food or whole food groups, should be undertaken under the direction of a medical specialist and supervision of a food allergy dietitian.
The removal of whole food groups or step-up diets may be recommended:
- 2 FED diet – removes the two most common trigger foods: cow’s milk (dairy) and wheat
- 4FED diet – removes the four most common trigger foods: cow’s milk (dairy), soy, egg and wheat
Amino acid based formulas may be used, particularly for babies.
Future Treatments
There is currently no cure for EoE and it is thought to be a lifelong condition. However, research into the diagnosis, management and treatment of EoE is rapidly developing. It is hoped that new medication and improved diet treatments will improve quality of life.
Useful links
The Australasian Society of Clinical Immunology and Allergy (ASCIA) is the peak professional body of clinical Immunology/allergy specialists in Australia and New Zealand: About Eosinophilic Oesophagitis
ausEE Inc. is an Australian Support Network for Eosinophilic Oesophagitis and related diseases www.ausee.org