What happens in the esophagus
Normally, there are no eosinophils in the esophageal mucosa. In this disease, the immune system reacts to food proteins as a threat, and eosinophils migrate into the wall of the esophagus, releasing substances that support inflammation. Gradually, the mucous membrane thickens, connective tissue grows underneath it, and the esophagus loses its extensibility. During endoscopy, longitudinal grooves, whitish deposits, circular rings and a narrowed lumen are visible. In later stages, a fibrous stricture forms.
- Infiltration of the mucosa by eosinophils
- Chronic inflammation and swelling of the wall
- Thickening and loss of elasticity of the esophagus
- Longitudinal grooves and rings during endoscopy
- Formation of narrowing in later stages
Who is sick and why
The disease is more common in young and middle-aged men, as well as in children. Almost all patients have other allergic diseases: hay fever, bronchial asthma, atopic dermatitis or food allergies. The leading role is played by food proteins, most often milk, wheat, eggs, soy, nuts and seafood. It is important that this is not a classic immediate allergy with rash and swelling, but a delayed immune reaction, so conventional skin tests and IgE tests do not always help identify the culprit product.
- Young and middle-aged men, children
- Concomitant asthma, rhinitis, atopic dermatitis
- Reaction to milk, wheat, eggs, soy, nuts, seafood
- Seasonal worsening of pollen allergies
- Hereditary predisposition
Symptoms in adults and children
In adults, the main complaint is difficulty swallowing solid foods and episodes of getting a piece stuck, due to which a person becomes accustomed to chewing thoroughly, washing down every sip, avoiding meat and bread, and eating slower than everyone else at the table. Heartburn and chest pain that are resistant to conventional treatment are common. In children, the picture is different: abdominal pain, nausea, vomiting, regurgitation, refusal to eat, poor weight gain. This is why the disease in children is often recognized late.
- Difficulty swallowing solid foods
- Food bolus stuck
- Heartburn that does not respond to treatment
- Chest pain
- In children - abdominal pain, vomiting, refusal to eat
- Slow eating, need to drink
Diagnostics
Endoscopy is mandatory, but one examination is not enough: in approximately some patients the mucous membrane looks normal. Therefore, at least six fragments are taken from different parts of the esophagus. The diagnosis is confirmed when at least 15 eosinophils are detected in the field of view at high magnification along with typical complaints. At the same time, reflux disease and other causes of eosinophilia are excluded. Allergy testing helps plan a diet, but does not make a diagnosis in itself. After treatment, a control endoscopy with a repeat biopsy is performed.
- Endoscopy with multiple esophageal biopsies
- Histological count of eosinophils
- Total IgE and allergy panels
- General blood test with formula
- Exclusion of reflux disease and parasitosis
- Control endoscopy to evaluate the effect
Treatment
Three approaches are used that can be combined. The first is proton pump inhibitors: in some patients they reduce eosinophilic inflammation. The second is topical glucocorticoids in a special form that is swallowed so that the drug acts on the lining of the esophagus, and not in the lungs. The third is an elimination diet with the exclusion of the main trigger foods and their consistent return under the control of repeated biopsies. When a narrowing is formed, careful endoscopic expansion is performed. The treatment is long-term, the doctor selects the regimen, and after discontinuation the inflammation often returns.
- Proton pump inhibitors
- Swallowed topical glucocorticoids
- Elimination diet under medical supervision
- Phased return of biopsy-guided products
- Endoscopic dilatation for stricture
- Observation by a gastroenterologist and allergist