Eosinophilic Esophagitis (or EE) was a hot topic at a gastroenterology conference I attended recently. EE is a chronic condition causing inflammation of the esophagus and appears to be on the rise in children. There are similarities in the symptoms and presentation of EE and Gastroesophageal Reflux Disease (GERD) so doctors are using new research-based methods of diagnosing EE. While EE and GERD may have similar symptoms, the treatments are quite different so the diagnosis is vitally important. With the heightened awareness of EE, it is likely research will add to our understanding of the diagnosis and management of this condition.
How EE differs from acid reflux
The symptoms of EE may include:
- abdominal pain
- problems with weight gain or weight loss.
You are probably thinking that EE sounds just like GERD. It may initially look like GERD, a patient may even be given GERD medication (such as proton pump inhibitors or PPI). The medication often works for GERD patients, but a patient with EE does not respond to this treatment.
Some major differences between EE and GERD are:
- EE patients often have rashes and skin conditions and swallowing problems leading to food impaction (food getting caught in the esophagus).
- It appears that more males than females are affected by EE.
- A patient with GERD will have an abnormal pH probe test showing the presence of acid in the esophagus while a patient with EE will have a normal pH probe test.
- The symptoms of EE change as the patient gets older. Infants with EE are more likely to have feeding issues. Children with EE may have vomiting. Adults with EE are more likely to have food impaction.
EE is diagnosed based on a pattern of symptoms and a high number of white blood cells called eosinophils in the esophagus. A test called an endoscopy is needed to detect the eosinophils. While a patient with GERD may have some eosinophils in the esophagus, a diagnosis of EE is based on a high number of eosinophils and a pattern of changes in the esophagus that often look like rings or furrows.
The main treatments for GERD are different than the treatments for EE. While most patients with GERD respond to medications and changes to the diet, patients with EE must follow a strict diet that often involves eliminating foods or drinking an elemental formula. Some patients with EE are also treated with anti inflammatory medications such as steroids to reduce the inflammation or swelling of the lining of the esophagus.
As doctors and researchers are learning more and more about EE, patients benfit greatly. While EE is less common than acid reflux, it makes sense that a doctor may initially try a GERD treatment. However, if the GERD treatment does not reduce symptoms, the doctor may try other GERD treatments and seek other explanations for the symptoms, including EE. While EE is a chronic condition, the vast majority of patients respond positively to dietary changes and can work and play normally.
An excellent resource for parents and patients is the American Partnership for Eosinophilic Disorders or Apfed. The Apfed website at www.apfed.org contains patient materials, resources and information on research.