Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
Eosinophilic esophagitis is an inflammatory condition in which the wall of the
esophagus becomes filled with large numbers of eosinophils, a type of white
blood cell.
The esophagus is a muscular
tube that propels swallowed food from the mouth into the stomach.
Esophagitis refers to inflammation of the esophagus that have several causes. The most
common cause of esophagitis is acid reflux which most frequently results in heartburn,
although acid reflux also can
cause ulcers in 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
therapy (such as during treatment of lung cancer). Doctors
believe that eosinophilic esophagitis is a type of esophagitis that is caused by
allergy for two reasons.
First eosinophils are prominent in other diseases associated with allergy such as asthma, hay fever, allergic rhinitis, and atopic dermatitis. Second,
patients with eosinophilic esophagitis are more likely to suffer from these
other allergic diseases. Nevertheless, the exact substance that is causing the allergic
reaction in eosinophilic esophagitis 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 the 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 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.
GERD (gastroesophageal reflux disease) is a condition in which the acidified liquid
contents of the stomach backs up into the esophagus. The symptoms of uncomplicated GERD are heartburn,
regurgitation, and nausea. Effective treatment is available for most patients with GERD.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Dysphagia or difficulty in swallowing, swallowing problems. Dysphagia is due to problems in nerve or muscle control. It is common, for example, after a stroke. Dysphagia compromises nutrition and hydration and may lead to aspiration pneumonia and dehydration.
Esophagitis is caused by an infection or irritation of the esophagus. Infections that cause esophagitis include candida yeast infection of the esophagus as well as herpes.
Barrett's esophagus occurs as a complication of chronic gastroesophageal reflux disease (GERD), primarily in white males. GERD refers to the reflux of acidic fluid from the stomach into the esophagus (the swallowing tube), and is classically associated with heartburn.
Achalasia is a disease of the esophagus that mainly affects young adults. Abnormal function of nerves and muscles of the esophagus causes difficulty swallowing and sometimes chest pain.
Gangrene may result when blood flow to a tissue is lost or not adequate to keep the tissue alive. There are two types of gangrene: wet and dry. All cases of wet gangrene are infected by bacteria. Most cases of dry gangrene are not infected. If wet gangrene goes untreated, the patient may die of sepsis and die within hours or days. Dry gangrene usually doesn't cause the patient to die. Symptoms of dry gangrene include numbness, discoloration, and mummification of the affected tissue. Wet gangrene symptoms include swelling, pain, pus, bad smell, and black appearance of the affected tissue. Treatment depends upon the type of gangrene and how much tissue is compromised by the gangrene.
Schatzki (Schatzki's) ring, is a narrow ring of tissue located just above the junction of the esophagus and stomach. The cause of Schatzki ring is not clearly known, however, some doctors believe they are caused by long term acid reflux. The symptoms of a Schatzki ring is primarily poorly chewed food that stays in chunks becoming stuck in the esophagus. Diagnosis of Schatzki's ring is barium x-ray or endoscopy. Treatment is generally a procedure to stretch or fracture the rings.
Dysphagia is the medical term for the symptom of difficulty
swallowing, derived from the Latin and Greek words meaning difficulty eating.
Mechanism of swallowing
Swallowing is a complex action.
Food is first chewed
well in the mouth and mixed with saliva.
The tongue then propels the chewed food
into the throat (pharynx).
The soft palate elevates to prevent the food from
entering the posterior end of the nasal passages, and the upper pharynx
contracts, pushing the food (referred to as a bolus) into the lower pharynx. At
the same time, the voice box (larynx) is pulled upwards by muscles in the neck,
and, as a result, the epiglottis bends downwards. This dual action closes off
the opening to the larynx and windpipe (trachea) and prevents passing food from
entering the larynx and trachea.
The contraction of the muscular pharynx
continues as a progressing, circumfe...
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