Eosinophilic esophagitis
"Eosinophilic esophagitis, although chronic, has effective treatment and a good prognosis if diagnosed early and approached in a personalized manner."
DR. SUSANA DE LA RIVA ONANDÍA
SPECIALIST. DIGESTIVE DEPARTMENT
What is eosinophilic esophagitis?
Eosinophilic esophagitis is a disease that causes chronic inflammation of the esophagus, the tube that connects the mouth to the stomach.
This inflammation is caused by an increase in the number of eosinophils, a type of white blood cell, in the esophageal mucosa.
The most common symptoms include difficulty swallowing, chest pain, regurgitation, vomiting, heartburn, weight loss, anemia, chronic cough and abdominal pain.
Diagnosis is made by a combination of medical history evaluation, laboratory tests to measure eosinophil levels and food allergies, and endoscopy with biopsy to confirm the presence of eosinophils in the esophageal mucosa.
What are the symptoms of eosinophilic esophagitis?
Eosinophilic esophagitis can manifest differently depending on the age of the patient. While in adults mechanical symptoms predominate when swallowing, in children the signs may be more nonspecific or confused with other digestive or allergic diseases.
Symptoms in adults
In adults, symptoms are usually directly related to difficulty swallowing (dysphagia) and retrosternal discomfort. The most frequent are:
- Progressive difficulty swallowing solid foods, especially dry or poorly chewed foods.
- Sensation of food getting stuck in the esophagus (impaction), sometimes requiring urgent medical attention to remove the food bolus.
- Central chest pain unrelated to exercise, which does not improve with antacids and may be mistaken for cardiac pain.
- Episodes of reflux or regurgitation of undigested food, even without acidity.
- They avoid certain foods or adapt their way of eating (eat slowly, drink liquids between bites), which may delay diagnosis.
Symptoms in children
In infancy, symptoms vary according to age and may be more difficult to identify:
- Infants: refusal of breast or bottle, crying while eating, difficulty gaining weight.
- Toddlers: frequent vomiting, recurrent abdominal pain, extreme selectivity with food.
Older children or adolescents:
- Difficulty swallowing solid foods (dysphagia).
- Episodes of esophageal impaction.
- Delayed growth, low weight or short stature.
- Lack of response to usual treatments for gastroesophageal reflux.
Do you have any of these symptoms?
You may have eosinophilic esophagitis
Causes of eosinophilic esophagitis
Genetic factors
Eosinophilic esophagitis is believed to have a genetic component, which means that people with a family history of the disease are at increased risk.
Food allergies
Food allergies are one of the main causes of eosinophilic esophagitis. Some common foods that can cause allergies include milk, eggs, wheat, soy, nuts and shellfish.
Other causes
There are also other medical conditions and environmental factors that can increase the risk of developing eosinophilic esophagitis, such as gastroesophageal reflux, asthma and parasitic infections.
Complications
If not properly treated, eosinophilic esophagitis can lead to complications such as esophageal narrowing, esophageal ulcers, food impaction and, in rare cases, esophageal perforation.Prevention of eosinophilic esophagitis
Although there is no guaranteed prevention for eosinophilic esophagitis, maintaining a healthy diet and avoiding foods known to trigger allergies may reduce the risk of developing the disease.How is eosinophilic esophagitis diagnosed?
Diagnosis should be based on a combination of clinical symptoms, endoscopic findings and histologic confirmation by biopsy.
Common medical tests
The first step is usually an upper endoscopy, which allows direct visualization of the esophagus. In patients with eosinophilic esophagitis, concentric rings ("esophagus in trachea"), longitudinal grooves, white exudates (inflammatory deposits) and/or narrowing or stiffening of the esophageal walls are frequently observed.
However, these findings are not always present, and their absence does not exclude the diagnosis. Therefore, it is essential to combine endoscopy with other tests:
- Esophageal pH-metry: to rule out acid reflux as the main cause.
- Allergy tests: especially in patients with atopic history.
- Nutritional evaluation: in cases of suspected multiple food allergies.
Esophageal biopsy: is it necessary?
Yes, esophageal biopsy is essential to confirm the diagnosis. During endoscopy, several samples of the esophageal lining are taken and analyzed by the pathologist. The key finding is the presence of eosinophils in high numbers (≥15 eosinophils per high magnification field).
The biopsy not only allows diagnosis, but also assessment of the response to treatment in subsequent controls. It is a safe test, well tolerated, and essential to differentiate eosinophilic esophagitis from other causes of esophageal inflammation.
How is eosinophilic esophagitis treated?
The main objective is to reduce esophageal inflammation, relieve symptoms and prevent long-term complications.
Proton pump inhibitors (PPIs)
Although PPIs - such as omeprazole, esomeprazole or pantoprazole - are commonly used to treat acid reflux, they have also been shown to exert an anti-inflammatory effect on the esophageal mucosa in patients with eosinophilic esophagitis.
Approximately 50% of patients respond favorably, with improvement in both symptoms and inflammatory findings on biopsy. They are simple to use, widely available drugs with a favorable safety profile, making them one of the first treatment options.
