what i have
http://www.medicinenet.com/eosinophilic_esophagitis/article.htm
Source: http://www.medicinenet.com
Eosinophilic Esophagitis
Medical Author: Dennis Lee, MD
Medical Editor: Jay W. Marks, MD
What is eosinophilic esophagitis?
What are eosinophilic esophagitis symptoms?
How does eosinophilic esophagitis cause dysphagia?
What are the other causes of dysphagia or solid food?
How is eosinophilic esophagitis diagnosed?
How is eosinophilic esophagitis treated?
What about elimination diets for treating eosinophilic esophagitis?
What is the future for eosinophilic esophagitis?
Eosinophilic Esophagitis At A Glance
What is eosinophilic esophagitis?
Eosinophilic esophagitis is an inflammatory condition in which the wall of the esophagus becomes filled with large numbers of eosinophils.
The esophagus is the muscular tube that propels swallowed food from the mouth into the stomach. Esophagitis refers to inflammation of the esophagus that has several causes. The most common cause of esophagitis is acid reflux which most frequently results in heartburn, though acid reflux also can cause ulcers on the inner lining of the esophagus. Other less common causes of esophagitis include viruses (such as herpes simplex), fungi (such as Candida), medications that get stuck in the esophagus (such as the antibiotic, tetracycline), and radiation (such as for treatment of lung cancer). Doctors believe that eosinophilic esophagitis is a type of esophagitis that is caused by allergy just like asthma, hay fever, allergic rhinitis, and atopic dermatitis even though the exact substance that is causing the allergy is not known. The hallmark of eosinophilic esophagitis is the presence of large numbers of eosinophils in the tissue just beneath the inner lining of the esophagus.
Eosinophils are white blood cells (leukocytes) manufactured in the bone marrow and are one of many types of cells that actively promote inflammation. They are particularly active in the type of inflammation caused by allergic reactions. Thus, large number of eosinophils can accumulate in tissues such as the esophagus, the stomach, the small intestine, and sometimes in the blood when individuals are exposed to an allergen. The allergen(s) that causes eosinophilic esophagitis is not known. It is not even known whether the allergen is inhaled or ingested. Eosinophilic esophagitis is more common among individuals with other allergic conditions such as asthma, hay fever, allergic rhinitis, and atopic dermatitis.
Eosinophilic esophagitis affects both children and adults. For unknown reasons, men are more commonly affected than women, and it is most commonly found among young boys and men.
This article primarily deals with the diagnosis and management of swallowing problems (dysphagia), the most common complication in adults with eosinophilic esophagitis.
What are eosinophilic esophagitis symptoms?
The major symptom among adults with eosinophilic esophagitis is difficulty swallowing solid food (dysphagia). Specifically, the food gets stuck in the esophagus after it is swallowed. Less common symptoms include heartburn and chest pain. Among children, the most common symptoms are abdominal pain, nausea, vomiting , coughing, and failure to thrive.
How does eosinophilic esophagitis cause dysphagia?
Eosinophilic esophagitis decreases the ability of the esophagus to stretch and accommodate mouthfuls of swallowed food. As a result, solid foods (particularly steak, turkey, and chicken) will have difficulty passing through the esophagus. When solid food sticks in the esophagus, it causes an uncomfortable sensation in the chest, referred to as dysphagia. If the solid food then passes into the stomach, the discomfort subsides, and the individual can resume eating. If the solid food does not pass into the stomach, individuals often must regurgitate the food by inducing vomiting before they can resume eating. Rarely, the solid food becomes impacted, that is, it can neither pass into the stomach or be regurgitated. The impacted solid food causes chest pain that can mimic a heart attack and repeated spitting of saliva that cannot be swallowed (because of the obstruction of the esophagus). Individuals with impacted food are unable to eat or drink. To relieve the obstruction, a doctor usually will have to insert a flexible endoscope through the mouth and into the esophagus to remove the impacted food.
