Eosinophilic esophagitis is characterized by inflammation of the oesophagal lining, leading to possible injury and throat narrowing. This condition can affect individuals of any age but is predominantly seen in children between 5 to 14 years and adults from 20 to 45 years. It occurs 3 to 4 times more frequently in males than females. There has been a noticeable increase in the incidence of this condition, particularly in North America and Europe. However, whether this is due to heightened awareness or an actual rise in the prevalence within the community remains to be seen.
The most common manifestations of eosinophilic esophagitis in adolescents and adults are difficulty swallowing and food lodged in the oesophagus. In contrast, children are more likely to experience symptoms such as abdominal pain, heartburn or reflux, a decreased appetite, chronic cough, vomiting, or failure to thrive. Remarkably, around 75% of patients with this condition have at least one atopic (allergic) condition, including food or environmental allergies, asthma, or eczema.
The diagnostic process typically involves taking the patient’s medical history and conducting 4 to 6 biopsies of the oesophagal tissue from at least two different areas during a gastroscopy or endoscopy. Management strategies, commonly called the “3 Ds” — diet, drugs, and oesophagal dilation — are implemented to mitigate long-term complications.
Distinguishing between eosinophilic esophagitis and eating disorders in adults is crucial as they can present similarly. Drs. Milli Gupta and Michelle Grinman from the Cumming School of Medicine at the University of Calgary highlight the importance of a detailed dietary history to understand the types of foods a patient avoids and the reasons behind such avoidance. For instance, individuals with eosinophilic esophagitis might steer clear of meat and bread due to previous choking incidents. In contrast, those with eating disorders might avoid these foods due to their caloric content.
The authors advocate for a collaborative approach in decision-making between the physician and the patient to lessen the impact of the disease and its treatment on the patient’s quality of life. They recommend a comprehensive treatment plan that may include dietary adjustments and medications tailored to the severity of the disease and the risk of future complications. Oesophageal dilation might be necessary for patients at high risk of food impaction, and consultations with a gastroenterologist and dietitian are advised to customize care.
More information: Milli Gupta et al, Diagnosis and management of eosinophilic esophagitis, Canadian Medical Association Journal. DOI: 10.1503/cmaj.230378
Journal information: Canadian Medical Association Journal Provided by Canadian Medical Association Journal
