Do you sometimes feel like your food is stuck in your throat when you eat, making it hard to swallow? Or do you just have chest pain or stomach discomfort? Many people think that this is normal, perhaps gastritis, but this may be something different and something to be concerned about. We are talking about such a condition today. It is Eosinophilic Esophagitis, or EoE for short.
What exactly is EoE?
Simply put, Eosinophilic Esophagitis (EoE) is an allergic reaction to our esophagus, the tube that carries food from our throat to our stomach. Think of it this way: if you're allergic to something like peanuts, you'll get a rash and itch when you eat it. Similarly, when someone with EoE is exposed to a trigger, their esophagus will react. The trigger could be a food (like milk, eggs, or soy) or a pollen in the environment.
When something like this enters the body, a type of white blood cell called eosinophils, which is part of our immune system, gathers in large numbers in the walls of the airways, as if going into battle. When these cells gather, they release chemicals that cause the inside of the airways to swell and become red (inflammation) .
Just like when a water pipe swells up inside, it makes it difficult for water to pass through. When this tube swells up, it makes it difficult for food to pass down. Over time, this can become narrow. This is because:
- Difficulty swallowing food (dysphagia).
- Food impaction.
- Vomiting.
- Stomach pain.
- Chest pain.
Symptoms like EoE can be a challenging condition, but it can be managed well with the help of your doctor.
The symptoms are very confusing!
The main reason why EoE can be a bit difficult to diagnose is that its symptoms are very similar to those of Gastroesophageal Reflux Disease (GERD) . As we all know, this is what is also known as 'acid reflux' or heartburn. Since both of these diseases have symptoms such as chest pain, difficulty swallowing, and vomiting, it is very easy to confuse the two.
But the reasons for these two occurrences are completely different.
- GERD is caused by stomach acid flowing up into the esophagus. This happens when the muscle, like the valve between the stomach and esophagus, doesn't close properly.
- EoE is not something caused by stomach acid, it is an immune system reaction caused by an allergy.
Another thing is that some people with GERD also have a certain amount of eosinophils in their esophagus, which further complicates the diagnosis.
| Characteristic | Eosinophilic Esophagitis (EoE) | GERD (heartburn) |
|---|---|---|
| The root cause | An immune system response due to an allergy. | Stomach acid coming into the esophagus. |
| Main symptoms | Severe difficulty swallowing, food choking, vomiting, chest pain. | Chest pain, sour taste in the throat, chest pain, difficulty swallowing. |
| Response to medication | Common gastritis medications (acid blockers) often do not cure it. | Gastritis usually responds well to medications (acid blockers). |
But there is one important thing to remember! Chest pain can also be a sign of a heart attack. So if you have chest pain along with shortness of breath, pain radiating down your arm, or sweating, don't wait and see a doctor or go to the nearest hospital's Emergency Department (ETU). This is very important.
So how exactly does the doctor find this?
After listening to your symptoms, your doctor will likely run several tests to determine if it's GERD, EoE, or something else.
1. Asking you for details
First, your doctor will ask you a lot about your symptoms. How long have you had them, when do they get worse, does it come on after you eat certain foods, and whether anyone in your family has allergies or asthma.
2. Endoscopy test
This is the most important step in diagnosis. An endoscopy involves inserting a thin, flexible tube with a camera and light through your mouth to examine the inside of your esophagus, stomach, and first part of your small intestine. Anesthesia is used to make you feel comfortable during this procedure. This allows the doctor to visually check for swelling, narrowing, white spots, or other changes in your esophagus.
3. Biopsy test
During the endoscopy, the doctor takes a small tissue sample from the wall of the esophagus and sends it to the lab. This is called a biopsy. This tissue sample is examined under a microscope to see if there are abnormally high numbers of eosinophils, which we talked about earlier. If you have EoE, the number of these cells will be very high. This test is 100% certain to confirm the disease.
Once you've been diagnosed with EoE, there's nothing to worry about. You can work with your doctor to manage it. They may try to identify the foods you're allergic to and recommend an elimination diet. Or they may prescribe medication to reduce swelling in your esophagus. The most important thing is to follow your doctor's instructions exactly.
Take-Home Message
- Eosinophilic Esophagitis (EoE) is not just gastritis or GERD (gastroesophageal reflux disease), it is an allergic condition that occurs in the esophagus.
- Difficulty swallowing, food sticking to the esophagus, and chest pain are the main symptoms. Don't ignore these.
- If you experience chest pain, it is important to seek immediate medical attention to rule out a serious condition such as a heart attack.
- Endoscopy and biopsy are essential to accurately diagnose the disease.
- This is not a condition to be feared and can be well controlled with dietary changes and medication under the guidance of your doctor.
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