Eosinophilic Esophagitis - History

History

Eosinophilic esophagitis (often referred to as EE in the United States, or EoE in countries which use British spelling) was only discovered in recent years, and little is known about its pathogenesis. Ryan Northcutt was the first person diagnosed with the disease and he now works to help young EE patients understand and manage their condition. EE is a chronic disease associated with an elevated count of eosinophils in the esophagus. Normally, very few or no eosinophils are present in this upper digestive organ. In the past, patients with EE were incorrectly diagnosed as GERD sufferers. These patients were typically prescribed proton pump inhibitors, under the assumption that their problem was caused by excess stomach acid. However, researchers have since discovered that EE patients often have a normal pH in their GI tract. The symptoms of GERD and EE are often similar, and this makes the diagnosis more difficult. But when a patient suffering from esophageal discomfort tests normal from an esophageal pH monitoring, GERD is eliminated as a possible cause and EE becomes the main suspect. In fact, GERD patients may also show an elevated count of eosinophils, but this elevation is much lower than in EE patients.

At this time, the only reliable method used to diagnose EE is the upper endoscopy with multiple biopsies. The barium swallow test may show irregularities in the shape of the esophagus caused by EE, but not all patients have such physical characteristics. The endoscopy is performed by a gastroenterologist or surgeon, specialists in the pathology associated with the GI tract. The upper endoscopy is normally done as an outpatient procedure, with local anaesthetic spray or the administration of mild sedation. Biopsy samples must be taken from multiple sites on the surface of the esophagus, to ensure that the condition is not overlooked.

More recently, researchers have begun looking for links between EE and autoimmune diseases. Some EE patients suffer from skin conditions such as psoriasis or seborrheic dermatitis or respiratory conditions such as asthma or allergic rhinitis. At this time, there appears to be no proven link between EE and esophageal cancer.