Dear Doc: Please explain EE vs. GERD?
A lot of exciting news is unfolding in the field of Allergy and Immunology. One area of research garnering much attention is that of EE (eosinophilic enteritis). The eosinophil is the white blood cell that causes allergy. Enteritis means inflammation of the GI tract, which can occur in the esophagus, stomach, small intestines or colon. Most of the research has been done on the esophagus, perhaps because it’s easiest to get to with scopes and probes.
Eosinophilic esophagitis first came to light a few years ago when GI doctors were studying a small group of individuals who had atypical GERD (gastroesophageal reflux disease). They were atypical in that the pH probe studies did not reveal a hyperacidic state in the esophagus, which is the usual state of affairs in GERD, as it is caused by refluxing of stomach acid (HCl) into the delicate esophagus. Also, they were atypical in that they had either no response or a poor response to proton pump inhibitors such as Prilosec, Nexium, Aciphex and Prevacid. The clue that a new entity was causing this atypical condition was finding eosinophils in biopsy specimens. Eosinophils are not present either in the normal esophagus or in GERD, but they are abundant in the patients with EE.
The clinical course in persons with EE showed a greater tendency to have food sticking in the upper esophagus. This is true because eosinophils infiltrate both the upper and lower esophagus, whereas in ERD the tissue injury tends to be primarily in the lower esophagus. Another feature of EE is that it tends to be more chronic and persistent in nature with fewer remissions. Finally, those with EE are more likely to be “allergic individuals.” The stimulus that draws the damaging eosinophils into the esophagus is either food allergy or pollen allergy. In the latter, what occurs is this: The pollen that is trapped in the nasal mucus is swallowed and causes allergic irritation as it passes through the esophagus.