What is EoE?
Eosinophilic Oesophagitis (EoE) is an allergic disease affecting the oesophagus, the muscular tube that takes food and drink from the mouth to the stomach. In EoE, the oesophagus becomes inflamed, resulting in pain, swelling and redness. This inflammation can be caused because of an allergy to food(s) and/or allergens in the environment, such as tree and grass pollen. EoE is more common in people with other allergies such as allergic rhinitis (hay fever) and asthma.
EoE affects around 1 in 1000 people (children and adults) and appears to be becoming more common.
Signs and Symptoms of EoE
- Poor appetite, not wanting to eat
- Eating issues: slow to eat, need soft or pureed foods, needing to drink when eating, fussiness or avoidance of certain foods
- Poor weight gain
- Difficulty swallowing
- Food sticking while trying to swallow
- Nausea, persistent gagging or retching (trying to vomit but nothing comes up) 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 person is sedated for this procedure. Tissue samples (biopsies) are taken during the endoscopy and reviewed by a pathologist to assess the number of eosinophils they can see in biopsies from the oesophagus. Eosinophils are a type of white blood cell and high numbers mean high levels of inflammation.
Management of EoE
Most people with EoE are managed by a gastroenterologist, an allergy specialist and, if diet changes are needed, an allergy dietitian.
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.
In a small number of patients, ongoing inflammation can cause scar tissue to form, and this can lead to difficulty swallowing or food getting stuck when eating. These people may need to have a procedure to help stretch (make bigger) 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 (food getting stuck and not moving into the stomach) 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.
EoE can be treated with medication. Some patients need a combination of different medication with or without diet changes to manage their EoE.
Medication Treatments
- Anti-acid medications that reduce acid production, used in the treatment of reflux, can be effective for some patients with EoE. These are known as PPIs (Proton Pump Inhibitors).
- Swallowed corticosteroid medication given in a way that allows the steroid to coat (create a protective barrier) on the lining of the oesophagus can reduce inflammation.
- Biological therapies that are an injection treatment that works on the body’s immune system.
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 difficult. Skin prick tests and blood tests are not useful. Reactions to foods are usually not obvious, as they may take days to weeks after the food is eaten, to happen. Changes to the diet, including removing a food, or whole food groups, should be done under the direction of a specialist doctor and supervision of an allergy dietitian.
ASCIA has a Dietary Guide for Two Food Elimination Diet (2FED) for EoE.
ASCIA has a Dietary Guide for Four Food Elimination Diet (4FED) for EoE.
Amino acid based (elemental) formula can be used in babies with EoE. It may not be practical to use these for older children or adults.
Long-term outcomes with EoE
There is currently no cure for EoE, and it is thought to be a lifelong condition. However, EoE diagnosis, management and treatment options are a rapidly developing area of research and do help improve quality of life.
Useful links
ASCIA EoE Frequently Asked Questions (FAQ) to provide information for patients, parents/carers.
A&AA Webinar: managing Eosinophilic Oesophagitis (EoE) in children – Allergy & Anaphylaxis Australia
A&AA Webinar: Adults with EoE – Allergy & Anaphylaxis Australia
Australian Support Network for Eosinophilic Oesophagitis and related disorders:
www.ausee.org