What to Expect After an Eosinophilic Esophagitis Diagnosis

Receiving a diagnosis of eosinophilic esophagitis (EoE) can feel overwhelming. This chronic immune system disease affects the esophagus and can lead to difficulty swallowing, food getting stuck, chest pain, and ongoing discomfort. Understanding what comes next is essential for effectively managing the condition and improving your quality of life.

Understanding Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition in which white blood cells called eosinophils accumulate in the esophageal tissue. This buildup leads to chronic inflammation, which can cause esophageal epithelial barrier impairment and contribute to difficulty swallowing.

EoE is one of several eosinophilic disorders that affect the digestive system. While the exact cause of EoE remains unclear, it is often linked to food allergies and gastroesophageal reflux disease (GERD).

Symptoms and Diagnosis

After an EoE diagnosis, it’s important to recognize the symptoms that may continue or worsen if not properly managed. Common symptoms include:

• Difficulty swallowing (dysphagia)
• Chest pain
• Feeling like food is getting stuck in the throat
• Stomach pain
• Chronic inflammation of the esophagus
• Acid reflux or GERD-like symptoms
• In some cases, an allergic reaction leading to irritation in the esophagus

Diagnosis of EoE is typically confirmed through an endoscopy with biopsies, where a doctor collects samples of esophageal tissue to check for high levels of eosinophils. Additional tests, such as an eosinophilic esophagitis diagnostic panel or food allergy testing, may be conducted to identify underlying triggers.

Treatment and Management Strategies

There is no cure for EoE, but various treatment approaches can help manage symptoms and prevent complications.

Dietary Approaches

Since food allergies are a major trigger for EoE, dietary modifications are key to managing the condition. There are several diet strategies that doctors may recommend:

• Food Elimination Diet: This approach involves removing common allergens such as dairy, wheat, soy, eggs, nuts, and seafood. After symptom improvement, foods are reintroduced one by one to identify specific triggers.
• Elemental Diet: This strict diet consists of an amino acid-based formula that provides essential nutrients while allowing the esophagus to heal. Though highly effective, it can be challenging to follow and is typically recommended for severe cases.
• Elimination Diet Variations: Some patients may be advised to eliminate just a few suspected trigger foods rather than following a full six-food elimination diet.

Medication Therapy

In addition to diet changes, medications can help control chronic inflammation and prevent long-term damage to the esophagus.

• Proton Pump Inhibitors (PPIs): These medications, commonly used to treat acid reflux, can help reduce inflammation in some EoE patients.
• Swallowed Topical Steroids: Corticosteroids such as budesonide or fluticasone are often prescribed in a liquid or powder form that is swallowed rather than inhaled, directly targeting the esophagus.
• Biologic Therapy: Certain biologic medications, which target specific parts of the immune system, are being tested in clinical trials and show promise for managing EoE.

Esophageal Dilation

For some patients, prolonged inflammation can lead to narrowing of the esophagus. This can make it difficult to swallow food, leading to episodes of food impaction. In such cases, doctors may perform esophageal dilation, a procedure that stretches the esophagus to relieve symptoms.

Long-Term Management and Follow-Up

EoE is a chronic disease, meaning ongoing management is necessary. After an initial diagnosis and treatment plan, regular follow-ups with a gastroenterologist are crucial to monitor progress. Your doctor may recommend periodic endoscopies to check the health of your esophagus and ensure treatments are working.

Lifestyle Adjustments

Adapting to life with EoE means making some lifestyle changes, including:

• Reading Food Labels: Avoiding trigger foods requires careful label reading and understanding ingredient lists.
• Meal Planning: Working with a dietitian to ensure a balanced, nutritious diet while avoiding allergens.
• Managing Stress: Stress can worsen symptoms, so mindfulness, meditation, or therapy may be beneficial.

EoE and Related Conditions

Many people with EoE also have other allergic conditions, including:

• Atopic dermatitis (eczema)
• Asthma
• Inflammatory bowel disease
• Eosinophilic gastrointestinal disease

Recognizing and treating these conditions can help improve overall health and quality of life.

Final Thoughts

Living with eosinophilic esophagitis (EoE) requires ongoing management, but with the right treatment plan, most people can control their symptoms and maintain a good quality of life. Whether through food elimination diets, proton pump inhibitors, or emerging clinical trials, treatment is advancing, offering new hope for those with this condition.

By staying informed, following a tailored treatment plan, and working closely with healthcare providers, you can take control of your EoE and minimize its impact on your daily life.