What is Eosinophilic Esophagitis?
Eosinophilic esophagitis (EOE) is inflammation of the esophagus that results in difficulty swallowing food. The inflammation occurs when eosinophils, a type of white blood cell, increase in numbers in the esophagus. This influx of eosinophils stiffens the esophagus making it difficult to swallow foods. Eosinophilic esophagitis can happen in children and adults.
What causes Eosinophilic Esophagitis?
Eosinophilic esophagitis is caused by an allergy, typically to a food (or possibly an inhaled allergen). When an allergenic food is consumed the immune system produces high numbers of eosinophils which accumulate in the tissue just beneath the lining of the esophagus.
Symptoms of Eosinophilic Esophagitis
The main symptom is difficulty swallowing food. People with EOE describe a sensation of food becoming stuck in the esophagus. Some people also experience heartburn and chest pain. Children can also experience nausea, vomiting, coughing and abdominal pain.
The difficulty swallowing occurs when the high number of eosinophils stiffen the esophagus and prevent it from stretching appropriately to allow food to pass. Certain foods are more likely to cause difficult swallowing, especially meats and breads.
Diagnosis of Eosinophilic Esophagitis
If you have difficulty swallowing your doctor will refer you for an endoscopy in order to take a look at your esophagus. During the endoscopy a biopsy will be taken to confirm the presence of eosinophils in the tissue of the esophagus.
The incidence of EOE is increasing in North America. This may be due to a general increase in allergic conditions, or increased awareness and diagnosis of EOE.
Mainstream Treatment of Eosinophilic Esophagitis
The mainstream treatments of eosinophil esophagitis include esophageal dilation (using a tube to gently stretch the esophagus to allow the passage of food), inhaled corticosteroids (i.e. Flovent) and proton pump inhibitors. None of these treatments are without potential side effects and possible negative impacts on overall health. This is why many people are exploring Naturopathic Medicine for the management of EOE.
Naturopathic Treatment of Eosinophilic Esophagitis
Treatment with Naturopathic Medicine is individualized for each patient. However, there are some common treatment goals which are applied in most cases of eosinophilic esophagitis.
1. Identify food allergies and sensitivities
Only by identifying and eliminating the cause of disease can we expect to overcome the symptoms of disease. The cause of eosinophilic esophagitis is allergy – in most cases to an ingested food. In addition to skin prick allergy testing done with an allergist, Naturopathic Doctors will also perform a food sensitivity test which looks for a different type of immunoglobulin (IgG) that can also result in accumulation of eosinophils in the esophagus.
While IgG based food sensitivities are not “allergies” per se, they still result in activation of the immune system that can lead to the symptoms of EOE. The food sensitivity panel allows you to identify the most likely food sensitivities that can be contributing to your symptoms and eliminate them from your diet. For more information read the article on Identifying Food Sensitivities.
2. Normalize function of the immune system
Allergies result from an over-activation of the immune system. By modulating your immune system – decreasing over-production of eosinophils without compromising your body’s ability to fight off viruses, bacteria and other pathogens, you can decrease symptoms of eosinophilic esophagitis without the negative side effects seen with pharmaceutical treatments.
The approach to normalizing the function of the immune system is different for every individual. Your Naturopathic Doctor will take a complete history and look at all the different systems of your body to determine the best treatment options for you.
3. Decrease inflammation in the esophagus
The inflammation of the esophagus due to the presence of eosinophils results in the difficulty swallowing seen in EOE. While you are identifying the underlying allergies and normalizing function of your immune system, your Naturopathic Doctor can help to decrease inflammation in the esophagus and improve symptoms. Natural supplements like omega-3 rich fish oil, slippery elm powder, marshmallow root and curcumin (turmeric) are all well-tolerated anti-inflammatories which may be used short term (or long term) to support the esophagus and allow you to be symptom free sooner.
Naturopathic Medicine can help you overcome your eosinophilic esophagitis. Book an appointment now with a Naturopathic Doctor experienced in the treatment of EOE and start the journey towards optimal health.