Topical corticosteroids
Locally acting corticosteroids, such as fluticasone or oral viscous budesonide (Jorveza®), are specifically formulated to act directly on the esophagus without being absorbed systemically.
This makes it possible to effectively reduce esophageal inflammation without the side effects of systemic corticosteroids. Several studies have demonstrated their efficacy in both symptom remission and histological healing, with very few adverse effects reported.
Biologic drugs
Designed to act specifically on the immunological mechanisms that cause the disease.
Currently, the only biologic approved for this indication is Dupilumab (Dupixent®), indicated in patients who have not responded adequately to conventional treatments, such as topical corticosteroids or elimination diets.
This drug acts by blocking the action of proteins involved in allergic inflammation - specifically the interleukin-4 (IL-4) and interleukin-13 (IL-13) pathways - thus reducing the eosinophilic response in the esophagus.
- Route of administration: subcutaneous injections, usually weekly.
- Clinical evidence: it has demonstrated a significant improvement of symptoms (such as dysphagia) and a clear reduction of histological inflammation in esophageal tissue.
At the Clínica Universidad de Navarra, we evaluate each case on a case-by-case basis to assess the indication for this advanced treatment, in coordination with our Allergology and Immunology teams.
Esophageal dilatation
In some patients with advanced eosinophilic esophagitis, chronic inflammation maintained over time can cause a narrowing of the esophagus (stricture), making the passage of food significantly more difficult and generating persistent dysphagia.
When this mechanical obstruction is relevant and does not improve with pharmacological or dietary treatment, endoscopic esophageal dilatation can be considered. This procedure consists of introducing, through endoscopy, a balloon or dilator that allows controlled widening of the esophageal duct.
Dilation does not directly treat the underlying inflammatory cause, but immediately relieves the mechanical symptoms of obstruction, improving the patient's ability to swallow and quality of life.
It is a safe, well-tolerated procedure with low risk of complications if performed in specialized centers. It may be necessary to repeat dilatation in some cases if the stricture tends to recur.
At the Clínica Universidad de Navarra, we carefully evaluate the indication for this technique, always considering the combination with a basic anti-inflammatory treatment that controls the disease and avoids new lesions.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Digestive
of the Clínica Universidad de Navarra
The Digestive Department of the Clinica Universidad de Navarra is composed of a multidisciplinary team of specialists who are experts in the diagnosis and treatment of diseases of the digestive tract.
Our objective is that each diagnosis be carefully established and the treatment plan adjusted to each patient.
Why at the Clinica?
- Medical specialists who are national references.
- Specialized nursing team.
- Endoscopy Unit and High Risk Digestive Tumor Prevention and Consultation Unit to offer the best care to our patients.
Our team of professionals
Preguntas frecuentes
The best diet for eosinophilic esophagitis is an elimination diet, which involves avoiding foods that may trigger or aggravate the symptoms of this disease. It is important to keep in mind that each person may react differently to certain foods, so the diet should be personalized and tailored to the patient's specific needs.
To establish the appropriate diet, it is essential to work with a physician and a nutritionist specialized in food allergies. Some of the most common foods that can cause eosinophilic esophagitis include:
- Dairy: milk, cheese, yogurt and other milk products.
- Eggs.
- Soy: soy products such as tofu, soy milk and other soy-containing foods.
- Wheat: bread, pasta, cereals and other foods containing gluten.
- Nuts: almonds, walnuts, peanuts, etc.
- Seafood: shrimp, crabs, lobsters and other shellfish.
- Fish: especially those with bones.
Once the trigger foods have been identified, they should be eliminated from the patient's diet.
Subsequently, they can be gradually reintroduced under medical supervision to determine whether the patient has developed tolerance to these foods. In addition, it is essential to ensure a balanced and nutritious diet, which provides the patient with all the essential nutrients to maintain good health.
Eosinophilic esophagitis is considered a chronic disease with an immunological cause. Although there is currently no definitive cure, effective treatments are available to control symptoms, reduce inflammation and prevent long-term complications.
The key is individualized follow-up: there are patients who achieve stable remission, even without symptoms, as long as they maintain the appropriate therapeutic measures.
Although both disorders can cause swallowing discomfort and chest pain, their origins and mechanisms are different.
Gastroesophageal reflux is due to the passage of acid from the stomach into the esophagus, whereas eosinophilic esophagitis is an immune-mediated inflammatory disease.
In addition, standard reflux treatments (such as antacids) are usually not sufficient in eosinophilic esophagitis. Only an esophageal biopsy can differentiate with certainty.
Yes. Although in many cases it begins with mild symptoms, failure to treat eosinophilic esophagitis can lead to complications such as the development of strictures (narrowing of the esophagus), repeated food impactions or a significant loss of quality of life.
In addition, persistent inflammation can lead to structural changes that are difficult to reverse. Therefore, early diagnosis and sustained treatment are essential.
The disease can appear at any age, but the form of presentation varies. In children, symptoms are usually more nonspecific or related to feeding and growth problems. In adults, dysphagia predominates.
What is common to both groups is the immunoallergic basis of the disease and the need for a multidisciplinary approach adapted to each stage of life.