Understanding Eosinophilic Esophagitis (EoE), Symptoms, Diagnosis, and Treatments

Understanding Eosinophilic Esophagitis (EoE) and Fatigue

Eosinophilic esophagitis (EoE) is an inflammatory condition that affects the esophagus, the tube that connects the throat to the stomach. In EoE, a type of white blood cell called eosinophils builds up in the lining of the esophagus in abnormally high numbers. This buildup of eosinophils can cause inflammation and damage to the esophageal tissues, leading to a variety of symptoms.

One common symptom that many people with EoE experience is fatigue. In this article, well explore the link between EoE and fatigue and discuss some of the potential causes and treatments available.

What Causes Fatigue in EoE?

There are a few reasons why EoE may lead to feelings of tiredness or fatigue:

• Difficulty swallowing and eating - One of the main symptoms of EoE is difficulty and pain with swallowing foods, especially dry or solid foods. This can make it challenging to eat enough calories and nutrients, leading to weakness and fatigue.
• Malabsorption and nutritional deficiencies - The inflammation in the esophagus can also impair the body's ability to properly absorb nutrients from food. Deficiencies in iron, vitamin B12, and other nutrients may develop.
• Sleep disturbances - Some people with EoE experience reflux and coughing at night which interrupts sleep. Poor sleep quality can result in daytime fatigue.
• Medications side effects - Certain medications used to manage EoE like topical steroids may list fatigue or tiredness as potential side effects.
• Stress and anxiety - Dealing with dysphagia, dietary restrictions, and the uncertainty of a chronic disease can be mentally and emotionally draining.

How Common Is Fatigue with EoE?

Studies show that fatigue and exhaustion are fairly common occurrences for those with EoE:

• In one survey study, 68% of adult EoE patients reported fatigue, tiredness, or lethargy.
• Up to 72% of parents reported chronic fatigue in their children with EoE.
• Those with uncontrolled, active EoE inflammation tend to experience more severe fatigue than those in remission.

So while not everyone with EoE struggles with significant fatigue, it is a symptom that affects a majority of patients to some degree, especially during EoE flares.

Tips for Managing EoE Fatigue

If you are experiencing ongoing fatigue related to your EoE, there are some management strategies that may help:

• Follow your EoE treatment plan - Getting the inflammation under control through medications and dietary changes can help minimize fatigue.
• Check for nutritional deficiencies - Ask your doctor to test for anemia, vitamin deficiencies, or malnutrition.
• Consider OTC supplements - Supplements like iron, vitamin D, B-complex vitamins may help if levels are low.
• Prioritize sleep - Maintain good sleep habits and treat conditions like reflux that disrupt sleep.
• Stay active - Light exercise like walking can help boost energy levels.
• Save energy - Pace yourself and take rests when needed. Let others help out with household tasks.
• Control stress - Make time for relaxing activities and connect with supportive friends and family.
• Communicate with your doctor - Report ongoing fatigue so causes can be evaluated and treatment adjusted if needed.

When to See Your Doctor

In general, occasional fatigue is to be expected when living with a chronic condition like EoE. However, if you are experiencing:

• Severe or persistent fatigue that limits your daily activities
• Fatigue along with other worrisome symptoms like fever, unexpected weight loss, dizziness
• Fatigue that doesn't improve with adequate rest and sleep

It's a good idea to check in with your doctor. They can examine you, review your EoE treatment, and determine if there's an underlying cause driving your fatigue that needs to be addressed.

The Link Between EoE and Mental Health

In addition to physical symptoms, EoE can also take a toll on mental health. Living with a chronic disease and dealing with dietary restrictions, swallowing difficulties, and social isolation can negatively impact quality of life.

Some common mental health concerns reported by EoE patients include:

• Anxiety and stress - Many patients experience anxiety around eating, social situations, and managing their condition. Coping with EoE can also be a significant source of stress.
• Depression - Rates of depression are higher among those with EoE compared to the general population.
• Poor body image - Some patients struggle with weight changes, food avoidance, or embarrassment over symptoms.
• Social isolation - Fears around eating out, being viewed as a picky eater, or missing school/work can lead to withdrawal from social situations.

