Eosinophilic esophagitis (EoE) is a chronic condition that causes inflammation in the esophagus and can lead to problems with swallowing and food impaction, where food becomes stuck in the esophagus and the patient requires medical attention to remove it. This condition was first recognized in the 1990s and has been increasing in incidence and prevalence since then. Once considered a rare disease, it is now becoming far more common.
Most patients with this condition have a family history of allergies or asthma, and often have food allergies that aggravate the condition. Unlike some food allergies though, patients with EoE often have a delayed reaction to the food they are allergic to. Instead of developing hives or anaphylaxis right after ingestion, patients will develop swelling in the esophagus hours, or even days later. This makes it difficult to identify the allergen, so allergy testing may be needed.
Treatment of EoE typically involves removing problematic foods from the diet. Common food allergens like eggs, soy, peanuts, shellfish, wheat, and dairy may be removed from the diet to see if the condition improves. Patients with severe difficulty swallowing, or food impaction may require endoscopic dilation to relieve symptoms. This involves using a device to stretch open the esophagus to allow food to pass.
Pharmacological therapy for EoE may include use of a proton pump inhibitor to prevent stomach acid from damaging the esophagus, or having the patient swallow small amounts of a corticosteroid to reduce inflammation. This is typically done using a steroid asthma inhaler and having the patient spray it in the back of the throat several times and then swallow. Pharmacists should be aware that these medications may be used for this condition also, in addition to their use as asthma therapy.