The US Food and Drug Administration announced on May 20 the approval of the first treatment for eosinophilic esophagitis (EoE). The medication dupilumab, also known as Dupixent, was approved for treatment of adults with EoE and those over age 12 weighing over 88 pounds. The medication had been previously approved for other conditions including some stages of asthma.
The esophagus is a muscular tube, usually between 10 and 13 inches in length, that transports food and liquid from the throat to the stomach. Muscles within the esophagus generate that transition. Part of the digestive system, the esophagus rests between the trachea — or windpipe — and the spine.
Eosinophilic esophagitis is a chronic disease of the immune system. According to Johns Hopkins University Medicine, eosinophilic esophagitis occurs when the esophagus becomes inflamed and proper contraction is prevented. This inflammation is caused by an accumulation in the esophagus of white blood cells called eosinophils.
Mayo Clinic states that EoE was first diagnosed in the 1990s but is now recognized as a major contributor to gastrointestinal illness. The American Gastroenterological Association reports in its journal that EoE has increased in recent years and is more often detected in gastroenterological situations and emergency rooms.
In the recent research that resulted in the approval of the new medication, trials over two 24-week periods determined that 60% of patients in one group showed a reduced level of eosinophils in the esophagus and 59% of patients in the other group proved to have a reduction.
risk factors
Eosinophilic esophagitis may create difficulty in swallowing, chest pain, abdominal pain, heartburn and other discomforts, including food sticking in the throat, a medical emergency. Because it is so frequently activated by allergens, among the most common risk factors are certain seasons of the year and climate. EoE is more likely to be diagnosed in high allergy seasons, such as spring and fall, and in cold and dry areas.
In a report from the National Institutes of Health (NIH), research compiled in 2019 shows that EoE was significantly more prevalent in men than in women and more likely to be diagnosed in adults than in children. The data collected between 1995 and 2019 revealed that among those diagnosed, 71% were men between the ages of 18 and 38 and 16% were children. The NIH National Library of Medicine further stated that during the 25-year period, EoE began as a case-reportable illness and grew to a clinicopathological entity, meaning it relates to symptoms determined by observation or laboratory tests.
Causes and symptoms
EoE may be caused by seasonal allergies, acid reflux or food allergies that cause the immune system to overreact, according to American College of Allergy, Asthma and Immunology. The Mayo Clinic states that allergens associated with EoE may be environmental, such as pollen, in addition to food allergens. If the esophagus is damaged, scarring or an increase in fibrous tissue lining the esophagus may also cause or contribute to EoE.
All age groups are affected and symptoms may vary as people get older. In adults, food may lodge in the esophagus. Other symptoms may include difficulty swallowing, especially solid food, chest pain, heartburn and acid reflux that does not improve with medication. The chest pain may be centrally located and may not respond to antacids. Additionally, regurgitation of food may also occur.
In infants and toddlers, vomiting, feeding problems and unusually low growth and weight gain may arise. As in adults, lingering reflux, despite medication may develop. That symptom is also found in older children, as well as vomiting and a poor appetite. Also for older children, abdominal pain may signal EoE, as well as problems swallowing solid and other foods.
Johns Hopkins Medicine has identified certain signs that should be taken seriously because they could represent EoE. They include increases in weight loss, more frequent vomiting, difficulty with swallowing and noticeably frequent stomach pain. A healthcare provider should be notified if these symptoms arise.
Managing EoE
Because EoE involves the digestive system and allergens, primary care physicians, gastroenterologists and allergist/immunologists may be involved in management. A plan should be developed involving them and the patient after diagnosis.
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Omar P. Haqqani is the Chief of Vascular and Endovascular Surgery at Vascular Health Clinics in Midland.
