Hard to Treat Reflux? Maybe You Have Eosinophilic Esophagitis

Esophagitis is a general term for any inflammation, irritation, or swelling of the esophagus, the tube that leads from the back of the mouth to the stomach. Eosinophilic esophagitis patients present with gastric reflux symptoms (heartburn, chest pain, vomiting, regurgitation, abdominal pain) in addition to difficulty swallowing and/ or food impaction and are found on biopsy of the esophagus to have high number of eosinophils (greater than 15-20 per high power field) without infiltration of the rest of the gastrointestinal tract.
eosinophils
Eosinophils are a type of white blood cell which play an important role in immune function, mainly as a defense against against parasites, but are also involved in diseases like allergies and asthma.
People with eosinophilic esophagitis usually have a personal or family history of allergic disease such as hayfever, asthma, or eczema. They present with difficult to treat reflux symptoms, and often food impaction in teens or young adults. Upper endoscopy can show linear furrows, mucosal rings, strictures, or appear normal.
esophageal rings
The diagnosis is established by obtaining multiple (at least 5) biopsy specimens of the esophagus which show increased eosinophils (15-20/hpf) in the mucosa only, with none in the stomach or duodenum.
The exact etiology of eosinophilic esophagitis is not yet known, but food and environmental allergies are possible contributors. Short-term studies of the natural history of the disease show no concomitant eosinophilic infiltration of stomach or duodenum, no progression to hypereosinophilic syndrome or development of malignancy.
Food Allergy testing via prick and atopy patch skin test have been used to identify relevant food allergens to guide elimination diets.

Treatment consists of elimination diets, topical corticosteroids, and systemic corticosteroids.

LINKS:

Center for Pediatric Eosinophil Disorders
Resources for Families
More Resources for Families dealing with Eosinophilic Disorders
American Partnership for Eosinophilic Disorders (APFED)
Allergy and Asthma Consultants of Rockland and Bergen
Neocate

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12 thoughts on “Hard to Treat Reflux? Maybe You Have Eosinophilic Esophagitis

  1. I think this is more of a problem than we know just diagnosis is so difficult and its gets overlooked unless its really serious most don’t get a endoscopy

    ryan

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  2. Hi, very informative post – thank you. I have esophagitis and can tell you it is extremely painfull when at its worst. Not very often does it play up I am glad to say. Keeping away from fatty and acidic foods helps though. Regards.

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  3. Ever seen eosinophilic esophagitis with swollen/painful joints (knees, jaw)? I’m trying to determine any relationship between my diagnosis and my symtoms.

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    1. wondering if you heard anything more about this. i have mild tmj, and i swear it’s from the chronic inflammation of the EE. let me know! hope you’re well!

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  4. Eosinophilic esophagitis has not been associated with swollen and/or painful joints. It presents with severe gastroesophagel reflux symptoms/ food impaction and may be associated with other allergic disease.

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  5. female, 26 yrs old, and diagonsed in april June 08. I almost guarantee this has been a problem for me for a very long time before I decided to take more steps in getting to the bottom of my symptoms. In response to a post I would like to say swollen, inflammation in the jaw can be linked to this. I also agree there are probably much more with this than have been diagnosed.

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  6. female 29 y/o, I too have TMJ, along with other autoimmune diseases. I am a gradstudent in Public Health and have been desperately trying to find females to correlate symptoms with and develop a support network – email me, rrhoda@mail.usf.edu

    We are a minority on this one !

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  7. I think i have eosinophilic esophagitis because for years i have been having reflux and allergic reactions to so many foods and medicines, it feels like my tongue is swelling and my throat is closeing i get dizzy and feel like i am going to suffocate and chest pain i rush to the hospital they treat me and release me with allergy meds, i have seen many allergist have been tested and everything i have a reaction to doesn’t show up on skin test or blood test, so i am told it’s not allergys well 3 weeks ago i went to my GI doctor again i just can’t stand this any more sometimes it’s hard to swollow my food sometimes even water will set my esophagitis off, he told me of this condition and that he wants to put me to sleep and scope me and now after reading this i am more then ready to let the doctor do it. Is there a cure for this problem i have lost 10 pounds in 2 months hardly ever eat vitamim D level is low and my thyroid level is now high is this happening to anyone else.

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  8. Many parents on the yahoo EE/EGID boards report their children have pain in the legs and/or joints, I have to say it is probably connected to EE somehow. Perhaps the cytokines in the blood cause pain in other parts of the body. Low Vitamin D will cause increased suceptability to autoimmune diseases, and also rickets, whcih can be painful. My son has EE and I have autoimmune disease, we are both on a vitamin D supplement much higher than the RDA of 400IU to get a sufficient blood level of vitamin D.

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