Eosinophilic esophagitis (EoE) is a chronic disorder of the digestive system in which large numbers of a particular type of white blood cell called eosinophils are present in the esophagus. The esophagus is the tube that carries food from the mouth to the stomach. Eosinophils are an important part of the immune system and play a role in immune regulation and fighting certain infection. This condition is characterized by vomiting, stomach or chest pain, failure to thrive (particularly in children), difficulty swallowing, and food getting stuck in the throat.
The symptoms of eosinophilic esophagitis are variable, especially in people of different ages. Common symptoms include difficulty swallowing (dysphagia); food getting stuck in the throat; nausea; vomiting; poor growth; weight loss; stomach pain; poor appetite; and malnutrition. Because of an overlap of these symptoms with gastroesophageal reflux disease (GERD), many patients are initially thought to have GERD, but EE patients do not typically respond to anti-GERD therapy and can be found not to have GERD upon diagnostic workup. Individuals with eosinophilic esophagitis often have allergic diseases such as asthma or eczema.
Eosinophilic esophagitis is caused by the presence of a large number of eosinophils in the esophagus. The production and accumulation of eosinophils may be caused by many factors such as particular foods or environmental irritants in some affected individuals. Some individuals with this condition have been found to have an unusually high expression of a particular gene called eotaxin-3 and an abnormal eotaxin-3 gene. This gene codes for a protein that is important in controlling the accumulation of eosinophils. Eosinophilic esophagitis can run in families but the mode of genetic transmission has not yet been determined.
The frequency of eosinophilic esophagitis has been estimated to be ~1 in 1,000 children. This condition has been reported in Switzerland, Australia, Canada, Japan, England and the US.
The diagnosis of eosinophilic esophagitis is often delayed because of a lack of awareness of this condition. A small tube is inserted through the mouth into the esophagus (upper endoscopy) and a small tissue sample is removed (biopsy) in order to count eosinophils, and look for tissue injury and thickening of tissue. If a diagnosis of EoE is made, allergy testing is usually then performed to determine if particular foods or environmental agents trigger esophageal symptoms or are contributing to other allergic problems.
Many children and adults with EE show improvement if the diet is modified. Some affected individuals require a liquid formula diet fed through a feeding tube. Steroid medications are often used to control inflammation if dietary changes alone are not sufficient. Additional endoscopies and biopsies are usually necessary to monitor the effectiveness of treatment.
Research is underway to develop medications to block the proteins produced as a result of the abnormal eotaxin-3 gene. In addition, research is in progress concerning the role of Interleukin-5, an eosinophil growth factor. The possibility of using Anti-IL-5, and Anti-IL-13 in the form of humanized antibodies, are promising strategies currently being tested. Companies involved in this research include GlaxoSmithKline, Cephalon, Roche, Millenium Pharmaceuticals and Cambridge Antibody Technology Group.
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