esophagitis

Eosinophilic esophagitis (EoE) is a chronic disease of the esophagus. Your esophagus is the muscular tube that carries food and liquids from your mouth to the stomach. If you have EoE, white blood cells called eosinophils build up in your esophagus. This causes damage and inflammation, which can cause pain, trouble swallowing, and food getting stuck in your throat.

EoE is rare. But because it is a newly recognized disease, it is being diagnosed more often. Some people who think that they have reflux (GERD) may actually have EoE.

Researchers are not certain about the exact cause of EoE. They think that it is an immune system/allergic reaction to foods or to substances in your environment, such as dust mites, animal dander, pollen, and molds. Certain genes may also play a role in EoE.

EoE can affect anyone, but it is more common in people who:

• Are male
• Have other allergic diseases, such as hay fever, eczema, asthma and food allergies
• Have family members with EoE

The most common symptoms of EoE can depend on your age.

In infants and toddlers::

• Feeding problems
• Vomiting
• Poor weight gain and growth
• Reflux that does not get better with medicines

In older children::

• Vomiting
• Abdominal pain
• Trouble swallowing, especially with solid foods
• Reflux that does not get better with medicines
• Poor appetite

In adults::

• Trouble swallowing, especially with solid foods
• Food getting stuck in the esophagus
• Reflux that does not get better with medicines
• Heartburn
• Chest pain

To find out if you have EoE, your doctor will likely:

• Ask about your symptoms and medical history. Since other conditions can have the same symptoms of EoE, it is important for your doctor to take a thorough history.
• Do an upper gastrointestinal (GI) endoscopy. An endoscope is a long, flexible tube with a light and camera at the end of it. Your doctor will run the endoscope down your esophagus and look at it. Some signs that you might have EoE include white spots, rings, narrowing, and inflammation in the esophagus. However, not everyone with EoE has those signs, and sometimes they can be signs of a different esophagus disorder.
• Do a biopsy. During the endoscopy, the doctor will take small tissue samples from your esophagus. The samples will be checked for a high number of eosinophils. This is the only way to make a diagnosis of EoE.
• Do other tests as needed. You may have blood tests to check for other conditions. If you do have EoE, you may have blood or other types of tests to check for specific allergies.

There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet.

Medicines used to treat EoE are:

• Steroids, which can help control inflammation. These are usually topical steroids, which you swallow either from an inhaler or as a liquid. Sometimes doctors prescribe oral steroids (pills) to treat people who have serious swallowing problems or weight loss.
• Acid suppressors such as proton pump inhibitors (PPIs), which may help with reflux symptoms and decrease inflammation.
• Monoclonal antibodies, which can reduce inflammation and may help with swallowing. They can be used in adults and children over age 12.

Dietary changes for EoE include:

• Elimination diet. If you are on an elimination diet, you stop eating and drinking certain foods and beverages for several weeks. If you are feeling better, you add the foods back to your diet one at a time. You have repeat endoscopies to see whether or not you are tolerating those foods. There are different types of elimination diets:
• With one type, you first have an allergy test. Then you stop eating and drinking the foods you are allergic to.
• For another type, you eliminate foods and drinks that commonly cause allergies, such as dairy products, egg, wheat, soy, peanuts, tree nuts and fish/shellfish.
• Elemental diet. With this diet, you stop eating and drinking all proteins. Instead, you drink an amino acid formula. Some people who do not like the taste of the formula use a feeding tube instead. If your symptoms and inflammation go away completely, you may be able to try adding foods back one at a time, to see whether you can tolerate them.

Which treatment your doctor suggests depends on different factors, including your age. Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it.

If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow.

Esophagus disorders are problems with how your esophagus works. The esophagus is the tube that carries food from your mouth to your stomach. You usually don't notice it unless you swallow something too big, hot, or cold. You might also notice it if something is wrong. When that happens, you might feel pain or have trouble swallowing (dysphagia).