Disclaimer
The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.
Hello,
I have just been reading your very informative article of EoE. I was diagnosed last year. I have had some terrifying incidents when swallowing steak, however I now avoid red meats to ensure that I won’t have any more incidents. I am extremely interested in your article as it mentions omega 3 fish oil may be effective in reducing inflammation. My question is, can this be in capsule form, as I think I would struggle taking it in liquid form as I believe it has a very bad after taste? My husband suffers with GORD and I’m wondering if he would also find Omega 3 fish oil useful as well.
I’ve been researching EoE for a long time now and your site is the first one that offers practical support.
Also, I don’t know if this will be helpful to your research but I have found that by not drinking certain wines i.e. Chardonnay, Chablis and Pinot Grigio, which cause me horrendous heartburn, this helps me control my EoE.
I would really appreciate your comments.
Kindest Regards
Deborah Webster
Hi Deborah,
Thanks for your comment. I’m glad you found the article informative! EoE is a challenging condition to be diagnosed with and I’m happy to be providing some guidance and hope for those with that condition.
The fish oils are available in capsules, but you’ll be happy to know most liquids are flavoured with lemon, citrus or berry and are actually quite palatable! You can add a dose to water or juice and you’ll barely notice it’s there.
Dr. Lisa
Hi Lisa,
I have been using essential oils to treat different things and wondering if there’s one that you could suggest to rub on my neck to try to reduce the swelling of the oesophagus? Alternatively, Have you heard of any oils regularly ingested that might also help the immune system fight this condition in particular?
Thanks in advance, Kristy
Hi Kristy,
Thanks for getting in touch. Essential oils are not part of my scope of practice as a Naturopathic Doctor. Many essential oils are toxic when ingested and I generally advise against them. You may be better using soothing botanical teas made from demulcent herbs like marshmallow or slippery elm.
Dr. Lisa
Hello Lisa.
I was recently diagnose with EOE along with a fungal infection in my Esophagus! Currently taking fluconazole for my infection and was wondering if it’s ok to start taking Omega 3 now or do i need to wait until after my antibiotic treatment? Also wondering what is an average time frame where I can expect some relief? Have you heard of any other natural ways to help relieve the tightness? as you can imagine it gets unbearable at times. Thank You for your time!
Appreciatively,
John
Hi,
Thanks for the article. I was diagnosed with IBS a few years back and recently had trouble swallowing and my primary doctor referred me to a Gastroenterologist. I had an endoscopy a few days ago and the gastro doc thinks I may have EoE. She also is testing for the presence of a known parasite. I have soo many questions. When I want to talk to the doctors about all my questions I feel rushed and they just go back to their treatment plans (normally consisting of medicine and other procedures). I’m still waiting on the biopsy results and my follow up appointment but I can’t stop wondering about the cause, treatment, options etc. They rarely want to get to the root or cause (which is my inquiry)…they just want to diagnose and treat the symptoms. After my research, I think the allergy testing should be first but she put me on Prilosec, which I’ve heard not so good things about. Again avoiding the root and treating the symptom.
I am allergic to milk and maybe other things. I do need to do a food allergy & sensitivity test but while I wait for the results, it’s uncomfortable to swallow and I feel heartburn somewhat constantly. I would like to have the herbal teas and other comforting remedies you mentioned and any another suggestion you may have for heartburn.
I look forward to next week for my results and next steps. If you know of any good Natural doctors in South Florida, I would love to have a referral.
