Do you feel like a lump of food is stuck in your throat when you eat? Do you feel like your chest is tight when you drink water? Only those who suffer from it know how difficult it can be to live with such discomfort. Although many people think that this is gastritis, sometimes the cause of this condition is Eosinophilic Esophagitis, or what we call `(EoE)` for short.
Simply put, what is Eosinophilic Esophagitis (EoE)?
Okay, let's put it simply. Your body's immune system has a special type of cell called an eosinophil. Normally, these cells are there to fight off things like parasites that enter our bodies. But sometimes, especially if you have an allergy, these eosinophils mistakenly start to accumulate in your esophagus - the tube that carries food from your mouth to your stomach.
When this happens, the esophagus becomes swollen, red, and sore from the inside. It's like a rash on the skin. This is often caused by certain foods we eat. This swelling causes the esophagus to narrow, making it difficult to swallow food, and food gets stuck.
Now that your doctor has confirmed that you have this condition, the first thing you might think is, "Okay, what's the best treatment for me now?" Let's talk about that now.
What are the main treatments for EoE?
There is no single best treatment for EoE. It's like a suit that fits one person may not fit another. Your doctor will consider many factors, including your condition, lifestyle, and preferences, to create a treatment plan that works best for you.
There are four main treatment methods.
| Treatment method | What happens to it? |
|---|---|
| Proton Pump Inhibitors (PPIs) | These are usually prescribed for gastritis, but they can also reduce inflammation in the esophagus. Often, doctors start with this treatment first. |
| Topical Steroids | These are medications that come in a special inhaler or as a lozenge. When you swallow them, the medication sticks to the walls of your airways and directly controls the swelling caused by those eosinophil cells. |
| Dietary Changes | As I mentioned earlier, the main cause of EoE is food allergies. So, the key here is to find out what foods you are allergic to and eliminate them from your diet completely. |
| Esophageal Dilation | If the esophagus is very narrow due to long-standing EoE and food is often stuck, a special balloon-like device is inserted during the endoscopy to slightly widen the esophagus. This provides immediate relief from difficulty swallowing. |
How does a doctor choose the treatment that is right for you?
Now you may be wondering, "Which of these four is right for me?" Your doctor will consider several factors carefully before making a decision.
1. History of your other allergies
Have you had asthma, eczema, or allergies to things like dust and pollen since childhood? If so, there is a high chance that your EoE condition is also caused by a food allergy. In such cases, your doctor may focus more on dietary changes rather than medication. You may also be referred to an allergist, a specialist in allergies.
2. The severity of your symptoms
Imagine that someone has only a slight difficulty swallowing food. Another person constantly gets food stuck and has to drink water to get it down. Sometimes, food gets completely stuck and they have to go to the Emergency Department (ETU).
If your symptoms are not too severe, your doctor may start with something simple like a PPI. However, if you are experiencing frequent food cravings or suspect that your esophagus is severely narrowed, your doctor may recommend a treatment plan that includes esophageal dilation.
3. Your lifestyle and preferences
This is very important. The doctor will talk to you and ask you about these things.
- Is it possible to control your diet? Imagine that you are a busy person who eats out all the time. For such a person, eliminating 6 main foods (dairy, eggs, soy, wheat, fish/seafood, nuts) and eating them (Elimination Diet) can be very difficult. In such a case, it may be easier for you to use a pill that you swallow once a day.
- Do you like medication? Some people don't like taking medication long-term. They prefer to find the cause of the disease and control it through diet. For such a person, diet control may be the best option.
That means, this is a decision you and the doctor will make together.
Can diet cure EoE?
This is the biggest problem for many people. Since the root cause of EoE is diet, if you can identify the exact food that triggers it and stop it, you can often almost completely cure the symptoms. But the challenge is figuring out what the food is.
It is difficult to find the food that causes EoE with regular allergy tests, such as skin prick tests. Because EoE is a slightly different type of allergic reaction, doctors use two special methods.
1. Elimination Diet: This involves completely eliminating a few key foods (usually 6) that have been found to be the most common causes of EoE for a few weeks. Then, we reintroduce them one by one to see if the symptoms improve. We can then see which foods cause the symptoms to return.
2. Elemental Diet: This is a bit more difficult. Here, you stop eating all your regular food and drink only a special liquid nutritional drink (amino acid formula). This gives your esophagus a complete rest and the swelling completely heals. Then, you add foods back in one by one.
Both of these methods should only be done under the advice of a doctor and a dietitian . Doing it alone can lead to nutritional deficiencies.
| Foods that most commonly cause EoE | |
|---|---|
| Milk and milk products | Wheat (bread, pasta, cakes) |
| Eggs | Soy |
| Nuts (such as cashews, peanuts) | Fish and seafood |
| Beef | Corn |
Ultimately, EoE is nothing to worry about. It is a manageable condition. The most important thing is to talk openly with your doctor and work together to develop a treatment plan that best suits your lifestyle, preferences, and condition.
Take-Home Message
- Eosinophilic Esophagitis (EoE) is an allergic condition that affects the esophagus. It can cause difficulty swallowing food.
- There are four main treatments for this: PPI medication, oral steroids, diet, and dilation.
- Your doctor will choose the treatment that is best for you, taking into account factors such as your symptoms, other allergies, and your lifestyle.
- Since diet is the main cause of EoE, identifying and avoiding offending foods is a very effective treatment.
- Before starting any treatment, talk to your doctor about it carefully. The treatment process is a collaboration between you and your doctor.
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