If you have self-diagnosed your heartburn as acid reflux, but the typical remedies haven’t helped, you might need a second opinion. Eosinophilic Esophagitis (EOE) is becoming widely recognized by physicians as having similarities to conditions like acid reflux or gastroesophageal reflux disease (GERD), but it is associated with allergies.
Allergies and EOE
There is no known cause of EOE, but the thinking is that it happens as a result of an immune response because of exposure to environmental or food allergies. Most people diagnosed with EOE have a combination of allergies in addition to a family history of allergies or of EOE. These allergies can include asthma, seasonal allergy (or hay fever), eczema, or food allergy. Allergy testing is an important step in understanding if you have EOE and how to treat it. Allergy testing involves testing for common environmental substances like animals, dust mites, pollen, and mold. Food allergy testing can include any or all of the following:
- Prick skin test
- Blood test
- Food patch test
Diagnosis of EOE
The only reliable way to diagnose EOE is by upper endoscopy and biopsy. During this procedure your doctor will examine the esophagus looking for damaged tissue, inflammation, or narrowing of the esophagus. It is possible for the esophagus to look normal and a person still have EOE, so small tissue samples will also be taken to examine for eosinophils. A high enough count of eosinophils warrants a diagnosis of EOE. Eosinophils can make it difficult to swallow and cause frequent sore throat and heartburn, so it is important that you and your doctor identify the problem and move toward a treatment plan.
Treatment of EOE
Your doctor may use the results of an allergy test to eliminate certain foods from your diet to see if symptoms improve. Instead of allergy testing, your doctor could use other forms of diet management to identify any problem foods. This could be through eliminating common allergy-causing foods like wheat, soy, nuts, or shellfish to see the effects, if any. Another form of diet management is to eliminate protein from the diet and replace it with an amino acid formula. Your doctor could also perform a food trial by eliminating suspect foods and adding them back in one at a time to identify the problem-causing food.
Medications may also be prescribed, especially in the case of environmental allergies where dietary changes won’t help. While there is currently no FDA approved medication for EOE, there are a few things that have been shown to help reduce symptoms. These include topical steroids taken through an inhaler to reduce inflammation, acid suppressors to help the reflux symptoms, corticosteroids like Prednisone, or a combination of these.
EOE has no cure, so it is important that you talk to your doctor and make a plan for ongoing monitoring of the disease. While it does not lead to shortened life-expectancy or esophageal cancer, it can cause serious complications like narrowing of the esophagus or lodging of food. If you are experiencing any symptoms and wondering if you may have EOE, make an appointment with GI Associates today.