By: Shelagh McNally for Reflux1People who have heartburn, nausea and cramping pain are routinely diagnosed as having gastroesophageal reflux disease (GERD). But in many cases, a different ailment could be causing the symptoms – Eosinophilic esophagitis (EE).
GERD is caused by acid splashing up into the stomach. EE is an inflammation of the esophagus making digestion painful and causing other symptoms including abdominal pain, choking and difficulty swallowing.
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Foods that can trigger EE:
Cow's milk
Soy
Eggs
Wheat
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Prior to 1993, EE was a rarely diagnosed condition but the incidence of this gastro disease has risen so dramatically in the past few years that it is now more common than Crohn's disease and ulcerative colitis. Dr. Philip Putnam, a pediatric gastroenterologist at Cincinnati Children's Hospital, said, "There seems to be both a real increase in the frequency of the disease, as well as better, if not earlier, recognition." Since 2000, Putnam has seen 315 children alone who met the criteria for EE.
Patients suffering from EE also tend to have an increase in asthma and allergies in general, Putnam noted. Dr. Bob Issenman, chief of pediatric gastroenterology at McMaster Children's Hospital in Hamilton, Ontario has also noted the alarming increase. “Previously, it was considered very rare, the average doctor only seeing a couple of cases. But now we have infants and toddlers with vomiting and feeding problems and otherwise healthy young people who suddenly develop problems swallowing their food."
More research needs to be done to determine the cause of EE and to study why it appears to be 75 percent higher in males. The symptoms of EE vary with age. The main trigger appears to an allergic reaction to certain foods including cow’s milk, soy, eggs and wheat. Because EE mimics the same symptoms as GERD, diagnosis can be difficult.
Some adults are diagnosed with EE only after taking medicine prescribed for GERD and not getting any relief. But diagnosis in children can be harder. The only positive way to diagnose EE is through a biopsy. Unlike those suffering from GERD, an EE patient will often have high levels of eosinophils, white blood cells detected in their esophagus but not in other parts of the digestive tract. Eosinophils are usually an indication of an allergic response. Another less invasive skin-prick test and patch testing is also coming into use.
In most cases there is no cure for EE. Acid blockage therapy, which is so successful in the treatment of GERD, does not relieve EE symptoms. The best course of treatment is to first identify and then avoid offending foods. Gradually eliminating the foods causing the allergic reactions often reduces the inflammation. Corticosteroids and anti-inflammatory medications may also be prescribed in severe cases.
The sudden rise in EE has lead families to form the American Partnership for Eosinophilic Disorders (APFED), a non-profit advocacy organization providing a resource for patients and families while trying to raise public awareness and encourage research initiatives and clinical trials. For more information on the group, visit their Web site at http://www.apfed.org