How eosinophilic esophagitis causes symptoms of abdominal pain, vomiting, and failure to thrive in children is not clear.
What are the other causes of dysphagia for solid food?
The most common causes of dysphagia for solid food are esophageal strictures and Schatzki (lower esophageal) rings. Esophageal strictures are narrowings of the esophagus that result from inflammation and scarring most commonly from chronic acid reflux. Strictures usually are located in the lower esophagus near the entrance to the stomach where the acid reflux is occurring. Schatzki rings are thin webs of tissue of unclear cause that can narrow the lumen (center) of the esophagus through which food passes. They also are located in the lower esophagus. A less common cause of dysphagia for solid food is esophageal cancer that narrows the esophageal lumen. A rare cause of dysphagia is achalasia, a disease of the nerves and the muscles of the esophagus that prevents the muscle at the lower end of the stomach (the lower esophageal sphincter) from relaxing and allowing swallowed food to pass into the stomach. Unlike the other causes of dysphagia, achalasia usually results in problems swallowing both solid and liquid food.
How is eosinophilic esophagitis diagnosed?
The diagnosis of eosinophilic esophagitis is suspected whenever dysphagia for solid food occurs, even though it is not one of the most common causes of dysphagia. Dysphagia almost always is evaluated with endoscopy (esophagogastroduodenoscopy or EGD) in order to determine its cause. During the EGD, a flexible viewing tube or endoscope is inserted through the mouth and into the esophagus. It allows the doctor to see the inner lining of the esophagus (as well as the stomach and duodenum). Cancers, esophageal strictures, and Schatzki rings-and usually achalasia-all can be diagnosed visually at the time of EGD.
The doctor performing the EGD also may see abnormalities that suggest eosinophilic esophagitis. For example, some patients with eosinophilic esophagitis have narrowing of most of the esophagus. Others have a series of rings along the entire length of the esophagus. The diagnosis of eosinophilic esophagitis is established with a biopsy of the inner lining of the esophagus. The biopsy is performed by inserting a long thin biopsy forceps through the channel of the endoscope that pinches off a small sample of tissue from the inner lining of the esophagus. A pathologist then can examine the biopsied tissue under the microscope to look for eosinophils.
In many patients with eosinophilic esophagitis, however, the esophagus looks normal or will show only minor abnormalities. Unless biopsies are taken of a normal-appearing esophagus, the diagnosis of eosinophilic esophagitis can be missed. In fact, not taking biopsies has resulted in some patients having dysphagia for years before the diagnosis of eosinophilic esophagitis has been made, and doctors are now more likely to perform biopsies of the esophagus in individuals with dysphagia--even those with a normal-appearing esophagus--who have no clear cause for their dysphagia.
The incidence of eosinophilic esophagitis is on the rise in the U. S. This rise in incidence may reflect either increased awareness of the disease among the doctors treating patients with dysphagia or an actual increase in the prevalence of this disease.
How is eosinophilic esophagitis treated?
The treatment of eosinophilic esophagitis is with gentle esophageal dilatation, and medications. The goal of treatment is to relieve symptoms of dysphagia.
Esophageal dilatation
For decades, gastroenterologists have been treating patients with dysphagia from eosinophilic esophagitis in the same manner as patients with dysphagia due to esophageal strictures and Schatzki rings, i.e., esophageal dilatation. Esophageal dilatation involves physically stretching the strictures or fracturing the rings, thus allowing freer passage of solid food. Stretching or fracturing can be performed with endoscopes, long and flexible dilators of different diameters inserted through the mouth, or with balloons inserted into the esophagus through the channels of endoscopes. The balloons are positioned at the level of the strictures or rings and then inflated.
While esophageal dilatation has been an effective and usually safe treatment, doctors have observed that some patients with eosinophilic esophagitis develop tears in the esophageal lining that can lead to severe chest pain after dilation. Rare cases of esophageal perforations (tears through the entire esophageal wall) also have been reported. Esophageal perforations are a serious complication that can lead to infections within the chest. Thus, although doctors may still use dilatation to treat dysphagia from eosinophilic esophagitis, they now are more likely to use smaller dilators and less force than they would when treating esophageal strictures and rings. Moreover, doctors also are more commonly using medications to treat dysphagia from eosinophilic esophagitis and using dilation only when meditations fail.
