Eosinophilic oesophagitis and food allergies

To a gastroenterologist, a swallowing problem means anything that feels abnormal when food travels from the mouth to the stomach. There are many causes but an increasingly common cause is eosinophilic oesophagitis (EoE). It is characterised as the presence of a certain type of immune cell, the eosinophil, accumulating in the oesophagus (food pipe) and can cause the oesophagus to narrow. It is though to be related to a sensitivity in some patients to specific foods and sometimes acid reflux, or both. This can affect patients of all ages but is most common in younger age groups (30’s-40’s). It has been fairly recently described but is being detected at an alarming fast rate and can cause a number of problems.

So what are the symptoms?

Most studies agree that the most common symptom is food getting stuck in the oesophagus, or being aware of the passge of food as it travels into the stomach. Most people with EoE say they feel this on an intermittent basis rather than with every swallow. Sometimes they may feel that they can only swallow certain foods, especially bulky or solid foods such as bread or meat, with liquids. Some people may actually feel that food gets stuck and at its worst, patients may have to come in to hospital to have food removed.

I’ve got a swallowing problem. How do I make sure I dont have EoE?

The only way to definitively diagnose EoE is to have a gastroscopy. This is a type of endoscopy where a camera is inserted into the oesophagus through the mouth. It is usually done with sedation and is a comfortable procedure. The endoscopist will take a series of biopsies from the oesophagus and count the eosinophils under the microscope.

So if I have EoE what is the risk?

EoE is a slowly progressive condition. The main problem is that if left unchecked, the eosinophils can cause scarring in the oesophagus. This results in the oesophagus becoming narrower and it becoming harder and harder to swallow. If this happens, then the oesophagus has to be widened during endoscopy which can be risky procedure and is best avoided in the first place. The risk of developing these narrowings is around 5% per year.

What can be done to prevent EoE?

In around 50% of people, the eosinophils can be suppressed with anti acid medication. This is possibly a result of an independent immunological effect of this type of medication (proton pump inhibitors) rather than because of acid suppression although both may be important. Some patients dont like to take regular medication. In this case trying to ascertain whether the patient is allergic to a food ingredient may be important. This can be done by excluding and then reintroducing foods into the diet and re-biopsying the oesophagus each time the food is reintroduced. The underlying food allergy is determined in around 70% of cases.

Other medications, such as low dose steroids (budesonide or fluticasone) can be used but these have to be taken continuously in order to suppress the eosinophils.

Sebastian Zeki
Sebastian Zeki
Gastroenterology consultant

My clinical practice and research interests included upper gastrointestinal pathologies