Thank you
Nicole
Hi! My 16 yr old daughter is suffering badly. Missing school, constant discomfort, and not to mention– socializing ?! Worried about depression. My question is what dose would I give her of fish oil . She’s 115 lbs. I’ll try anything to help her. I also read aloe juice- what do you think ?? Thank u
The only real way to manage EoE is with a fully comprehensive approach. The omega 3s in fish oil can decrease inflammation, but if the underlying cause is not identified and eliminated you’re just clearing smoke without putting out the fire. A good quality omega 3 supplement with at least 1000mg of EPA is generally recommended, but that may not be enough to get your daughter back on track. ~Dr. Lisa
Nicole, I am sorry for the frustrating delay that sometimes results in medicine! Having an appropriate diagnosis is important, but don’t delay in starting some of the gentle natural remedies I discussed in this article. You can read more about my approach to heartburn in this article: http://drlisawatson.com/natural-approaches-to-heartburn
And for a naturopathic doctor in Florida, I’d suggest meeting with someone registered with the Florida Naturopathic Physicians Association – it’s currently an unlicensed state and I want you to get the best quality of care possible – http://www.fnpa.org
~Dr. Lisa
Dr Lisa,
I have a 7 year old daughter that has had EOE for about 3 years now and she’s had good testing done, skin testing and about 4 endoscopys. She’s not allergic to any foods. She’s just has some environmental allergies and asthma. She swallows with no problem, doesn’t have any heart burn or reflexes, doesn’t vomit anything. She is a very picky eater and doesn’t eat much of anything but she eats enough to be satisfied.
What do you recommend for her?
Food allergies and food sensitivities are very different issues – and I find that often my patients with EoE do have significant sensitivities once tested. Consider having her food sensitivity testing done – it’s a simple process that may result in improvements. Read more here: http://drlisawatson.com/food-sensitivity-testing
~Dr. Lisa
I was diagnosed over 7 years with EoE and I’ve researched and researched trying to find something that would help. This is so scary. Thank you for this article.
Lois
Hi Lisa, I have a 5y old son with EOE. He’s been on a dairy, gluten, soy and egg free diet but still something else is causing allergies. We live in Australia But I can’t find a Naturopath with experience on EOE, do think that any naturopath would be able to help me or would you be able to give long distance consultation?
Thanks,
My doctor tested me for food and environmental allergies and found that i have no known food but many many environmental allergies. I have EoE and have already had my esophagus dilated twice. The medication being thrown at me is unreal and Ive already gained 10 pounds in 2 months from inhibitors and steroid inhalers. I do have reflux but I feel it can be contained through diet. So, my question is that since i have no food allergies, could it be just sensitivities that are just unnoticed through the testing? And if i stop each food group such as gluten and dairy, will my EoE heal on its own? I want natural remedies instead of the medication. Im starting allergy shots in a week for the environmental issues. I just dont want to take all of this medication.
This site has given me hope for my newly diagnosed 19 year old son. He has several food allergies and some sensitives. We are starting acupuncture for part of his treatment. Is the Marshmallow plant made into tea or the elm something he should be tested for before taking in case he has an allergy to that as well?
Slippery elm is part of the elm family, so I’d be cautious if he had an environmental allergy to those type of trees. The marshmallow plant is a small flowering plant – less likely to cause allergies. Generally with EOE I find that food allergies are more of an issue than environmental. But I agree- caution should be taken if he has an elm allergy.
Best of luck! ~Dr. Lisa
You really need to pursue the IgG food sensitivity testing. I have found this to be incredibly valuable in treating EOE. Any way we can calm the immune system response, and the infiltration of eosinophils into the esophagus, is important for your treatment. Don’t delay – get this testing.
~Dr. Lisa
See a naturopath there to get IgG testing. Your naturopath can always contact me if they have questions!
~Dr. Lisa
I have learned to put everything I eat in the blender and just drink it
This makes swallowing my food so much easier.
In addition to the difficulty swallowing I have a large build up of very thick green and yellow mucus that climgs to my troat and inside my mouth.
This mucous grabs my pills and food particles causing a blockage. To counter this I have to keep a glass of water to wash everything down.
I also use a mixture of raw unfiltered apple cider vinegar, water and honey to gargle and rinse out my mouth. This breaks up the clogs of mucous and I spit it all out. Then I take another mouth full of the mixture an rinse and gargle. Then I swallow some of the mixture, wait a few seconds and then spit it out. I then have to “hark” and cough to spit out more. This is when large clumps of heavy mucous that were clinging to my throat finally come out. After all of this I can swallow most things without a lot of problems.
It is a lot of work but you do what you have to do to survive.