The cause depends on the type of disorder. Some run in families. Others are linked to allergic reactions to food or substances in your environment. Sometimes, the cause is unknown.

You may be more likely to develop an esophagus disorder if you:

• Are overweight or have obesity
• Are pregnant
• Take certain medicines
• Have had radiation treatmentt to your neck or chest
• Smoke or are around secondhand smoke

The most common esophagus problem is gastroesophageal reflux disease (GERD). This happens when the muscle at the bottom of your esophagus doesn't close properly. Stomach acid can move back up and irritate the esophagus.

Other esophagus disorders include:

• Heartburn is a burning feeling in your chest or throat. It is often caused by acid reflux.
• Barrett's Esophagus happens when the lining of your esophagus changes. It is often caused by chronic (long-term) GERD.
• Achalasia is a problem where the lower muscle in your esophagus doesn't relax like it should.
• Esophageal Spasms are muscle contractions that cause chest pain or swallowing problems.
• Eosinophilic Esophagitis (EoE) is a rare condition where certain white blood cells (eosinophils) build up in the esophagus, causing swelling, pain, and trouble swallowing.
• Esophageal Cancer is a type of cancer that starts in the tissues of the esophagus.

Symptoms can be different for each condition but may include:

• Pain in your chest, abdomen (belly), or back
• A cough or sore throat that doesn't go away
• Trouble swallowing or feeling like food is stuck
• A hoarse voice or wheezing
• Heartburn or a burning feeling in your stomach
• Tasting acid or food in the back of your mouth
• Food or liquid coming back up into your mouth (regurgitation)
• Losing weight without trying

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These could be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may order one or more tests, such as:

• Upper gastrointestinal (GI) endoscopy. This test uses a tiny camera to look inside your esophagus and stomach.
• Biopsy. This test takes a small tissue sample to check.
• Barium swallow. This test uses imaging to see how you swallow.
• Esophageal manometry. This test checks how well your esophagus moves food to your stomach.
• Esophageal pH test. This test measures how often acid backs up into your esophagus and how long the acid stays there.

Treatment depends on what's causing the problem and your overall health. Some esophagus disorders get better with over-the-counter medicines, diet changes, or lifestyle changes. Others may need prescription medicine or surgery.

Without treatment, some disorders may lead to other problems, such as pneumonia, from food entering the windpipe. GERD, Barrett's esophagus, and achalasia can also raise your risk for esophageal cancer.

You can help prevent or reduce symptoms by:

• Not smoking and limiting alcohol
• Eating smaller meals
• Avoiding eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

An allergy is a reaction by your immune system to something that does not bother most other people. People who have allergies often are sensitive to more than one thing. Substances that often cause reactions are:

• Pollen
• Dust mites
• Mold spores
• Pet dander
• Food
• Insect stings
• Medicines

Normally, your immune system fights germs. It is your body's defense system. In most allergic reactions, however, it is responding to a false alarm. Genes and the environment probably both play a role.

Allergies can cause a variety of symptoms such as a runny nose, sneezing, itching, rashes, swelling, or asthma. Allergies can range from minor to severe. Anaphylaxis is a severe reaction that can be life-threatening. Doctors use skin and blood tests to diagnose allergies. Treatments include medicines, allergy shots, and avoiding the substances that cause the reactions.

A food allergy is an abnormal immune system reaction to certain foods. Your immune system normally protects you from germs. But if you have a food allergy, your immune system mistakenly reacts to certain foods as if they were harmful. This reaction is usually mild. But in some cases, it can be serious or even life-threatening.

A food intolerance is different than a food allergy. If you have a food intolerance, you also have symptoms when you eat that food. But these are typically just digestive symptoms such as bloating and gas. Also, an intolerance is not an immune system reaction.

Most food allergies are caused by:

• Cow's milk
• Chicken eggs
• Crustacean shellfish, such as shrimp, crab, lobster, and crayfish
• Fish
• Peanuts
• Sesame
• Soy
• Tree nuts, such as almonds, walnuts, pecans
• Wheat

People with a food allergy may be allergic to more than one type of food.

