Eosinophilic Esophagitis (cont.)
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 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
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