Eosinophilic Esophagitis

What is eosinophilic esophagitis (EoE)?

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

What causes eosinophilic esophagitis (EoE)?

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

Who is at risk for eosinophilic esophagitis(EoE)?

EoE can affect anyone, but it is more common in people who:

• Are male
• Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
• Have family members with EoE

What are the symptoms of eosinophilic esophagitis (EoE)?

The most common symptoms of EoE can depend on your age.

In infants and toddlers::

• Feeding problems
• Vomiting
• Poor weight gain and growth
• Reflux that does not get better with medicines

In older children::

• Vomiting
• Abdominal pain
• Trouble swallowing, especially with solid foods
• Reflux that does not get better with medicines
• Poor appetite

In adults::

• Trouble swallowing, especially with solid foods
• Food getting stuck in the esophagus
• Reflux that does not get better with medicines
• Heartburn
• Chest pain

How is eosinophilic esophagitis (EoE) diagnosed?

To find out if you have EoE, your doctor will likely:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

What are the treatments for eosinophilic esophagitis (EoE)?

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
• Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
• With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
• For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your doctor suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

Esophageal Cancer

The esophagus is a hollow tube that carries food and liquids from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may have symptoms such as:

• Painful or difficult swallowing
• Weight loss
• A hoarse voice or cough that doesn't go away

You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid reflux. Your risk also goes up as you age

Your doctor uses imaging tests and a biopsy to diagnose esophageal cancer. Treatments include surgery, radiation, and chemotherapy. You might also need nutritional support, since the cancer or treatment may make it hard to swallow.

NIH: National Cancer Institute

Exercise and Physical Fitness

Regular exercise is one of the best things you can do for your health. It has many benefits, including improving your overall health and fitness, and reducing your risk for many chronic diseases. There are many different types of exercise; it is important that you pick the right types for you. Most people benefit from a combination of them:

• Endurance, or aerobic, activities increase your breathing and heart rate. They keep your heart, lungs, and circulatory system healthy and improve your overall fitness. Examples include brisk walking, jogging, swimming, and biking.
• Strength, or resistance training, exercises make your muscles stronger. Some examples are lifting weights and using a resistance band.
• Balance exercises can make it easier to walk on uneven surfaces and help prevent falls. To improve your balance, try tai chi or exercises like standing on one leg.
• Flexibility exercises stretch your muscles and can help your body stay limber. Yoga and doing various stretches can make you more flexible.

Fitting regular exercise into your daily schedule may seem difficult at first. But you can start slowly, and break your exercise time into chunks. Even doing ten minutes at a time is fine. You can work your way up to doing the recommended amount of exercise. How much exercise you need depends on your age and health.

Other things that you can do to make the most of your workouts include:

• Choosing activities that work all the different parts of the body, including your core (muscles around your back, abdomen, and pelvis). Good core strength improves balance and stability and helps to prevent lower back injury.
• Choosing activities that you enjoy. It's easier to make exercise a regular part of your life if you have fun doing it.
• Exercising safely, with proper equipment, to prevent injuries. Also, listen to your body and don't overdo it.
• Giving yourself goals. The goals should challenge you, but also be realistic. It's also helpful to reward yourself when you reach your goals. The rewards could be something big, like new workout gear, or something smaller, such as movie tickets.

Exercise for Older Adults

Exercise and physical activity are good for just about everyone, including older adults. There are four main types and each type is different. Doing them all will give you more benefits.:

• Endurance, or aerobic, activities increase your breathing and heart rate. Brisk walking or jogging, dancing, swimming, and biking are examples.
• Strength exercises make your muscles stronger. Lifting weights or using a resistance band can build strength.
• Balance exercises help prevent falls
• Flexibility exercises stretch your muscles and can help your body stay limber

If you have not been active, you can start slowly and work up to your goal. How much exercise you need depends on your age and health. Check with your health care provider on what is right for you.

NIH: National Institute on Aging

Fistulas

A fistula is an abnormal connection between two parts inside of the body. Fistulas may develop between different organs, such as between the esophagus and the windpipe or the bowel and the vagina. They can also develop between two blood vessels, such as between an artery and a vein or between two arteries.

Some people are born with a fistula. Other common causes of fistulas include:

• Complications from surgery
• Injury
• Infection
• Diseases, such as Crohn's disease or ulcerative colitis

Treatment depends on the cause of the fistula, where it is, and how bad it is. Some fistulas will close on their own. In some cases, you may need antibiotics and/or surgery.