Eosinophilic esophagitis is an inflammatory condition of the esophagus or feeding tube that is characterized by the abnormal presence of eosinophils (a type of white blood cell involved in allergic reactions) in the lining of the esophagus. Eosinophils are thought to migrate to the esophagus in response to foods that trigger an allergic response. The most common foods reported are milk, egg, soy, corn, wheat, beef, chicken, potato, oats, peanuts, turkey, barley, pork, rice, green beans, apples, pineapple, tree nuts and seafood.
Interestingly these very foods cause the majority of food allergies and food sensitivities or intolerance and are foods that contain many of the lectins that are suspected of causing problems in the gut, joints, skin and the brain. Restriction of these foods frequently improve symptoms in the gut and outside the gut in many people. If specific foods identified by allergy testing can be avoided improvement is usually noted. However, the symptoms and signs of eosinophilic esophagitis frequently, if not usually, return after stopping steroids unless accompanied by dietary manipulation that includes elimination of problem foods.
When food allergy testing is negative or equivocal, elimination diet may be the only way to determine what food or foods may be causing ongoing or recurrent eosinophilic esophagitis. Strict elimination diet has been most effective but is difficult to follow long term for most adults and children. More recently, Kagalwalla published success with a six food elimination diet (SFED) in children with eosinophilic esophagitis. The SFED restricted foods from six of the most common food allergens. The SFED eliminated cow's milk protein (casein), soy, wheat, egg, peanut/tree nuts, and seafood. This SFED was compared with an elemental diet (ELED), that consists of proteins broken down into simple forms in a liquid, such as what protein intolerant infants are fed. Such a diet is expensive, tastes poor and is not well received.
In this particular study it was noted that though the SFED was not quite as effective (74% versus 88% achieving significant improvement), the six food elimination diet has better acceptance, cost and likelihood of people complying with the diet. I would point out that the SFED is actually not a six food elimination diet. Not only are more than six food categories eliminated (peanuts are legumes and separate from tree nuts) but much more than six foods are eliminated considering there a multiple nuts and seafood. Processed foods containing any known or suspected foods must also be eliminated during an elimination diet.
The helpfulness of a diet symptom diary prior to an elimination diet is that sometimes it is difficult to identify problem foods and relate their elimination and re-introduction to various symptoms. Various simple diet diaries exist in print form and online formats that can be printed out to record manually foods eaten and symptoms noted. However, an online diet diary that provides an ongoing tracking of diet and symptoms as well as feedback does not exist, especially those customized according to an individual's health history.
понедельник, 12 апреля 2010 г.
Eosinophilic Esophagitis (EE).
Is an inflammation of the esophagus as a result of the abnormal infiltration of eosinophils in an allergic reaction. Because many of the symptoms are the same as gastroesophageal reflux disease (GERD) it is usually mistaken for reflux and misdiagnosed, sometimes for years. EE can be considered as food allergies and is usually classed as a blood disorder.
EE tends to occur more often in males, but is otherwise an equal opportunity disorder. With EE, you will see painful swallowing and digestion (if they can even get the food down), vomiting and abdominal pain making it very difficult to live with. Children with Eosinophilic Esophagitis will often experience weight loss that can lead to failure to thrive and hospitalization.
What are Eosinophils?
Eosinophils (pronounced: ee-oh-sin-oh-fillz) are actually a certain type of white blood cell, but just not as numerous as the regular white blood cells, and are a vital part of the immune response system. Eosinophils are designed to respond to parasites, or invaders that are too large to be absorbed by white blood cells. They attach themselves to the invader and penetrate the cell walls to kill and destroy the parasite.
When your body detects an invader (such as a parasite, or an allergic substance) that it decides is a harmful protein, it calls on the immune system which produces a substance called immunoglobulin E (IgE). These are the antibodies that are sent out to do battle with the intruder (which Eosinophils are a part) and when they contact the detected protein invader, they release reactive chemicals called histamines and leukotrienes and these chemicals are what produce the allergic symptoms such as shortness of breath, hives, swelling, rashes, itchy skin, nausea and diarrhea.
Eosinophils are not normally found in the esophagus, and the buildup and allergic responses are the result of the body deciding certain proteins (such as certain foods) are on the dangerous list when they shouldn't be. The eosinophils actually end up attacking the lining of the esophagus, causing damage which in the long term the inflammation could cause the esophagus to close up (stricture) and increase of fibrosis, which can interfere with swallowing.
Symptoms
Eosinophils congregating in the esophagus will cause problems all the way down the gastrointestinal pathway, which makes the normal function of eating and digestion difficult and painful. Here is a list of the symptoms:
Difficulty swallowing
Choking
Nausea
Vomiting
Cramping
Diarrhea
Weight loss
Abdominal pain
Chest pain
Failure to thrive
Reflux not relieved by standard anti-reflux therapy
These conditions are usually present for many years prior to an EE diagnosis, so keep in mind that occasional reflux, stomach ache or even vomiting may be other common ailments that cause these same symptoms.
Diagnosis
An initial clinical diagnosis is usually made based on the history of symptoms and ruling out other possible causes. A number of tests are performed to try to determine the specific triggers or allergens causing the Eosinophilic reaction. These tests include:
Elimination diet and food challenges
Allergic skin prick testing
RAST testing (radioallergosorbent test), a blood allergy test for specific IgE antibodies
Patch testing where food substances are secured against the skin for a period of time
Endoscopy and biopsy of the esophagus
The only way to confirm the clinical diagnosis is by counting the actual concentrations of eosinophils in the tissue samples taken by biopsy during the endoscopy procedure.
