eosinophils

Eosinophils are a type of white blood cell. They help fight off infections and play a role in your body's immune response. They can also build up and cause inflammation.

Normally your blood doesn't have a large number of eosinophils. Your body may produce more of them in response to:

• Allergic disorders
• Skin conditions
• Parasitic and fungal infections
• Autoimmune diseases
• Some cancers
• Bone marrow disorders

In some conditions, the eosinophils can move outside the bloodstream and build up in organs and tissues. This can happen in many different parts of the body, including the esophagus, heart, lungs, blood, and intestines. Treatment of eosinophilic disorders can vary, depending on the cause and which part of the body is affected. Steroids are often part of the treatment.

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

EoE can affect anyone, but it is more common in people who:

• Are male
• Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
• Have family members with EoE

The most common symptoms of EoE can depend on your age.

In infants and toddlers::

• Feeding problems
• Vomiting
• Poor weight gain and growth
• Reflux that does not get better with medicines

In older children::

• Vomiting
• Abdominal pain
• Trouble swallowing, especially with solid foods
• Reflux that does not get better with medicines
• Poor appetite

In adults::

• Trouble swallowing, especially with solid foods
• Food getting stuck in the esophagus
• Reflux that does not get better with medicines
• Heartburn
• Chest pain

To find out if you have EoE, your doctor will likely:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
• Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
• With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
• For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your doctor suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

Esophagus disorders are problems with how your esophagus works. The esophagus is the tube that carries food from your mouth to your stomach. You usually don't notice it unless you swallow something too big, hot, or cold. You might also notice it if something is wrong. When that happens, you might feel pain or have trouble swallowing (dysphagia).

The cause depends on the type of disorder. Some run in families. Others are linked to allergic reactions to food or substances in your environment. Sometimes, the cause is unknown.

You may be more likely to develop an esophagus disorder if you:

• Are overweight or have obesity
• Are pregnant
• Take certain medicines
• Have had radiation treatmentt to your neck or chest
• Smoke or are around secondhand smoke

The most common esophagus problem is gastroesophageal reflux disease (GERD). This happens when the muscle at the bottom of your esophagus doesn't close properly. Stomach acid can move back up and irritate the esophagus.

Other esophagus disorders include:

• Heartburn is a burning feeling in your chest or throat. It is often caused by acid reflux.
• Barrett's Esophagus happens when the lining of your esophagus changes. It is often caused by chronic (long-term) GERD.
• Achalasia is a problem where the lower muscle in your esophagus doesn't relax like it should.
• Esophageal Spasms are muscle contractions that cause chest pain or swallowing problems.
• Eosinophilic Esophagitis (EoE) is a rare condition where certain white blood cells (eosinophils) build up in the esophagus, causing swelling, pain, and trouble swallowing.
• Esophageal Cancer is a type of cancer that starts in the tissues of the esophagus.

Symptoms can be different for each condition but may include:

• Pain in your chest, abdomen (belly), or back
• A cough or sore throat that doesn't go away
• Trouble swallowing or feeling like food is stuck
• A hoarse voice or wheezing
• Heartburn or a burning feeling in your stomach
• Tasting acid or food in the back of your mouth
• Food or liquid coming back up into your mouth (regurgitation)
• Losing weight without trying

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These could be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may order one or more tests, such as:

• Upper gastrointestinal (GI) endoscopy. This test uses a tiny camera to look inside your esophagus and stomach.
• Biopsy. This test takes a small tissue sample to check.
• Barium swallow. This test uses imaging to see how you swallow.
• Esophageal manometry. This test checks how well your esophagus moves food to your stomach.
• Esophageal pH test. This test measures how often acid backs up into your esophagus and how long the acid stays there.

Treatment depends on what's causing the problem and your overall health. Some esophagus disorders get better with over-the-counter medicines, diet changes, or lifestyle changes. Others may need prescription medicine or surgery.

Without treatment, some disorders may lead to other problems, such as pneumonia, from food entering the windpipe. GERD, Barrett's esophagus, and achalasia can also raise your risk for esophageal cancer.

You can help prevent or reduce symptoms by:

• Not smoking and limiting alcohol
• Eating smaller meals
• Avoiding eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases