Hey Bones/everyone,
Was out of town, then have been working night shifts sorry for the delayed response...
Eosinophilic esophagitis is often seen in patients with "allergic" conditions such as asthma, eczema, or chronic rhinitis or in those who have a family history of atopic disease.
Your endoscopic findings are fairly classic for the condition. Endoscopy may reveal a ringed appearance or linear furrows. Standard biopsy findings reveal severe eosinophilic infiltration; more than 15-20 eosinophils per high-magnification microscopic field are necessary for diagnosis. Eosinophils are specialized immune cells (white blood cells) that modulate the allergic response and originally evolved to help to fight off parasites.
In contrast to GERD, eosinophilic esophagitis involves the mucosa, submucosa, and, possibly, the muscularis. GERD typically only affects the mucosal or submucosal layer. In your case, you have inflammation that goes into the muscular layer, which explains your issues with swallowing as described.
Multiple food antigens (eg, eggs, nuts, beef, wheat, fish, shellfish, corn, soy) can induce eosinophilic esophagitis; cow's milk protein is the most common precipitant.
The exact pathophysiology of eosinophilic esophagitis is unknown, but contact of the allergen with the esophageal or intestinal mucosa is thought to be the initiating event. In recent years, animal models of oral and respiratory eosinophil-associated GI disorders have been developed. In these models, oral antigens induced the recruitment of eosinophils to the GI tract, including the esophagus and Peyer patches (immune areas like lymph nodes in the esophagus), and promoted GI inflammation and motility dysfunction. Interleukin-5 (IL-5), interleukin 13 (IL-13), and eotaxin-1, a chemokine specific to eosinophils, play a major role in eosinophil recruitment and T-cell proliferation and polarization in the tissues.
The treatment of eosinophilic esophagitis is still widely debated.
Evidence shows that food allergy is the most common cause of EE, and different approaches to removing the causative food antigens are available. You might want to see an allergist or rhematologist to assist with this.
Patch testing can help determine the allergen (most commonly milk, eggs, nuts, beef, wheat, fish, shellfish, corn, and soy). Selective elimination of implicated foods based on allergy testing, or, in certain cases, initiation of elemental diet is required.
For 1-3 months, patients are placed on an exclusion diet or an elemental diet, and repeat endoscopies with biopsies are often necessary to determine both improvement and the time to start progressive reintroduction of foods. Elemental diet has found to have a higher success rate than testing-based elimination diet.
Other treatments, such as anti-inflammatory medications, mast cell stabilizers, and leukotriene receptor antagonists, have also been used.
Oral corticosteroids were demonstrated to be effective in treating symptoms and normalizing the histology, but the disease recurs when these agents are discontinued. Since 1998, multiple studies demonstrated effectiveness of swallowed topical corticosteroids delivered from a metered dose inhaler in treating clinical symptoms and abnormal histology associated with eosinophilic esophagitis. This is likely why they have you treating your condition in this way.
Your condition will not induce an "allergic reaction" in the anaphylactic sense. This is a chronic immune mediated inflammation of the tissues of your esophagus that affect the way your muscles function. I don't know army rules, but I don't see any reason it should affect your qualifications as a pilot. As for your condition, I would recommend having a gastroenterologist and a rhematologist or allergist that can work on decreasing your allergen exposures to improve your symptoms. You may also want to work with a nutritionist if they recommend any special diets.
Also... I'm an ER doc so this is not my specific area of medical expertise, I did use emedicine for some of the info in this post.
Hope this helps. Good luck and feel better.
EMSDoc :cool: