Marc Rothenberg, MD, a Principal Investigator of the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) and Professor of Medicine at Cincinnati Children's Hospital gives an overview of eosinophilic esophagitis (EoE).

Watch the full video or read his explanation below.

The Nature and Symptoms of Eosinophilic Oesophagitis (EoE)

Eosinophilic Oesophagitis (EoE) is a chronic, allergic disease, a hypersensitivity of the immune system, primarily to foods.

Unlike anaphylaxis, when one or two foods typically cause immediate reactions, with EoE, we often have a breakdown of immune tolerance to multiple foods leading to various chronic symptoms.

These symptoms can be non-specific regarding upper gastrointestinal (GI) symptoms that often mimic reflux, but reflux is not a primary driver of eosinophilic GI disease.

Age-Dependent Variations in EoE Symptoms

The symptoms can vary depending on the patient's age. Typically, it's vomiting and failure to thrive and grow in young kids.
As kids get older, it's abdominal pain and sometimes vomiting.

In adults, more common symptoms are difficulty swallowing (dysphagia) and food getting stuck in the oesophagus.

Causes of that are complex but primarily related to hypersensitivity and over-activation of the immune system's allergic arm. This process causes specific and severe inflammation, usually limited to the oesophagus.

It is associated with high accumulation levels of the particular white blood cells called eosinophils.

Becky: Living With Eosinophilic Oesophagitis as a Young Person

Treatment Approaches of EoE

Eosinophilic oesophagitis typically starts with allergic manifestations of the disease. The commonly accepted idea is that food is driving the condition.

One of the first treatments we used is the avoidance of the most common allergens that cause food anaphylaxis, which are six major food groups. This is called the Six-Food Elimination Diet (6FED).

Watch videos on children's diets in EoE

Watch videos on adult diets in EoE

More recent diet studies have found an effective diet therapy is to start by removing just cows' milk and stepping up to further restrictions if this does not result in remission of symptoms and eosinophilic infiltration.

Proton pump inhibitors are often used as an initial therapy even though the disease is not mechanically responsive to these drugs' work because of the acid component. But they have rather anti-inflammatory effects on EoE.

The other commonly used therapy is topical glucocorticoids with an off-label indication in the United States, but they are now approved in Europe.
It involves taking asthma doses and formulations of glucocorticoids and, instead of inhaling them, swallowing them.

Stella: Symptoms and Treatments Journey

The Future of EoE Treatment

Finally, we're pleased to see that in May of 2022, the FDA approved the first drug for eosinophilic esophagitis, a biological agent called Dupilumab. It is used to suppress the allergic arm of the immune system and treat patients with EoE that are particularly moderate to severe in nature.