Unrecognized and untreated mental health issues can then further exacerbate physical symptoms like fatigue. Seeking psychological support is important for overall wellbeing.

Tips for Managing Mental Health with EoE

Some tips for protecting your mental health while coping with EoE include:

• Connect with an EoE support group - Knowing you aren't alone is comforting.
• Confide in loved ones - Share your experiences and feelings with close family/friends.
• See a therapist - Get professional support in managing stress, anxiety, depression.
• Practice self-care - Make time for hobbies, relaxation, proper rest, healthy food.
• Focus on what you can eat - Dwelling on restrictions will only breed resentment.
• Be open about EoE - Educating people in your life creates understanding.
• Stay hopeful - With treatment, most can achieve symptom control and good quality of life.

Your psychological wellbeing is just as important as your physical symptoms. Don't hesitate to reach out for mental health support when needed.

Dietary Treatment for EoE

Along with medications, dietary therapy is one of the main treatment approaches for controlling inflammation and managing EoE. The goals of dietary treatment include:

• Identifying and eliminating trigger foods that provoke an immune reaction
• Providing nutritional support to aid growth and development in children
• Preventing food from getting stuck in the esophagus
• Improving overall quality of life

There are a few different dietary approaches that may be recommended:

Elimination Diets

Elimination diets involve removing the foods most likely to trigger inflammation. Some options include:

• Six food elimination diet - excludes dairy, eggs, wheat, soy, nuts, and seafood
• Four food elimination diet - excludes dairy, eggs, wheat, and legumes
• Elemental formula diet - liquid nutrition formulas that provide essential nutrients without whole foods

After following the elimination diet for several weeks to months, foods are systematically reintroduced one at a time while monitoring symptoms. This helps pinpoint triggers.

Allergy Testing

Identifying allergy triggers through skin prick or patch testing can guide elimination of those foods. This targeted approach may provide similar benefits as broader elimination diets.

Texture Modification

Soft, moist foods like mashed potatoes or soup can be better tolerated than dry, crunchy foods when the esophagus is inflamed. Patients may also benefit from:

• Taking smaller bites of food
• Drinking plenty of liquids with meals
• Chewing thoroughly before swallowing

Making these changes can help prevent episodes of food getting stuck (food impactions).

Supplements

Oral vitamin/mineral supplements or electrolyte solutions are sometimes needed if the diet is very restrictive or malnutrition is a concern, especially in children. Work with a dietitian to determine if supplements are recommended.

Dietary treatment can significantly improve outcomes and health status for many EoE patients. A combination approach tailored to the individual often provides the best results under the guidance of an experienced dietitian.

EoE Complications

While eosinophilic esophagitis (EoE) is a manageable condition for most people, complications can sometimes occur if it remains untreated for a long time or isnt properly controlled. Being aware of the possible complications can help motivate patients to stick with their treatment regimen.

Esophageal Strictures

A stricture is an abnormal narrowing of the esophagus. In EoE, strictures develop due to scar tissue that builds up from chronic inflammation and injury to the esophageal lining. Strictures can worsen swallowing difficulties.

Treatment usually involves gently dilating (stretching) the stricture using an endoscope and balloon system. Multiple dilations over time may be needed to allow food to pass through easily. Strictures can be prevented by keeping EoE well-controlled with medications and diet.

Food Impactions

When a piece of food becomes completely stuck in the esophagus, this is called a food impaction or food bolus impaction. Impactions are more likely to occur in untreated EoE due to inflammation and strictures.

Urgent endoscopy is required to remove the obstruction. Repeated impactions can scratch and scar the esophageal lining, so its important to treat the EoE to prevent recurrences. Chewing food thoroughly and drinking fluids during meals can also lower risk.

Esophageal Tears

In severe cases, excessive straining to vomit up an impacted food item can cause tears (perforations) in the esophageal wall. This allows bacteria and food contents to leak into the chest cavity, resulting in a dangerous condition called mediastinitis.

Esophageal tears are rare but require immediate hospital care. IV antibiotics, pain management, and possible surgery are needed to drain and clean out the infection.

