Eosinophilic Esophagitis

What is Eosinophilic Esophagitis (E.E.)?

Eosinophilic esophagitis is one of many types of esophagitis.  It is not as common as reflux esophagitis, but has many of the same symptoms.  It is caused by an abnormal accumulation of eosinophils in the lining of the esophagus (swallowing tube).  Eosinophils are a type of blood cell that can be seen in the esophagus.  In this condition however they are present at an increased level.  The reason for this increased accumulation is unknown.  Often individuals with Eosinophilic esophagitis have allergies or an allergic disorder (i.e. asthma, allergic rhinitis, urticaria, etc.)

Symptoms often include heartburn and more commonly difficulty in swallowing, or the feeling that food is getting caught or stuck in the esophagus (swallowing tube).

How common is Eosinophilic Esophagitis?

Eosinophilic Esophagitis is a rare condition. Of those adults affected with E.E.; the majority are men in their 20-30s.  Children can also be affected.

How do you know if you have Eosinophilic Esophagitis?

The only way to diagnose Eosinophilic Esophagitis is by Upper Endoscopy with biopsies (tissue samples)  of the esophagus. Upper Endoscopy or EGD (Esophagogastro-duodenoscopy) is a procedure where a small lighted tube is passed through your mouth into you esophagus, stomach and first portion of your small intestine.  The tube that is used has a camera within it and is connected to a computer.  This test allows the doctor to see the lining of your esophagus, stomach and first portion of your small intestine.  Pictures can be taken and can be part of your medical record.  Biopsies can be taken at the time of endoscopy.    There is no pain associated with taking biopsies.

Findings at the time of endoscopy can show a normal appearing esophagus, or an esophagus that appears to have many rings (somewhat like a spring).  Biopsies show an increase in the amount of eosinophils that are present.

How is Eosinophilic Esophagitis treated?

Treatment involves the use of the topical steroid Flovent (Fluticasone) inhaler.  The dosage used is 220 mgs. per puff taking 4 puffs twice daily for 6 weeks.

Unlike inhaled steroids where a spacer is used to help get the medication into the lungs, you are to spray the medication without a spacer.  This allows for the medication to be delivered to the back of you throat and swallowed.  This brings the  medication   in contact with your esophagus.

To operate the inhaler:

• Shake the inhaler for 5 seconds
• Position the inhaler with the index finger on the top of the medication canister and the thumb supporting the bottom of the inhaler. Position the mouth piece between your teeth. Close your mouth around the mouth piece. Press down on the top of the medication canister with your index finger to release the medication.
• The medication should be taken after meals. After taking the medication you should rinse your mouth with water and spit it out.
• You should avoid eating for 3-4 hours after taking the medication to avoid washing the medication away

Side effects to Fluticasone include the development of a fungal infection in the mouth (thrush), esophagus or respiratory tract.  Other side-effects for steroids would apply to Fluticasone, but because so little of it is absorbed, they are not experienced very often.

Are there any complications to Eosinophilic Esophagitis?

The most common complication is  food becoming caught in the esophagus.  This can lead to erosions (irritation) or ulcerations on the wall of the esophagus.

What kind of follow up will I need?

Routine follow up is not required.  If you continue to have problems after you finish the course of medication, call your gastroenterologist.

11/18/2004