Medications
The medications used in treating eosinophilic esophagitis are proton pump inhibitors (Protonix, Nexium, Aciphex, Prevacid, Prilosec, and Zegarid), and fluticasone propionate (Flovent).
Fluticasone propionate (Flovent)
The current treatment of eosinophilic esophagitis is with swallowed (not inhaled) fluticasone propionate. Fluticasone propionate is a man-made steroid that is related to the naturally occurring steroid hormone, cortisol or hydrocortisone, produced by the adrenal glands. These steroids have potent anti-inflammatory actions. When used as an inhaler, fluticasone propionate reduces inflammation in the airways of patients with asthma, thus relieving wheezing and breathing difficulties. When fluticasone propionate is swallowed, it has been shown to reduce the eosinophils in the esophagus and relieve dysphagia among patients with eosinophilic esophagitis.
In treating eosinophilic esophagitis, fluticasone propionate is administered with the same inhaler as for asthma but without the usual spacer in the inhaler. The removal of the spacer causes the fluticasone propionate to deposit in the mouth rather than enter the lungs. The fluticasone propionate that deposits within the mouth then is swallowed with a small amount of water, usually twice daily for several weeks. Patients are instructed not to eat or drink for two hours after each treatment. Improvement in dysphagia usually is prompt, within days or weeks. Some patients may develop recurrent symptoms months after stopping treatment and require retreatment.
When used in low doses, little fluticasone propionate is absorbed into the body and therefore side effects are minimal. One possible side effect is thrush (infection of the mouth and throat by a fungus, candida). When higher doses are used for a prolonged period, enough fluticasone propionate may be absorbed to cause side effects elsewhere in the body. Side effects of high doses of fluticasone propionate are similar to the side effects of oral steroids such as prednisone and cortisone.
Proton pump inhibitors
Proton pump inhibitors, pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), lansoprazole (Prevacid), and omeprazole (Prilosec, Zegarid) reduce production of acid by the stomach. They are very safe and effective treatment for the symptoms of acid reflux and esophagitis. Since acid reflux may aggravate esophagitis in some patients with eosinophilic esophagitis, doctors frequently use proton pump inhibitors for treating eosinophilic esophagitis.
What about elimination diets for treating eosinophilic esophagitis?
Doctors have used elimination diets (for example, diets without wheat, soy, milk, peanuts, and/or seafood) and elemental diets (for example, liquid diets that contain only amino acids but no proteins to act as allergens) in treating children with eosinophilic esophagitis with some success. Doctors have little experience, however, in treating adults with elimination diets. It would be difficult to identify an individual allergen causing eosinophilic esophagitis, and elemental liquid diets are difficult to tolerate for more than a few weeks.
What is the future of eosinophilic esophagitis?
Eosinophilic esophagitis in adults is a newly-recognized disease. Therefore, understanding of the cause(s), natural history, diagnosis and management is limited and will evolve over the coming years. Currently, the recommended treatments (for example, with oral fluticasone propionate) are based on a limited number of small studies. More studies involving larger numbers of patients followed for longer periods of time are necessary to determine the long-term efficacy and safety of treatment.
Montelukast (Singulair) is an oral leukotriene receptor antagonist that is used for treating asthma and seasonal allergic rhinitis (hay fever). Leukotrienes are a group of naturally occurring chemicals in the body that promote inflammation in asthma, seasonal allergic rhinitis, and other diseases involving allergy. They are formed by cells, released, and then bound to other cells that participate in inflammation. It is the binding to these other cells that stimulates the cells and promotes inflammation. Montelukast blocks the binding of some of these leukotrienes and has been used with success in treating a small number of patients with eosinophilic esophagitis. More studies are needed.
