Eosinophilic Esophagitis (EoE)

Eosinophilic esophagitis is a rare (18/100,000), chronic inflammatory disease of the esophagus of as yet unknown cause. Male patients between the ages of 30 and 50 are affected in 80%.

It is named after the increased occurrence of a subfraction of white blood cells, namely eosinophilic granulocytes, in the mucous membrane of the esophagus. Often the patients also suffer from allergies and asthma. The main symptoms are the feeling that something gets stuck when swallowing (= dysphagia), pain when swallowing or reflux-like symptoms, which occur especially when a diaphragmatic hernia (= hiatal hernia) is the triggering cause of reflux. In the maximum variant, a swallowed bite has an impact, can no longer be mobilized by the patient himself and must be removed by a doctor. Allergens that are dissolved in the food come into contact with the lining of the esophagus during passage and cause inflammation. The main culprits are cow's milk and wheat (each & gt; 50%). Soy, nuts, fish and seafood have a slightly lower priority. The inflammatory response is similar to asthma. Allergens in the air can also trigger EoE. In children the symptoms are often atypical and the only failure to thrive is due to the loss of appetite. The diagnosis is therefore often lengthy and difficult. In adolescents or adults there are pronounced avoidance strategies such as avoiding certain foods or going to restaurants. Those affected often chew small bites for a long time or drink frequently and copiously in order to conceal the swallowing disorder. If the EoE is left untreated, it almost always leads to a narrowing of the esophagus. The symptom of the swallowing disorder that occurs is then either caused by the inflammation or by the narrowing of the esophagus that has already occurred. Although the disease has a massive impact on quality of life, the patients also perceive the avoidance strategies as normal and come to the doctor very late. The diagnosis is made via gastroscopy and tissue samples from the entire esophagus. The disease itself is still not curable to this day. However, there are 3 different treatment strategies that significantly improve symptoms and enable a normal life without massive restrictions:

• Medication with proton pump inhibitors for 6-8 weeks, success rate good, mechanism of action unclear, cortisone (budesonide orodispersible tablets) for 6-12 weeks, success rate 85%
• Elimination diet for 6-8 weeks with avoidance of all skin allergens; An allergen is added every 8 weeks and the status is recorded in a gastroscopy after a further 8 weeks. This allows the allergen to be identified and subsequently avoided. The step-up elimination diet avoids the two "main suspects" cow's milk and wheat (gluten), 70% success rate; if there is no response, avoid 4-6 allergens; Amino acid based nutrient solution efficiency over 90% with complete avoidance of food; bad compliance
• Stretching constrictions in the course of a gastroscopy (70% success rate)

The first two strategies are successfully used in acute inflammation. This should not only reduce the symptoms, but also avoid the chronic stage, the stenosis. When stenoses occur, stretching is the most promising.

Unfortunately, the disease cannot (yet) be cured. Interrupting or discontinuing therapy would most likely result in another flare-up of the disease. Consistent and long-term treatments as well as regular gastroscopic controls are therefore of the utmost importance.