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Eosinophilic Esophagitis: A reflux look-alike?

Eosinophilic Esophagitis (EE) is a chronic condition causing inflammation of the esophagus and appears to be on the increase in children. There are similarities in the symptoms and presentation of EE and Gastroesophageal Reflux Disease (GERD) so doctors are using new research based methods of diagnosing EE. While EE and GERD may have similar symptoms patterns, the treatments are quite different so the diagnosis is vitally important. Eosinophilic Esophagitis was a hot topic at a gastroenterology conference I attended recently. With the heightened awareness of EE, it is likely research will add to our understanding of the diagnosis and management of this condition.

The symptoms of EE may include vomiting, abdominal pain, problems with weight gain or weight loss. You are probably thinking that EE sounds just like the symptoms list for GERD. EE may initially look like GERD and a patient may even be given GERD medication such as a Proton Pump Inhibitor or PPI. A patient with GERD often has a reduction or elimination of symptoms on a PPI medication while a patient with EE does not respond to this treatment. Patients with EE often have rashes and skin conditions and swallowing problems leading to food impaction (food getting caught in the esophagus). It appears that more males than females are affected by EE. The symptoms of EE change as the child grows. Infants with EE are more likely to have feeding issues while children with EE may have vomiting. Adults with EE are more likely to have food impaction.

Eosinophilic Esophagitis is diagnosed based on a pattern of symptoms and a high number of white blood cells called eosinophils in the esophagus. A test called an endoscopy is needed to detect the eosinophils. While a patient with GERD may have some eosinophils in the esophagus, a diagnosis of EE is based on a high number of eosinophils and a pattern of changes in the esophagus that often look like rings or furrows. A patient with GERD will have an abnormal pH probe test showing the presence of acid in the esophagus while a patient with EE will have a normal pH probe test.

The main treatments for GERD are different than the treatments for EE. While most patients with GERD respond to medications and changes to the diet, patients with EE must follow a strict diet that often involves eliminating foods or drinking an elemental formula. Some patients with EE are also treated with anti inflammatory medications such as steroids to reduce the inflammation or swelling of the lining of the esophagus.

As doctors and researchers are learning more and more about EE, patients are benefiting greatly. While GERD is common and EE is less common, it makes sense that a doctor may initially try a trial of GERD treatment under the assumption that a patient has GERD, a common condition. However, if the GERD treatment does not reduce symptoms, the doctor may try other GERD treatments and also explore other reasons for the symptoms including EE. While EE is a chronic condition, the vast majority of patients responds positively to dietary changes and can work and play normally. An excellent resource for parents and patients is the American Partnership for Eosinophilic Disorders or Apfed. The Apfed website at www.apfed.org contains patient materials, resources and information on research.


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