Eosinophilic Esophagitis - The Difference Between Acid Reflux and Allergic Esophagus Explained

What is eosinophilic esophagitis?

Eosinophilic esophagitis, abbreviated EE or EoE, is an inflammation of the esophagus or feeding tube characterized by the presence of a type of white blood cell called eosinophil. It is a reddish appearing cell that is typically found in tissues of the body affected by allergic reactions and some parasite infections. The cell was named by Paul Erlich in 1879 after Eos, the Greek goddess of dawn. It is also called allergic esophagitis. Eosinophils, when activated, release chemicals that can cause intense swelling, itching, and tissue damage.

What are the symptoms of eosinophilic esophagitis?

The symptoms of EoE in adults is classically episodes of food sticking when swallowing that is called dysphagia in medical terms. Typically, a young man or teenage boy presents with an episode of food being lodged in the esophagus or feeding tube. Food that won't go down and can't be regurgitated up along with a history of difficulty swallowing foods (such as bread or dry meats like chicken and beef) is common, especially associated with a personal and/or family history of allergic conditions.

Failure of the food to go down (or up) causes a food impaction resulting in the inability to swallow even saliva, chest discomfort and usually sends the person to the emergency room. Sometimes, intravenous medication that relaxes the esophagus will allow the food to pass but usually it has to be removed by an endoscope. The classic patient has little or no heartburn though some people have moderate to severe heartburn symptoms. The tip off in this setting is that the heartburn symptoms frequently don't improve with acid blocking medications.

Young children may present with complaints of chest pain, abdominal pain, poor appetite, regurgitation or reflux, vomiting, or failure to grow (failure to thrive). Some may have unexplained low blood counts or iron deficiency from bleeding from the esophagus. People with these types of symptoms should be evaluated for possible allergic or eosinophilic esophagitis. Treatment is usually dietary avoidance of food allergens and swallowed nasal steroids but is reviewed in more detail in a separate article.