Treatment
Eosinophilic Esophagitis is usually treated first by avoiding the allergen causing the reaction. This is where all the allergy testing comes in to generate the "avoid at all costs" and "let's give it a try" food listing. Many EE kids are on an elemental diet taking an amino based formula as the major source of nutrients and possibly a few other foods that have tested successfully. Elimination diets and food trials are considered normal in the lives of kids (or adults) with Eosinophilic Esophagitis.
Some do quite well with an alteration in diet and removal of reactive foods, but for others, medication is needed. Antihistamines can help relieve the histamine produced allergic reactions, and reflux medication can help prevent acid damage to the esophagus. To help reduce inflammation that results from the eosinophil infiltration, corticosteroids are used. Recently EE patients have been treated with fluticasone without the spacer so that the drug is swallowed instead of inhaled.
If the esophagus becomes restricted, a procedure called dilation is used to open it back up so the patient can swallow food a little easier. Esophagial restriction is quite serious and could mean installing a G-tube to be able to get nutrition into the body.
What is the Impact of EE?
Having a diagnosed Eosinophilic disorder means that your life, and the life of your family will never be the same. It is a life altering diagnosis with implications that go beyond the pain and limited diet and extends into the social emotional arena in a society that is completely centered on food.
Helping those around you to understand what Eosinophilic Esophagitis is and how it affects you or your child opens the door to the support you need. Learn as much as you can, stay current on medical advances, work with your doctor and above all, keep a positive attitude. You can do this.
EE tends to occur more often in males, but is otherwise an equal opportunity disorder. With EE, you will see painful swallowing and digestion (if they can even get the food down), vomiting and abdominal pain making it very difficult to live with. Children with Eosinophilic Esophagitis will often experience weight loss that can lead to failure to thrive and hospitalization.
What are Eosinophils?
Eosinophils (pronounced: ee-oh-sin-oh-fillz) are actually a certain type of white blood cell, but just not as numerous as the regular white blood cells, and are a vital part of the immune response system. Eosinophils are designed to respond to parasites, or invaders that are too large to be absorbed by white blood cells. They attach themselves to the invader and penetrate the cell walls to kill and destroy the parasite.
When your body detects an invader (such as a parasite, or an allergic substance) that it decides is a harmful protein, it calls on the immune system which produces a substance called immunoglobulin E (IgE). These are the antibodies that are sent out to do battle with the intruder (which Eosinophils are a part) and when they contact the detected protein invader, they release reactive chemicals called histamines and leukotrienes and these chemicals are what produce the allergic symptoms such as shortness of breath, hives, swelling, rashes, itchy skin, nausea and diarrhea.
Eosinophils are not normally found in the esophagus, and the buildup and allergic responses are the result of the body deciding certain proteins (such as certain foods) are on the dangerous list when they shouldn't be. The eosinophils actually end up attacking the lining of the esophagus, causing damage which in the long term the inflammation could cause the esophagus to close up (stricture) and increase of fibrosis, which can interfere with swallowing.
Symptoms
Eosinophils congregating in the esophagus will cause problems all the way down the gastrointestinal pathway, which makes the normal function of eating and digestion difficult and painful. Here is a list of the symptoms:
Difficulty swallowing
Choking
Nausea
Vomiting
Cramping
Diarrhea
Weight loss
Abdominal pain
Chest pain
Failure to thrive
Reflux not relieved by standard anti-reflux therapy
These conditions are usually present for many years prior to an EE diagnosis, so keep in mind that occasional reflux, stomach ache or even vomiting may be other common ailments that cause these same symptoms.
Diagnosis
An initial clinical diagnosis is usually made based on the history of symptoms and ruling out other possible causes. A number of tests are performed to try to determine the specific triggers or allergens causing the Eosinophilic reaction. These tests include:
Elimination diet and food challenges
Allergic skin prick testing
RAST testing (radioallergosorbent test), a blood allergy test for specific IgE antibodies
Patch testing where food substances are secured against the skin for a period of time
Endoscopy and biopsy of the esophagus
The only way to confirm the clinical diagnosis is by counting the actual concentrations of eosinophils in the tissue samples taken by biopsy during the endoscopy procedure.
Treatment
Eosinophilic Esophagitis is usually treated first by avoiding the allergen causing the reaction. This is where all the allergy testing comes in to generate the "avoid at all costs" and "let's give it a try" food listing. Many EE kids are on an elemental diet taking an amino based formula as the major source of nutrients and possibly a few other foods that have tested successfully. Elimination diets and food trials are considered normal in the lives of kids (or adults) with Eosinophilic Esophagitis.
Some do quite well with an alteration in diet and removal of reactive foods, but for others, medication is needed. Antihistamines can help relieve the histamine produced allergic reactions, and reflux medication can help prevent acid damage to the esophagus. To help reduce inflammation that results from the eosinophil infiltration, corticosteroids are used. Recently EE patients have been treated with fluticasone without the spacer so that the drug is swallowed instead of inhaled.
If the esophagus becomes restricted, a procedure called dilation is used to open it back up so the patient can swallow food a little easier. Esophagial restriction is quite serious and could mean installing a G-tube to be able to get nutrition into the body.
What is the Impact of EE?
Having a diagnosed Eosinophilic disorder means that your life, and the life of your family will never be the same. It is a life altering diagnosis with implications that go beyond the pain and limited diet and extends into the social emotional arena in a society that is completely centered on food.
Helping those around you to understand what Eosinophilic Esophagitis is and how it affects you or your child opens the door to the support you need. Learn as much as you can, stay current on medical advances, work with your doctor and above all, keep a positive attitude. You can do this.
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