Cromolyn is a synthetic compound that is used to prevent allergic reactions. Many of the symptoms and signs of allergic reactions are caused by chemicals, for example, histamine, that are released from mast cells, a type of cell that is found throughout the body as well as in the lungs, nose, and eyelids. Cromolyn works by preventing the release of these chemicals from the mast cells. Cromolyn is inhaled to prevent episodes of asthma due to allergy. It also is used as a nasal inhaler to treat seasonal allergic rhinitis (due to inflammation of the lining of the nose) and as an ophthalmic (eye) solution to treat allergic conjunctivitis (due to inflammation of the lining of the eyelids). More studies are needed to determine whether cromolyn also will be effective in treating eosinophilic esophagitis.
Eosinophilic Esophagitis At A Glance
Eosinophilic esophagitis is an inflammatory condition of the esophagus that affects both children and adults and men more than women.
Eosinophilic gastroenteritis may be due allergy to an as yet unknown allergen.
The major symptom among adults with eosinophilic esophagitis is dysphagia for solid food.
Eosinophilic esophagitis stiffens the esophagus so that solid foods have difficulty passing through the esophagus and into the stomach.
Other common causes of dysphagia for solid food are esophageal strictures and Schatzki rings.
The diagnosis of eosinophilic esophagitis usually is made during an EGD being done for the evaluation of dysphagia. The diagnosis is confirmed by biopsy of the esophagus.
The treatment of eosinophilic esophagitis is with proton pump inhibitors and swallowed fluticasone propionate. Gentle esophageal dilatation is used when meditations fail to relieve dysphagia.
Last Editorial Review: 12/20/2005
© 1996-2005 MedicineNet, Inc. All rights reserved. Copyright and Legal Disclaimer.
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
Statements and information regarding dietary supplements have not been evaluated or approved by the Food and Drug Administration. Please consult your healthcare provider before beginning any course of supplementation or treatment.
close window
Source: http://www.medicinenet.com
Eosinophilic Esophagitis
Medical Author: Dennis Lee, MD
Medical Editor: Jay W. Marks, MD
What is eosinophilic esophagitis?
What are eosinophilic esophagitis symptoms?
How does eosinophilic esophagitis cause dysphagia?
What are the other causes of dysphagia or solid food?
How is eosinophilic esophagitis diagnosed?
How is eosinophilic esophagitis treated?
What about elimination diets for treating eosinophilic esophagitis?
What is the future for eosinophilic esophagitis?
Eosinophilic Esophagitis At A Glance
What is eosinophilic esophagitis?
Eosinophilic esophagitis is an inflammatory condition in which the wall of the esophagus becomes filled with large numbers of eosinophils.
The esophagus is the muscular tube that propels swallowed food from the mouth into the stomach. Esophagitis refers to inflammation of the esophagus that has several causes. The most common cause of esophagitis is acid reflux which most frequently results in heartburn, though acid reflux also can cause ulcers on the inner lining of the esophagus. Other less common causes of esophagitis include viruses (such as herpes simplex), fungi (such as Candida), medications that get stuck in the esophagus (such as the antibiotic, tetracycline), and radiation (such as for treatment of lung cancer). Doctors believe that eosinophilic esophagitis is a type of esophagitis that is caused by allergy just like asthma, hay fever, allergic rhinitis, and atopic dermatitis even though the exact substance that is causing the allergy is not known. The hallmark of eosinophilic esophagitis is the presence of large numbers of eosinophils in the tissue just beneath the inner lining of the esophagus.
Eosinophils are white blood cells (leukocytes) manufactured in the bone marrow and are one of many types of cells that actively promote inflammation. They are particularly active in the type of inflammation caused by allergic reactions. Thus, large number of eosinophils can accumulate in tissues such as the esophagus, the stomach, the small intestine, and sometimes in the blood when individuals are exposed to an allergen. The allergen(s) that causes eosinophilic esophagitis is not known. It is not even known whether the allergen is inhaled or ingested. Eosinophilic esophagitis is more common among individuals with other allergic conditions such as asthma, hay fever, allergic rhinitis, and atopic dermatitis.
