Not so long ago, if you had eosinophilic esophagitis, or EoE, your doctor probably thought you had gastro-esophageal reflux disease (GERD), also known as acid reflux. The only problem was that GERD medication didn’t make you any better. It wasn’t until the 1990s that doctors realized that EoE isn’t caused by GERD. It’s a similar but totally separate condition.
EoE is a chronic immune system disease that has identical symptoms to GERD, like trouble swallowing and chest pain. It happens when white blood cells, called eosinophils, build up in your esophagus, the tube that connects your mouth to your stomach.
EoE was also considered a children’s disease for many years, but now adults are being diagnosed more and more. Experts think that this is partly because doctors are more aware of it, but also because there have been more cases of related conditions like allergies and asthma.
EoE symptoms are basically the same for children and adults, and include:
- Difficulty swallowing, known as dysphagia
- Food impaction (when food gets stuck in the esophagus, which is a medical emergency)
- Chest and upper abdominal pain
- Vomiting (mostly in children)
- Failure to thrive (in children)
All of these symptoms are also signs of GERD, which is why the two conditions were thought to be the same for so long. The key to diagnosing EoE is that people with EoE don’t get better with GERD medications.
EoE is the most common cause of white blood cells in the esophagus, but a number of other things (like GERD, parasites, and inflammatory bowel disease) can also be the problem. And because the symptoms of EoE and GERD are virtually identical, your doctor will have to rule out acid reflux before settling on a diagnosis.
They can do this with an upper endoscopy and biopsy. White blood cells will usually show themselves on the endoscopy as pale or white flecks. There could also be lines, creases, and other signs of inflammation.
But things could also look totally normal even if you have white blood cells present, which is why your esophageal tissue will also need to be biopsied.
If you’re positive for white blood cells, your doctor will start you on GERD medication to see if it helps your symptoms. If your next endoscopy and biopsy are normal, acid reflux is your problem. If not, it’s probably EoE.
Food allergies. This seems to be the biggest risk factor for EoE, but doctors aren’t certain how it all works. They haven’t figured out how and why certain foods trigger white blood cells to travel to the esophagus, or why this reaction happens in some people and not others. Dairy, eggs, soy, and wheat are usually the culprits.
Sex and age. EoE used to be known as a children’s condition, but more adults are being diagnosed now. About 3 times more men have EoE than women, and they’re usually diagnosed between the ages of 20 and 40.
Family history. Genetics definitely play a part in EoE, but scientists aren’t sure how big a factor they are. What they do know is that you’re more likely to get EoE if one of your relatives has had it.
Climate. If you live in a cold or dry area, you’re more likely to get EoE. It also tends to flare up in the spring, summer, and fall.
The tried-and-true treatment for children with EoE is dietary therapy. Allergy tests can sometimes pinpoint which food is the problem, but more often an elimination diet does the trick. You take major food allergens out of your child’s diet and then add them back one at a time. Figuring out food allergies has been shown to clear up the white blood cells within weeks.
There’s no single accepted therapy for adults, possibly because EoE has been primarily a children’s issue for so long. Adults can do dietary elimination as well, but sometimes doctors will also prescribe oral steroids. Esophageal dilation, which is stretching the esophagus, is a short-term fix that helps symptoms but doesn’t help get rid of the white blood cells.