GI Systems & Disorders

At Minnesota Gastroenterology, we know that patients and families want to know as much as they can about the GI system and disorders that affect their daily lives.  Refer to the list below to find the information that is most helpful to you.  If you still have questions, please contact us through our website Quick Links or call (612) 871-1145 to make an office appointment.

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Eosinophilic Esophagitis (EoE)

What is eosinophilic esophagitis (EoE)?
Eosinophilic esophagitis is one of many types of esophagitis (inflammation of the esophagus). 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 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.). Eosinophilic esophagitis is a chronic condition, meaning it may reoccur or last a lifetime.

What are the symptoms of eosinophilic esophagitis?
Symptoms often include difficulty swallowing or the feeling that food is getting caught or stuck in the esophagus. Symptoms may also include heartburn.

How common is eosinophilic esophagitis?
Eosinophilic esophagitis is a rare condition. Of those adults affected with eosinophilic esophagitis, 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 your 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 a steroid administered either with an inhaler or in a liquid form. Recurrent or ongoing treatment may be necessary. Occasionally, patients are referred to an allergist for additional testing.

Steroids administered with an inhaler (example: fluticasone): Unlike inhaled steroids, where a spacer is used to help get the medication into the lungs, spray the medication without a spacer. This allows for the medication to be delivered to the back of your throat and swallowed and brings the medication in direct contact with your esophagus. This medication should be taken after meals.

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 mouthpiece between your teeth.
  • Close your lips around the mouthpiece. Holding your breath, press down on the top of the medication canister with your index finger to release the medication, and swallow the medication. Do not breathe in until the medication is swallowed.
  • Wait 15 seconds and repeat if you were instructed to take 2 puffs of the fluticasone. Replace cap on the inhaler when done.
  • After taking the medication you should rinse your mouth with water, without swallowing it, and spit it out. Rinsing the mouth helps to prevent thrush, an infection that can occur in the mouth and produces white patches.
  • You should avoid eating or drinking for 30 minutes after taking the medication to avoid washing the medication away.

Steroids administered in liquid form (example: budesonide): This medication comes in a single-use plastic vial. This medication should be taken after meals.

  • To start, gently shake the plastic vial with a circular motion. Then twist and remove the cap of the vial.
  • Partially fill a teaspoon with honey or syrup and squeeze the liquid from the vial into the honey or syrup.
  • Swallow the mixture. The honey or syrup will help the medication “stick” to the esophagus.
  • After taking the medication you should rinse your mouth with water, without swallowing it, and spit it out. Rinsing the mouth helps to prevent thrush, an infection that can occur in the mouth and produces white patches.
  • You should avoid eating or drinking for 30 minutes after taking the medication to avoid washing the medication away.

Side effects of steroids can include the development of a fungal infection in the mouth (thrush), esophagus, or respiratory tract. Other typical side effects of steroids can occur, but with a lessened incidence as compared to oral medication.

Are there any complications from 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 or when should I seek medical attention?
Routine follow up is not required however, if you continue to have problems after you finish the course of medication, call your gastroenterologist. Recurrent or ongoing treatment may be necessary. If an obstruction causes an inability to swallow or interferes with breathing, call 911 or go to the nearest emergency department.