Is it difficult to swallow food? Could it be Eosinophilic Esophagitis (EoE)?

When you eat, do you find it difficult to swallow food, or do you feel like it's stuck in your throat? Or do you have a burning or pain in your chest? Many people think that this is gastritis, but sometimes the cause of this can be a different, allergy-related condition. Because of this condition, some people even feel like they don't want to eat. Today we are talking about a similar condition, but not many people have heard of it, called Eosinophilic Esophagitis.

Simply put, what is Eosinophilic Esophagitis (EoE)?

While this name may sound a bit complicated, the story is very simple. Let's break this name down.

• The esophagus is the tube that carries food from our mouth to our stomach. We call this in Sinhala as gullet.
• Eosinophils are a type of white blood cell in our body. They usually increase in our body when we have an allergy.
• The suffix -itis means "inflammation" or "swelling."

Simply put, Eosinophilic Esophagitis (EoE) is an allergic reaction that causes white blood cells called eosinophils to accumulate in our esophagus, causing the esophagus to swell. Think of it like eczema, where the skin becomes red, swollen, and itchy, but the same thing happens inside the esophagus.

If this swelling continues, scar tissue forms inside the esophagus, narrowing the passage for food. This is when you start to have difficulty swallowing and feeling like your food is stuck. The food you eat may not pass easily from your mouth to your stomach, and it may feel stuck. This is a chronic condition. This means that it will not get better overnight, and you will have to take treatment for the rest of your life. But don't worry, there are good treatments that can help control it.

What are the symptoms of EoE? Do they change with age?

Yes, the symptoms of this condition can vary depending on the age at which it occurs. It is not the symptoms that occur in a small baby, but in an adult. Let's look at this in order to understand this clearly.

In addition to these main symptoms, there are several other symptoms that can occur at any age:

• Stomach ache: Pain in the stomach area.
• Nausea and vomiting: Nausea and vomiting after eating.
• Regurgitation: The regurgitation of swallowed food into the throat or mouth.
• Food Impaction: This is a medical emergency . A piece of food that is being eaten gets stuck in a narrowed area in the esophagus, neither moving down the throat nor coming back up. In such cases, there is a risk of esophageal rupture, so it is essential to go to a hospital's emergency room (ETU) immediately.

Why do we have this? What is the reason?

Simply put, the main reason for this is that our immune system overreacts to certain allergens. To be precise, when certain things in the food we eat, or things in the environment like dust, enter our airways, our body thinks that this is a big enemy.

Then, the immune system sends a large number of cells, including eosinophils, into the esophagus to attack the 'enemy.' These cells accumulate and cause inflammation, or swelling, inside the esophagus.

Main foods that can trigger EoE

Most of the time, these allergies are caused by the foods we eat. Among them, there are a few main suspects.

Most people don't have all of these problems. Perhaps one or two of these could be the cause of your problem. We'll see how to find out exactly when we talk about treatment.

Who is at higher risk of developing EoE?

Although anyone can develop this disease, some people are more susceptible. In particular, people with other allergic diseases are at higher risk of developing EoE.

• Asthma
• Allergic rhinitis - frequent runny nose, sneezing
• Skin diseases (Eczema, Atopic dermatitis)
• Other food allergies

Having these conditions means that your immune system is generally more sensitive to allergens. Also, if someone in your family (parents, siblings) has EoE, you have a small risk of developing it too.

How do you know for sure if you have this disease?

If you have the symptoms we discussed earlier, the first thing you should do is see a qualified doctor. The doctor will first ask you a few questions and take a look at your medical history.

Things you might ask your doctor:

• The way you eat: Do you chew your food thoroughly to make it easier to swallow? Do you avoid certain foods, such as bread and meat? Do you drink a lot of water to help you swallow your food? These things can give your doctor an idea of ​​how you are coping with your symptoms without realizing it.
• Your other medical conditions: Ask if you have asthma, dust allergies, or skin conditions.
• Your family medical history: Ask if anyone in your family has similar swallowing difficulties or EoE.

Based on this information, if your doctor suspects EoE, he or she will refer you to a gastroenterologist, who will perform two main tests to confirm the diagnosis.

1. Endoscopy or EGD: This involves inserting a thin, flexible tube with a camera at the end through your mouth to examine your esophagus, stomach, and the first part of your small intestine. You will be given pain-free medication during this procedure. The camera allows the doctor to see things like swelling, white spots, and narrowing inside your esophagus.

2. Biopsy: During the endoscopy, the doctor takes a small sample of tissue from the lining of the esophagus. This is called a biopsy. The tissue is then examined under a microscope to see if there are abnormally high numbers of eosinophils. This biopsy is essential to confirm EoE.

What are the treatments for EoE?

The main goal of treating EoE is to control the inflammation in the esophagus. There are two main ways to do this: medication and dietary changes. You and your doctor will decide together which method is best for you.

Treatment with medication

These medications help reduce swelling in the throat.

• Proton Pump Inhibitors (PPIs): These are a type of medication commonly prescribed for gastritis. They can also help reduce swelling in the esophagus in some EoE patients.
• Corticosteroids: These are powerful medications that reduce inflammation. They are usually given as a topical solution (as a spray or a tablet). These medications work directly in the throat, so they have fewer side effects.
• Biologic agents: For some people, when other treatments don't work, specific drugs, such as dupilumab (Dupixent®), are given as injections. These target and control the specific part of the immune system that causes the allergic reaction.

Changing the diet (Food Group Elimination)

This is also a very effective treatment. It involves completely eliminating the 6 main food groups that we discussed earlier that are most likely to cause allergies (milk, eggs, wheat, soy, nuts, seafood) from your diet.

1. First, stop eating all these food groups for a while.

2. After that, the doctor will do another endoscopy and biopsy to see if the swelling in the esophagus has decreased.

3. If the bloating has decreased, it means that one or more of these foods is the cause of your problem.

4. Next, add the eliminated food groups back into your diet, one by one, over a period of several weeks.

5. After adding each food group, a biopsy is performed again to see if the swelling has returned.

Although this method may seem a bit time-consuming and cumbersome, it is the best way to find out exactly what foods you are allergic to. Once you find that out, you can avoid just those foods and eat everything else normally.

Is living with EoE a challenge?

EoE is not a life-threatening disease, but because it is chronic, it requires lifelong treatment or dietary management.

For many people, symptoms almost completely disappear after treatment begins. However, some people, especially those who have had a bad experience with food impaction, may develop a fear of swallowing (phagophobia) . They may feel afraid and anxious about eating large bites of food, such as bread.

There are a few things that can help you at a time like this:

• Connect with others: Talking to other people who know about this disease and have it can be a great help. It will help you feel like you're not alone. You can ask your doctor about support groups.
• Get help from a nutritionist: A nutritionist can help you create a delicious meal with foods that are suitable for you and that are free of harmful ingredients.
• Get mental health support: If things like fear of swallowing are affecting your life, it's very important to talk to a mental health professional about it.

If you experience a return of symptoms after treatment, or if you develop new difficulty swallowing, see your doctor immediately.

Eosinophilic Esophagitis, EoE, difficulty swallowing, esophageal allergies, dysphagia, food impaction, endoscopy