Lately the media has been paying more attention to food allergies, and for good reason. Food allergies are increasing in America, and we are not sure why. One such food allergy issue is eosinophilic esophagitis. This is a medical condition that occurs when the esophagus becomes inflamed with eosinophils, which are white blood cells associated with allergies. The inflammatory reaction is most often diagnosed by obtaining a biopsy of the esophagus during a procedure called an esophagogastroduodenoscopy, also known as an endoscopy. If the inflammatory reaction occurs repeatedly, over time people may experience esophageal spasms, weakening of the LES (lower esophageal sphincter) and possibly structural changes of the esophagus itself. There are a variety of symptoms that someone may experience with eosinophilic esophagitis, the most common symptoms are explained below.
One symptom is difficulty swallowing. When the esophagus becomes chronically inflamed it can even spasm and cause food to become lodged or impacted. This is a quite painful reaction, which may result in the individual regurgitating water and saliva. Often these symptoms are quite alarming and patients will seek immediate medical treatment in the emergency room. Fortunately, the symptoms resolve once the food has passed or after it is removed via endoscopy. Foods that typically become impacted are items that are thick in consistency, such as meat, or items that swell with the introduction of fluid, such as bread or rice.
Other symptoms may occur due to the regurgitation of stomach acid, which result from the LES not working properly. The LES is a muscle that prevents acid from leaving the stomach and entering the esophagus. The LES is the reason we can stand on our head and food won’t rush out. In infants the LES does not work as well as it does in adults. This is why infants tend to “spit up” after eating. Inflammation from eosinophilic esophagitis interferes with the LES and allows stomach acids to wash up into the esophagus. This acid causes burning pain, chest discomfort, regurgitation of food and various other symptoms.
If eosinophilic esophagitis becomes a chronic problem, structural changes of the esophagus may occur. The most common structural changes are the formation of esophageal rings or strictures. These rings in the esophagus cause food to “catch”, and swallowing can be obstructed. If the strictures become severe, a gastroenterologist will perform a procedure called “dilation”. The purpose of this procedure is to break or stretch the rings or adhesions and prevent food from becoming obstructed in the esophagus.
In closing, eosinophilic esophagitis can cause a myriad of symptoms and is still under diagnosed. Food allergies quite often play a major role in eosinophilic esophagitis, and there are ways to test for food allergies with a board certified allergist. This can include skin testing and blood testing. If you are experiencing some of these symptoms, talk to your physician or seek an allergist or gastroenterologist who are familiar with this condition and are willing to work as a team with you.