Eosinophilic esophagitis affects both children and adults. For unknown reasons, men are more commonly affected than women, and it is most commonly found among young boys and men.
This article primarily deals with the diagnosis and management of swallowing problems (dysphagia), the most common complication in adults with eosinophilic esophagitis.
What are eosinophilic esophagitis symptoms?
The major symptom among adults with eosinophilic esophagitis is difficulty swallowing solid food (dysphagia). Specifically, the food gets stuck in the esophagus after it is swallowed. Less common symptoms include heartburn and chest pain. Among children, the most common symptoms are abdominal pain, nausea, vomiting , coughing, and failure to thrive.
How does eosinophilic esophagitis cause dysphagia?
Eosinophilic esophagitis decreases the ability of the esophagus to stretch and accommodate mouthfuls of swallowed food. As a result, solid foods (particularly steak, turkey, and chicken) will have difficulty passing through the esophagus. When solid food sticks in the esophagus, it causes an uncomfortable sensation in the chest, referred to as dysphagia. If the solid food then passes into the stomach, the discomfort subsides, and the individual can resume eating. If the solid food does not pass into the stomach, individuals often must regurgitate the food by inducing vomiting before they can resume eating. Rarely, the solid food becomes impacted, that is, it can neither pass into the stomach or be regurgitated. The impacted solid food causes chest pain that can mimic a heart attack and repeated spitting of saliva that cannot be swallowed (because of the obstruction of the esophagus). Individuals with impacted food are unable to eat or drink. To relieve the obstruction, a doctor usually will have to insert a flexible endoscope through the mouth and into the esophagus to remove the impacted food.
How eosinophilic esophagitis causes symptoms of abdominal pain, vomiting, and failure to thrive in children is not clear.
What are the other causes of dysphagia for solid food?
The most common causes of dysphagia for solid food are esophageal strictures and Schatzki (lower esophageal) rings. Esophageal strictures are narrowings of the esophagus that result from inflammation and scarring most commonly from chronic acid reflux. Strictures usually are located in the lower esophagus near the entrance to the stomach where the acid reflux is occurring. Schatzki rings are thin webs of tissue of unclear cause that can narrow the lumen (center) of the esophagus through which food passes. They also are located in the lower esophagus. A less common cause of dysphagia for solid food is esophageal cancer that narrows the esophageal lumen. A rare cause of dysphagia is achalasia, a disease of the nerves and the muscles of the esophagus that prevents the muscle at the lower end of the stomach (the lower esophageal sphincter) from relaxing and allowing swallowed food to pass into the stomach. Unlike the other causes of dysphagia, achalasia usually results in problems swallowing both solid and liquid food.
How is eosinophilic esophagitis diagnosed?
The diagnosis of eosinophilic esophagitis is suspected whenever dysphagia for solid food occurs, even though it is not one of the most common causes of dysphagia. Dysphagia almost always is evaluated with endoscopy (esophagogastroduodenoscopy or EGD) in order to determine its cause. During the EGD, a flexible viewing tube or endoscope is inserted through the mouth and into the esophagus. It allows the doctor to see the inner lining of the esophagus (as well as the stomach and duodenum). Cancers, esophageal strictures, and Schatzki rings-and usually achalasia-all can be diagnosed visually at the time of EGD.
The doctor performing the EGD also may see abnormalities that suggest eosinophilic esophagitis. For example, some patients with eosinophilic esophagitis have narrowing of most of the esophagus. Others have a series of rings along the entire length of the esophagus. The diagnosis of eosinophilic esophagitis is established with a biopsy of the inner lining of the esophagus. The biopsy is performed by inserting a long thin biopsy forceps through the channel of the endoscope that pinches off a small sample of tissue from the inner lining of the esophagus. A pathologist then can examine the biopsied tissue under the microscope to look for eosinophils.