Only problem I have now is gaining weight. No matter what I eat I can’t gain weight.
Yes, you can take omega 3s while on antibiotics. The other options in the article can give you some relief – especially consider the food sensitivity testing and the slippery elm.
~Dr. Lisa
Hi Dr. Lisa, my husband has been diagnosed with EOE. He’s currently on medication after inconclusive food allergy testing and a failed elimination diet of top 8. I plan to share your ideas for reducing inflammation, but we really need to get to the source of the problem. Any suggestions on what to try next?
What type of allergy testing has he done? Has he done a IgG food sensitivity test? I find that to be very valuable in treating EOE.
You are playing with fire if you treat your eoe with naturopathy alone. My daughters treatment does not involve steroids but is still managed by a paediatric gastroenterologist.
It is well documented that IGG / IGE allergies offer no clues to EOE triggers, so if you go down that road you will be going on a wild goose chase that will not isolate your triggers.
Thanks for your comment Emma. I practice integrative medicine – integrating all the best forms of medicine to improve patient outcomes. I do not suggest people should choose one over the other – but instead know that there are ways to integrate both natural treatments, like diet and botanicals, to their conventional treatments, in order to improve their health, and the health of their families. ~Dr. Lisa
Hi there. I have had EOE (diagnosed) for about a decade (I’m 38) and mostly just dealt with it. I did the PPI, food restriction, and even a repeat Upper. When I asked the GI doctor exactly what DPP I was doing and he shrugged his shoulders and said “we don’t know”, I was done.
What brought me here was a question on Aloe Vera juice. I have been drinking 4-6 ounces morning and evening for the last two weeks. For me, it has been about a 75% reduction in the times my stuck food (and sometimes liquids) would need to come back up.
I cannot find anything to speak to why this is working and the GI doc said he doesn’t read homeopathic studies. Have you seen similar findings in your practice or have an idea as to why this works?
Hi David. Aloe vera contains high amounts of compounds known as “mucilages” – these help to support and repair the mucous barrier of the esophagus and stomach. It works well in EOE by decreasing inflammation in the esophagus and helping to repair the damaged lining. I haven’t seen any studies on it either, unfortunately. But the truth is that no drug company (they fund the majority of studies) would test aloe vera juice because you can’t patent a natural compound and make a drug from it. Sometimes we just have to accept the truth of our experience, and share that in the hope that it may help others.
~Dr. Lisa
Thank you for this article. I have been dealing with this for over 20 years and was finally diagnosed with Gastroparesis two years ago and EoE two months ago. I’m still figuring all of this out. My NP has helped me get the GP under control but working on elimination diet for EoE at this time. I will add in the fish oil and marshmallow root powder. My NP isn’t very familiar with GP or EoE, unfortunately.
can marajuana help? i know that the terpenes contain anti inflammatory?
I’ve never seen any research on medicinal cannibinoids being used for eosinophil mediated conditions. The only study I could find was in mice and the cannabis aggravated eosinophil-mediated lung inflammation. So my guess would be that it wouldn’t help – but we don’t have the research to confirm that at this point!
Dr. Lisa
I have suffered for many years with extreme pain and blockages. I was diagnosed with EOE 5 years ago. Testing revealed no allergies although if I avoid honey, poppyseeds, and chicken I have far less issues with blockage. But I do have times of having symptoms without exposure to any of those…so it is still a mystery.
I am very chemically sensitive so I have chosen to not try conventional medication.
All that to say I very much appreciated your suggestions for relieving the inflammation and I will try those right away!
What’s difference between IGg and ige testing
IgE testing looks at a specific immunoglobulin (IgE) that is associated with an acute phase hypersensitivity – or allergy.
IgG testing looks at a different immunoglobulin (IgG) that is associated with a delayed phase hypersensitivity – or sensitivity.
IgG antibodies are one of the dominant immunoglobulins made in the digestive tract and can be associated with EoE.
You can read more about this topic here: https://drlisawatson.com/food-sensitivity-testing
Great question!
Dr. Lisa