Nutrient Deficiencies

Difficulty swallowing and restricting foods due to EoE puts patients at increased risk of nutritional deficiencies. Malabsorption from intestinal damage related to allergies can further compound this.

Prolonged deficiencies in calories, protein, vitamins, or minerals can impair growth and development in children. Monitoring nutrition status and supplementing when needed helps counter deficiencies.

While complications aren't common for most, remaining vigilant with treatment is important to avoid serious progression of the disease. Working closely with your doctor allows any complications to be caught and addressed early.

EoE Treatment Options

Treatment for eosinophilic esophagitis focuses on reducing inflammation in the esophagus and preventing long-term damage. The main therapies include:

Medications

Corticosteroids: Topical steroids like fluticasone (Flovent) or budesonide (Pulmicort) are commonly used to reduce esophageal inflammation. They can be delivered directly to the esophagus as a viscous slurry or inhaler powder.

Biologics: Injectable monoclonal antibodies like dupilumab (Dupixent) block certain immune pathways. They may be prescribed for severe refractory EoE.

Dietary Therapy

Identifying and eliminating trigger foods through elimination diets or allergy testing can help resolve symptoms for many patients. Making dietary changes reduces immune activation.

Dilation

Esophageal dilation stretches narrow areas of strictures using endoscopically guided balloons or bougies. This improves the esophageal diameter to allow easier food passage and intake.

Acid Suppression

Though different from acid reflux, some patients find benefit by adding proton pump inhibitors or H2 blockers to reduce stomach acid production.

Treatment is tailored to each patients unique situation based on symptom severity, triggers identified, and response to various options. Kids often need more aggressive anti-inflammatory treatment while dietary approaches may suffice for some adults.

Following the treatment regimen helps achieve symptom relief and long-term remission. Close monitoring and follow-up are key to ensure effectiveness.

EoE vs Eosinophilic Gastroenteritis (EGE)

Eosinophilic esophagitis (EoE) involves eosinophilic inflammation specific to the esophagus. A related condition is eosinophilic gastroenteritis (EGE) which affects the stomach and small intestine.

Here is how these two eosinophilic GI disorders compare:

• Location - EoE is isolated to the esophagus. EGE can impact any part of the GI tract, but usually the stomach and small intestine.
• Prevalence - EoE is more common. Estimates indicate up to 1 in 2000 people may have EoE vs. 1 in 100,000 for EGE.
• Age - EoE typically first appears in childhood. EGE can affect a wider range of ages.
• Symptoms - Dysphagia and food impactions are unique to EoE. EGE causes symptoms like abdominal pain, nausea, and diarrhea.
• Causes - Both involve food allergies triggering increased eosinophils. EGE is occasionally caused by autoimmune disorders.
• Diagnosis - Endoscopy and biopsy show eosinophilia limited to the esophagus in EoE. EGE requires more extensive GI biopsies.
• Treatment - Elimination diets and steroids work for both. Elemental formula is used more in EGE.

While having some similarities and often co-occurring, EoE and EGE are considered distinct conditions. Increased awareness of eosinophilic disorders helps doctors recognize them.

EoE Symptoms in Adults vs Children

The main manifestations of eosinophilic esophagitis (EoE) are similar between children and adults. However, there are some differences in how symptoms may appear.

Swallowing Issues

Dysphagia, or difficulty swallowing, occurs in both groups but the specific symptoms vary by age:

• Children - may choke on foods, have a fear of eating, or resist eating certain textures
• Adults - sensation of food sticking, needing to drink to push down food, long eating times

Feeding Issues

Young children may exhibit:

• Refusing foods outside their comfort zone
• Messy eating or pocketing food in their mouth
• Failure to advance to textured foods by expected ages
• Not meeting growth milestones

GI Symptoms

In adults, GERD-like symptoms are more common, such as:

• Heartburn
• Reflux
• Chest pain

Nausea and abdominal pain may be seen in children.

Diagnosis

EoE is often diagnosed earlier in life now thanks to increased awareness. Average ages at diagnosis include:

• Children - 8 years old
• Adults

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.