In many patients with eosinophilic esophagitis, however, the esophagus looks normal or will show only minor abnormalities. Unless biopsies are taken of a normal-appearing esophagus, the diagnosis of eosinophilic esophagitis can be missed. In fact, not taking biopsies has resulted in some patients having dysphagia for years before the diagnosis of eosinophilic esophagitis has been made, and doctors are now more likely to perform biopsies of the esophagus in individuals with dysphagia--even those with a normal-appearing esophagus--who have no clear cause for their dysphagia.
The incidence of eosinophilic esophagitis is on the rise in the U. S. This rise in incidence may reflect either increased awareness of the disease among the doctors treating patients with dysphagia or an actual increase in the prevalence of this disease.
How is eosinophilic esophagitis treated?
The treatment of eosinophilic esophagitis is with gentle esophageal dilatation, and medications. The goal of treatment is to relieve symptoms of dysphagia.
Esophageal dilatation
For decades, gastroenterologists have been treating patients with dysphagia from eosinophilic esophagitis in the same manner as patients with dysphagia due to esophageal strictures and Schatzki rings, i.e., esophageal dilatation. Esophageal dilatation involves physically stretching the strictures or fracturing the rings, thus allowing freer passage of solid food. Stretching or fracturing can be performed with endoscopes, long and flexible dilators of different diameters inserted through the mouth, or with balloons inserted into the esophagus through the channels of endoscopes. The balloons are positioned at the level of the strictures or rings and then inflated.
While esophageal dilatation has been an effective and usually safe treatment, doctors have observed that some patients with eosinophilic esophagitis develop tears in the esophageal lining that can lead to severe chest pain after dilation. Rare cases of esophageal perforations (tears through the entire esophageal wall) also have been reported. Esophageal perforations are a serious complication that can lead to infections within the chest. Thus, although doctors may still use dilatation to treat dysphagia from eosinophilic esophagitis, they now are more likely to use smaller dilators and less force than they would when treating esophageal strictures and rings. Moreover, doctors also are more commonly using medications to treat dysphagia from eosinophilic esophagitis and using dilation only when meditations fail.
Medications
The medications used in treating eosinophilic esophagitis are proton pump inhibitors (Protonix, Nexium, Aciphex, Prevacid, Prilosec, and Zegarid), and fluticasone propionate (Flovent).
Fluticasone propionate (Flovent)
The current treatment of eosinophilic esophagitis is with swallowed (not inhaled) fluticasone propionate. Fluticasone propionate is a man-made steroid that is related to the naturally occurring steroid hormone, cortisol or hydrocortisone, produced by the adrenal glands. These steroids have potent anti-inflammatory actions. When used as an inhaler, fluticasone propionate reduces inflammation in the airways of patients with asthma, thus relieving wheezing and breathing difficulties. When fluticasone propionate is swallowed, it has been shown to reduce the eosinophils in the esophagus and relieve dysphagia among patients with eosinophilic esophagitis.
In treating eosinophilic esophagitis, fluticasone propionate is administered with the same inhaler as for asthma but without the usual spacer in the inhaler. The removal of the spacer causes the fluticasone propionate to deposit in the mouth rather than enter the lungs. The fluticasone propionate that deposits within the mouth then is swallowed with a small amount of water, usually twice daily for several weeks. Patients are instructed not to eat or drink for two hours after each treatment. Improvement in dysphagia usually is prompt, within days or weeks. Some patients may develop recurrent symptoms months after stopping treatment and require retreatment.
When used in low doses, little fluticasone propionate is absorbed into the body and therefore side effects are minimal. One possible side effect is thrush (infection of the mouth and throat by a fungus, candida). When higher doses are used for a prolonged period, enough fluticasone propionate may be absorbed to cause side effects elsewhere in the body. Side effects of high doses of fluticasone propionate are similar to the side effects of oral steroids such as prednisone and cortisone.
