Is it difficult to swallow food? Is it stuck in the throat? Is this Eosinophilic Esophagitis? (EOSINOPHILIC ESOPHAGITIS)

Do you feel like your food is stuck in your throat instead of going down your throat? Or do you often have a burning sensation in your chest, pain, and a loss of appetite? Many people think that these symptoms are a common gas problem (gastritis), but sometimes there may be another reason behind this. Today we are going to talk about a relatively new, but now increasingly common, condition. That is Eosinophilic Esophagitis.

Simply put, what is Eosinophilic Esophagitis?

This name may seem a bit long and complicated, but let's keep it simple.

The tube that carries food from our mouth to our stomach is called the esophagus . It's like a water pipe. The "eosinophilic" part comes from a type of white blood cell in our body called "eosinophils." "Esophagitis" is inflammation of the esophagus, meaning swelling or injury.

So, to put it simply, Eosinophilic Esophagitis (EoE) is when a type of white blood cell called eosinophils accumulates in large numbers in our esophagus, causing inflammation inside that tube. This is like an allergy that occurs on our skin, but this happens inside the body, in the food pipe.

Over time, this inflammation causes fine scar tissue to form inside the esophagus, and the tube gradually narrows. Think of it like a water pipe getting clogged with rust. What happens then? When you swallow a mouthful of food, it doesn't go down easily. You may feel like the food is stuck, or it may feel like it's going down very slowly.

What are the symptoms of this condition?

Symptoms may vary slightly depending on your age. Symptoms are not as common in young children as they are in adults.

In addition to these main symptoms, people of any age can also experience these symptoms:

• Stomach pain: Pain in the stomach area.
• Nausea and vomiting: Feeling sick and vomiting after eating.
• Regurgitation: The return of swallowed food or stomach fluids into the throat or mouth.
• Food impaction: This is a medical emergency . A piece of food gets stuck in a narrowed part of the esophagus, making it difficult to breathe. In such a case, it is essential to go to a hospital's emergency room (ETU) immediately. Sometimes, this blockage can cause the esophagus to burst.

Some people don't have these symptoms all the time. They may go away for a while and then recur again.

Why does this happen? What are the reasons?

Although the exact cause is not yet known, it is believed to be the result of our immune system malfunctioning. Our immune system mistakenly identifies something that is normally harmless, such as a food we eat, as an enemy.

When this is misidentified, a large number of cells called eosinophils are sent to the esophagus in response. These cells gather there and cause the inflammation mentioned earlier.

What foods cause this condition the most?

Most of the time, these allergic reactions are caused by the foods we eat. The most common foods that are affected are:

• Milk and dairy products (Dairy)
• Egg
• Wheat
• Soy
• Seafood/shellfish
• Peanuts and other nuts (Peanuts, tree nuts)

Who is most at risk of developing this disease?

We call things that increase the risk of developing a disease risk factors. Many people with EoE also have one or more of these other allergic conditions.

• Asthma
• Frequent colds (Allergic rhinitis)
• Eczema and rashes (Eczema / Atopic dermatitis)
• Other food allergies

Also, if someone in your family, especially a sibling or parent, has this disease, you are at slightly higher risk of developing it too.

How does a doctor diagnose this?

When you tell your doctor about your symptoms, he or she will ask you a few questions.

• The way you eat: Many people unknowingly adapt to these symptoms. For example, when they eat, they chew their food thoroughly and swallow it with plenty of water. Some people avoid foods that are difficult to swallow, such as bread and meat. Your doctor will ask you about these things.
• Your and your family's medical history: Ask if you or anyone in your family has allergies, such as asthma or eczema.

After this information, if the doctor suspects that you have EoE, he or she will refer you to a gastroenterologist , who will perform several tests to confirm the diagnosis.

1. Endoscopy (EGD): This involves inserting a thin, flexible tube with a small camera at the end through the mouth to examine the esophagus, stomach, and beginning of the small intestine. This allows the doctor to visually check the inside of the esophagus for inflammation, swelling, white spots, and narrowing.

2. Biopsy: During the endoscopy, the doctor takes a small sample of tissue from the wall of the esophagus. This is not painful. The sample is then examined under a microscope to see if there are abnormally high numbers of eosinophils. This biopsy is the only way to definitively diagnose Eosinophilic Esophagitis.

What are the treatments for this?

The main goal of treatment is to control the inflammation in the esophagus. There are two main methods for this. Sometimes both methods can be used together. You can decide which method is best for you by talking to your doctor.

1. Treatment with medication

The following medications are used to reduce inflammation:

• Proton Pump Inhibitors (PPIs): These are medications commonly prescribed for gastritis, but they also have the potential to reduce the inflammation caused by EoE.
• Corticosteroids: These are swallowed steroids that are applied to the inside of the esophagus. They work directly at the site of inflammation and reduce swelling.
• Biologic agents: Vaccines, such as the recently introduced Dupilumab (Dupixent®), are also used for this purpose. These directly affect the allergic process and control the disease.

2. Dietary Therapy

What you do in this case is gradually eliminating foods that you think you might be allergic to.

• Elimination Diet: The 6 main food groups that most commonly cause allergies, namely milk, eggs, flour, soy, seafood, and nuts, are all eliminated from the diet at once.
• Then the doctor will do another endoscopy in a while to see if the inflammation has subsided.
• Once the inflammation has subsided, the eliminated food groups are reintroduced into the diet one by one, over a period of several weeks.
• After each food group is added, an endoscopy and biopsy are performed again to see if the inflammation has returned. This way, you can find out exactly what type of food you are allergic to.

How do you live with this situation?

Because Eosinophilic Esophagitis is a chronic condition, living with it can sometimes be challenging. However, with proper treatment, symptoms can be almost completely controlled.

However, especially for someone who has had a food stuck in their throat, they may develop a fear of swallowing food again (phagophobia). They may be afraid to eat large mouthfuls of food, or to eat things like bread. These tips will help you in times like these.

• Get help from a nutritionist: A nutritionist can help you create a delicious, nutritious diet using foods that are not allergens.
• Seek mental health support: It is very important to seek the help of a psychiatrist or psychologist to overcome your fear of swallowing, as well as to manage the stress that comes with this chronic illness.
• Talk to people who have had similar experiences: Ask your doctor about support groups where you can talk to other people with this disease. It's a great strength to know that you're not alone.

The most important thing is to follow your doctor's instructions exactly and attend clinics on time.

Eosinophilic Esophagitis, EoE, dysphagia, heartburn, esophagus, allergy, eosinophils, endoscopy