Tough to Swallow

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Posted 2/19/2013 by UNMC Physicians

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Maybe you have had to “work down” some bites from dinner or needed an extra sip of water to help gulp down your meal. Maybe you are affected by Eosinophilic (e-o-sin-o-fil-ik) Esophagitis (e-so-fa-gi-tis).

Eosinophilic Esophagitis, also referred to as EoE, is a chronic allergic inflammatory disease of the esophagus, causing difficulty swallowing.

Jill Poole, MD, allergy and immunology, sees new EoE patients nearly every week.

“Some in the allergy field are calling this a mini-epidemic, because it’s relatively a new disease that we are dealing with and trying to find the right way to manage it,” Poole said.

The main symptom of EoE is difficulty swallowing solid food, and the food gets lodged in the esophagus after it is swallowed. In children, the most common symptoms are abdominal pain, nausea, vomiting and coughing. According to Poole, EoE is commonly caused by a food allergy or an environmental allergy. 

“Some of these patients have probably had it years and years and it finally hit a breaking point,” Poole said.

The breaking point Poole refers to usually results in an evening trip to the emergency room for a person and seeing a gastroenterologist. Poole works with a team of gastroenterologists at UNMC Physicians, as well as others in the Omaha community.

“The typical patient I see comes to the emergency room in the middle of the night with a piece of food that is lodged in their esophagus,” said Grant Hutchins, MD, gastroenterology.

After the food impaction is taken care of, Hutchins would then perform an upper endoscopy and then a follow-up endoscopy a couple weeks later. During the second endoscopy, Hutchins will also perform biopsies of the lower, middle and upper areas of the esophagus.

“Esophageal biopsies are essential for confirming the presence of Eosinophilic Esophagitis and ruling out other possible disorders,” Hutchins said.

After the gastroenterologist performs the biopsies, a pathologist will evaluate them for eosinophils, which are the white blood cells that can cause inflammation and scarring of the esophagus.

If the eosinophil counts are 15 and greater then the diagnosis of EoE is likely. The patient will then be sent to Poole so she can conduct skin tests, food elimination and challenges.

“Once I work with the patient and have them on a regiment and they are feeling good, I will send them back to the gastroenterologist and they will rescope them to see if the eosinophils have lessened,” Poole said.

For some patients, it could be as easy as cutting a particular food out of their diet that they didn’t know they were allergic to. The most common food allergies Poole sees with patients are beef, peanuts, tree nuts, wheat, milk and eggs. If EoE is caused by environmental allergies such as pollen, they are treated with anti-allergy medications, allergy shots and also an asthma inhaler.

Because EoE is relatively new, there is not a lot of long-term data on it. Poole said it is common practice for her to make sure her EoE patients continue to have check-ups for the following three to five years.

“There has certainly been an increase of Eosinophilic Esophagitis, but I think we are better at diagnosing it today,” Hutchins said. “However, work remains to figure out the intricacies of it at a molecular level – that’s where people like Dr. Poole come in.”

Poole enjoys the puzzle-like challenge that Eosinophilic Esophagitis can bring, but more importantly likes the fact the disease is well-treated once it is figured out.

“I enjoy this patient population a ton, because we can make them better and improve their quality of life,” Poole said. 


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