Proton pump inhibitors
Proton pump inhibitors, pantoprazole (Protonix), esomeprazole (Nexium), rabeprazole (Aciphex), lansoprazole (Prevacid), and omeprazole (Prilosec, Zegarid) reduce production of acid by the stomach. They are very safe and effective treatment for the symptoms of acid reflux and esophagitis. Since acid reflux may aggravate esophagitis in some patients with eosinophilic esophagitis, doctors frequently use proton pump inhibitors for treating eosinophilic esophagitis.
What about elimination diets for treating eosinophilic esophagitis?
Doctors have used elimination diets (for example, diets without wheat, soy, milk, peanuts, and/or seafood) and elemental diets (for example, liquid diets that contain only amino acids but no proteins to act as allergens) in treating children with eosinophilic esophagitis with some success. Doctors have little experience, however, in treating adults with elimination diets. It would be difficult to identify an individual allergen causing eosinophilic esophagitis, and elemental liquid diets are difficult to tolerate for more than a few weeks.
What is the future of eosinophilic esophagitis?
Eosinophilic esophagitis in adults is a newly-recognized disease. Therefore, understanding of the cause(s), natural history, diagnosis and management is limited and will evolve over the coming years. Currently, the recommended treatments (for example, with oral fluticasone propionate) are based on a limited number of small studies. More studies involving larger numbers of patients followed for longer periods of time are necessary to determine the long-term efficacy and safety of treatment.
Montelukast (Singulair) is an oral leukotriene receptor antagonist that is used for treating asthma and seasonal allergic rhinitis (hay fever). Leukotrienes are a group of naturally occurring chemicals in the body that promote inflammation in asthma, seasonal allergic rhinitis, and other diseases involving allergy. They are formed by cells, released, and then bound to other cells that participate in inflammation. It is the binding to these other cells that stimulates the cells and promotes inflammation. Montelukast blocks the binding of some of these leukotrienes and has been used with success in treating a small number of patients with eosinophilic esophagitis. More studies are needed.
Cromolyn is a synthetic compound that is used to prevent allergic reactions. Many of the symptoms and signs of allergic reactions are caused by chemicals, for example, histamine, that are released from mast cells, a type of cell that is found throughout the body as well as in the lungs, nose, and eyelids. Cromolyn works by preventing the release of these chemicals from the mast cells. Cromolyn is inhaled to prevent episodes of asthma due to allergy. It also is used as a nasal inhaler to treat seasonal allergic rhinitis (due to inflammation of the lining of the nose) and as an ophthalmic (eye) solution to treat allergic conjunctivitis (due to inflammation of the lining of the eyelids). More studies are needed to determine whether cromolyn also will be effective in treating eosinophilic esophagitis.
Eosinophilic Esophagitis At A Glance
Eosinophilic esophagitis is an inflammatory condition of the esophagus that affects both children and adults and men more than women.
Eosinophilic gastroenteritis may be due allergy to an as yet unknown allergen.
The major symptom among adults with eosinophilic esophagitis is dysphagia for solid food.
Eosinophilic esophagitis stiffens the esophagus so that solid foods have difficulty passing through the esophagus and into the stomach.
Other common causes of dysphagia for solid food are esophageal strictures and Schatzki rings.
The diagnosis of eosinophilic esophagitis usually is made during an EGD being done for the evaluation of dysphagia. The diagnosis is confirmed by biopsy of the esophagus.
The treatment of eosinophilic esophagitis is with proton pump inhibitors and swallowed fluticasone propionate. Gentle esophageal dilatation is used when meditations fail to relieve dysphagia.
Last Editorial Review: 12/20/2005
© 1996-2005 MedicineNet, Inc. All rights reserved. Copyright and Legal Disclaimer.
Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. You should carefully read all product packaging. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider.
Statements and information regarding dietary supplements have not been evaluated or approved by the Food and Drug Administration. Please consult your healthcare provider before beginning any course of supplementation or treatment.
close window