Struggling to swallow? What you need to know about eosinophilic oesophagitis (EoE)

Have you ever struggled with swallowing food, experienced discomfort in your chest, or found yourself drinking excessive water to help food go down? These could be signs of a condition known as eosinophilic oesophagitis, or EoE. Although not very common, EoE is becoming more frequently diagnosed in both adults and children. In this blog, based on insights from Dr Reshma Rakshit, a consultant gastroenterologist, we’ll explore what EoE is, its symptoms, how it’s diagnosed, and the treatment options available.

What Is eosinophilic oesophagitis?

EoE is a condition that affects the oesophagus, the tube that connects your mouth to your stomach. The exact cause of EoE is still unknown, but it is believed to be linked to allergies. In people with EoE, a specific type of white blood cell, called eosinophils, builds up in the oesophagus. This leads to inflammation and, over time, can cause scarring. Left untreated, this can make it difficult to swallow food properly and impact daily life.

Although EoE was once thought to mainly affect children, it is now increasingly diagnosed in adults. Dr Rakshit notes that she sees around 10 to 15 new patients with EoE each year.

Symptoms of EoE

The most common symptom of EoE is difficulty swallowing, particularly solid foods. This difficulty, known as dysphagia, can develop gradually over time, leading many people to adopt coping mechanisms without even realising it. Some common signs include:

• Taking longer to chew and swallow food
• Needing to drink large amounts of water with meals
• Avoiding certain foods that tend to get stuck
• Experiencing discomfort or pain while swallowing

In severe cases, food can become lodged in the oesophagus, a condition called food bolus obstruction. This may require urgent medical attention to remove the food using an endoscope, a flexible camera used to examine the digestive tract.

EoE can have a significant impact on social situations. For example, people with EoE may feel anxious about eating in public, as they often take longer to finish meals and may need to stand up or hit their chest to help food pass through the oesophagus. These social impacts can affect relationships and general well-being, making it all the more important to seek medical advice if you notice any of these symptoms.

What causes EoE?

While the exact cause of EoE remains unclear, there are some common links with other allergic conditions. People with a history of hay fever, asthma, eczema, or food allergies are more likely to develop EoE. It can also run in families, suggesting a possible genetic component.

If you’re experiencing any of the symptoms mentioned above, it’s essential to visit your GP. They can refer you to a specialist for further evaluation and testing.

How is EoE diagnosed?

The primary method for diagnosing EoE is through an endoscopy. During this procedure, a flexible tube is inserted into your mouth and down into your oesophagus, allowing the doctor to examine your digestive tract. Small tissue samples, or biopsies, are taken from the oesophagus and examined under a microscope to confirm the presence of eosinophils.

Endoscopy is a straightforward procedure and is key to accurately diagnosing EoE. Once diagnosed, your doctor can start exploring treatment options to help manage the condition.

Treatment options for EoE

Treatment for EoE focuses on reducing the number of eosinophils in the oesophagus and relieving symptoms. There are several options available, and your doctor will tailor the treatment plan to suit your specific needs.

1. Proton pump inhibitors (PPIs): these medications are often the first line of treatment. PPIs reduce stomach acid and can help alleviate symptoms for some patients, though they are not effective for everyone.
2. Topical steroids: another common treatment involves swallowing a steroid medication typically used for asthma patients. Instead of inhaling the medicine, you swallow it to coat the oesophagus and reduce inflammation. Your doctor can guide you on how to use this effectively.
3. New medications: dr Rakshit highlights an exciting development in the treatment of EoE—a medication called Jorveza. This dissolvable tablet is placed on the tongue and works by coating the oesophagus and reducing inflammation. It has shown promising results in helping many patients manage their symptoms.
4. Dietary changes: in some cases, diet plays a crucial role in managing EoE. Working with a dietitian, you may need to eliminate specific food groups that trigger inflammation. This approach can be challenging, as it may involve excluding two to six types of food. However, for many patients, these dietary adjustments can significantly reduce symptoms.

Living with EoE: support and ongoing research

EoE is a chronic condition, meaning that patients need long-term management. Fortunately, ongoing research is providing new insights into the condition, and more treatments are becoming available. In the UK, the EOS Network is a charity that offers support and resources for people living with EoE, helping patients and families navigate the challenges of this condition.

If you’re struggling with swallowing difficulties or other symptoms mentioned here, don’t hesitate to reach out to your doctor. With the right diagnosis and treatment plan, it’s possible to manage EoE and improve your quality of life.

Dr Reshma Rakshit is a highly regarded Consultant Gastroenterologist with expertise in managing a wide range of gastrointestinal conditions, including irritable bowel syndrome (IBS), inflammatory bowel disease (IBD), and liver disorders. She currently practises at leading healthcare institutions across London and Essex. With a compassionate approach and dedication to patient care, Dr Rakshit is committed to helping individuals understand their symptoms and improve their quality of life through personalised treatment plans.