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What you should know about Eosinophilic Esophagitis

Hi, I'm Dr. Jeffrey Mark. 
 
If you or a loved one has had trouble with swallowing you should know about eosinophilic esophagitis.  Eosinophilic esophagitis, or EOE  is a chronic immune mediated inflammatory disease localized in the esophagus.
 
The prevalence of EOE is increasing, and can occur across all ages, sexes, and races. EOE is characterized by a range of symptoms , endoscopic manifestations and histopathology findings that vary by people and age.  Infants and toddlers may present with nonspecific symptoms, such as feeding problems, vomiting, and failure to thrive;  while dysphasia or difficulty swallowing is the predominant symptom in children, adolescents and adults.
 
These symptoms can be masked when people unknowingly use adaptive behaviors, which may contribute to diagnostic delays. The mean time from symptom onset to diagnosis of  EOE  was reported to be up to 3.5 years in children, and eight years in adults reported in a systematic review. There should be clinical assessment of symptoms, endoscopic findings and histopathology or tissue biopsy in order to make a diagnosis.
 
Although the exact cause is unknown, EOE  involves the complex interplay of genetics, environmental factors and other aspects of immune system dysfunction. Often people with EOE  also have immune issues  and EOE can be characterized by increased levels of esophageal immunoglobulin G four, or IgG 4 which is  largely triggered by food or airborne allergens.  Antigens or the irritating particles,  present in the esophagus, resulting  in the production of epithelial cell derived cytokines which recruit inflammatory cells, such as Th T cells, eosinophils,  mast cells, and basophils.
 
The diagnosis of EOE requires a threshold of inflammation found on tissue sampling showing  greater than or equal to 15 eosinophils per high power field on microscopic examination. These immune cells are activated and secrete additional cytokines, causing recruitment of further immune cells that contribute to chronic esophageal inflammation. Continued allergen exposure perpetuates the cycle of inflammation, which leads to epithelial barrier disruption or breakdown of the lining of the esophagus. Chronic inflammation may lead to endoscopic features, which include edema or swelling,  rings  and furrows depending on the person's reaction and presentation.
 
Untreated EOE may result in persistent inflammation, which can lead to remodeling or scarring and fibrous bands leading to strictures in some people, ultimately, causing food impaction. EOE can be identified early and managed appropriately to help reduce the risk of long term complications by holistically assessing its three characteristic features found on looking at the symptoms by asking the right questions,  endoscopy by direct visualization and histopathology by getting a biopsy at the time of endoscopy. 
 
We have helped many people by working to identify food and airborne allergies and sensitivities, optimizing the immune system, and repairing the gut lining. If you or a loved one has had issues with swallowing or any of the symptoms we listed contact me and let us help you get back on the road to better health.
 
Take care and stay healthy. 
 
Jeffrey Mark, MD
Author
Jeffrey Mark, M.D. Helping clients with compassionate and comprehensive medical care for over 25 years with 4 board certifications in functional medicine, gastroenterology, internal medicine, and anti-aging/ regenerative medicine . IFMCP, ABIM Gastroenterology, NPAS Internal Medicine, ABAARM.

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