FAQ
Eosinophilic Esophagitis (EoE) is a chronic disease characterized by inflammation of the esophagus, determined by a particular type of blood cells, called eosinophils. It causes a impaired passage of food from the mouth to the stomach, with consequent difficult swallowing (dysphagia), episodes of bolus impaction and pain.
EoE is a rare and “young” condition, considering that clinicians started to describe this disease since 1993. Its frequency is significantly increasing year after year, especially in Europe and North-America, and it is estimated around 1 case per 1000 people. Nowadays it is considered the most frequent cause of dysphagia in young people, and the second cause of chronic inflammation of the esophagus after gastro-esophageal reflux disease (GERD). EoE can occur at any age, even if typical presentation age is between 30 to 40 years old. Male are three times more frequently involved than female.
The cause of EoE has not been completely understood yet, but it seems that genetic features, immune system malfunctioning and environmental factors play an important role. In EoE patients the immune system abnormally reacts against food and air allergens, determining inflammation of the esophagus. Most researcher think it is an allergic disorders.
The typical symptom of this disease in adults is the difficult swallowing (dysphagia), with the feeling that food is not properly progressing or remains blocked. Episodes where the food is stucked behind throat/chest are also common (food impaction), similarly to pain or discomfort during swallows. Sometimes patients use compensatory behaviors as drinking abundant water during meals, eating in small bites, chewing a lot food before swallow, avoiding solid or dry food. In some cases food cannot be swallowed, regurgitated or coughed up and endoscopic intervention is required to unblock the esophagus.
Other times this disease may present with symptoms similar to GERD, such as heartburn or retrosternal pain and regurgitation. In children, manifestations are much more heterogeneous, including refusal to thrive, vomiting and resulting in growth retardation or weight loss.
In all cases of clinical suspicious of EoE, symptoms should be carefully taken into account by a specialist and esophagogastroduodenoscopy (EGD) with multiple samples (biopsies) of the esophageal mucosa is mandatory to obtain the diagnosis. There may be abnormal features of the esophageal mucosa such as paleness, presence of whitish papules, furrows and annular narrowing of the esophagus, that are suggestive of this disease. However, these characteristics do not allow a definitive diagnosis. Biopsies are mandatory, even in patients with normal appearance esophagus, in order to identify increased eosinophilic inflammation of the esophageal mucosa. At the first evaluation with esophagogastroduodenoscopy (EGD), biopsies are often also taken from the stomach and small bowel mucosa if there is any suspicion of eosinophilic gastroenteritis.
EoE is a chronic disease that requires long-term therapy, with frequent relapse of symptoms when treatments are stopped. Drugs and diet are the most frequently proposed options. Among the drugs used, guidelines suggest proton pump inhibitors (PPIs) and topical steroids (budesonide and fluticasone) as the first therapeutic options. Although topical steroids have higher efficacy than PPIs, these latter are frequently chosen as the first line medicament because of their excellent safety profile and availability.
Another therapeutic approach is based on the elimination of culprit food allergens from the diet. The most commonly used diet regimens provides the empirical elimination of groups of food mainly involved, namely milk, eggs, wheat, soy, nuts, and fish/shellfish (6 group food elimination diet or SFED).
In recent years, so-called "biological" drugs have been the subject of many studies. They have been shown to be able to induce remission in a high percentage of patients. However, further studies are still required before they can used in regular patient care. In the near future, biologics could be useful to treat patients poorly responder to conventional therapies.
The effectiveness of all these treatments should be evaluated, after 8-12 weeks, not only considering the improvement of symptoms, but also with esophageal biopsies, aimed to assess the resolution of esophageal eosinophilic inflammation.
Unfortunately, sometimes medical treatments alone are not able to restore a complete clinical remission. Long course of untreated inflammation could determine the development of complications such as esophageal stenosis and narrowing. For these fibrotic complications, endoscopic dilation is a treatment that may be necessary to re-establish an adequate caliber of the esophageal lumen and completely resolve dysphagia.
EoE is a chronic disease and therefore, needs long lasting treatment. Unfortunately, studies dedicated to evaluate effects of therapy discontinuation have shown recurrence of symptoms and esophageal inflammation in most of patients. It seems likely that treatment should be continued for many years, perhaps life-long.
EoE is an disease caused by the immune-system so it cannot be transmitted from one person to another.
Regarding heritability, it is known that there are certain genes in which minor changes increase the chance subjects develop EoE, these genes including the minor changes. An higher risk of being affected by EoE in family members has also been found. However, we do not know whether or not, and, if yes, how often children will inherit this disease from their parents.
EoE is a chronic condition related to the immune system and cannot be prevented. We still do not know exactly how EoE develops. However, there are some indications that it runs in families and that there is a genetic predisposition. Treatment cannot start until you experience symptoms and obtain a diagnosis through your specialist.
We are setting up an interactive list of European Centers specialized in the management of EoE and other eosinophilic gastrointestinal disorders. We will update our website as soon as possible.
Take a look of “European Patient Associations” section on our website to find out more information. For any question please contact us.
Some European Countries recognize exemption from payment of healthcare taxes for EoE patients. If you are affected by this disease, ask your Gastroenterologist or get in touch with us if you are entitled to this possibility.