Both children and adults can have food allergies. Some children will outgrow their food allergies. And sometimes people can develop food allergies as adult.

Certain factors can make you more likely to have a food allergy. They include:

• Having eczema, a disease that causes inflammation, redness, and irritation of the skin. Your immune system also plays a role in eczema.
• Having asthma or other allergies, such as hay fever.
• Your genes. Certain genes may influence the development of food allergies. And you are more likely to have food allergies if someone in your family has allergies, asthma, or eczema.

If you are allergic to a food you have eaten, you may have a variety of symptoms. These symptoms are not always the same for every person. And the symptoms that you get each time you eat the food may not always be the same. For example, your symptoms may sometimes depend on how much of the food you ate.

Food allergy symptoms usually start within a few minutes to two hours after you eat that food. They may include:

• Hives
• Flushed skin or rash
• Tingling or itchy sensation in the mouth
• Face, tongue, or lip swelling
• Vomiting and/or diarrhea
• Abdominal (belly) cramps
• Coughing or wheezing
• Dizziness and/or lightheadedness
• Swelling of the throat and vocal cords
• Trouble breathing

In rare cases, a food allergy can cause a life-threatening reaction called anaphylaxis. It may start out with some milder symptoms, but then it becomes more serious. It can lead to:

• Narrowed airways in the lungs
• Severe trouble breathing because of swelling in the throat
• Severe lowering of blood pressure and shock ("anaphylactic shock")
• Loss of consciousness

This is a medical emergency. Call 911 if someone is having the symptoms of anaphylaxis.

To find out if you have a food allergy, your health care provider will

• Ask about your symptoms, family health history, and medical history, including other allergies.
• Likely do a physical exam.
• Do food allergy testing. This could involve skin testing, blood testing, a food elimination diet, and/or an oral food challenge test. An oral food challenge test is the most accurate food allergy test.

There is no cure for food allergies. The only way to prevent a reaction is to avoid eating the food that you are allergic to.

There are medicines for people with food allergies. They include:

• Medicines to reduce food allergy symptoms, including antihistamines and corticosteroids.
• Medicines to reduce allergic reactions, including severe reactions.
• Epinephrine, a medicine to treat anaphylaxis. Your provider may give you a prescription for an epinephrine auto-injector. It is a device used to inject epinephrine when someone is having symptoms of anaphylaxis. If you have been prescribed one, it's important to learn how to use it and to carry it with you at all times.

If you have a food allergy, it's a good idea to have a medical alert bracelet that says what your allergy is.

Sometimes, after eating a large meal or lying down too soon after eating, you might feel acid coming up into your throat. This is called gastroesophageal reflux (GER). It happens when the muscle at the end of your esophagus (the tube that carries food from your mouth to your stomach) doesn't close properly. Stomach contents can then move back up and irritate the esophagus.

Having reflux occasionally is common. But if you have symptoms two or more times a week or if they cause damage to the lining of your esophagus, you may have gastroesophageal reflux disease (GERD). GERD is a chronic (long-lasting) condition that can cause discomfort and, over time, lead to other health problems.

Anyone can have GERD, including infants and children.

GERD can happen when the muscle at the bottom of your esophagus becomes weak or relaxes at the wrong time. You are more likely to have GERD if you:

• Are overweight or have obesity
• Are pregnant
• Smoke or are around secondhand smoke
• Have a hiatal hernia (when part of the stomach pushes up into the chest)

Certain foods, drinks, or medicines can also make GERD worse.

The most common symptom of GERD is heartburn. This is a burning feeling in your chest or throat. You can also have GERD without having heartburn. Other symptoms may include:

• Tasting acid or food in the back of your mouth
• A dry cough or hoarse voice
• Asthma-like symptoms
• Trouble swallowing

Get medical help right away if you have chest pain with shortness of breath, or pain in your jaw or arm. These can be signs of a heart problem.

Your health care provider will ask about your symptoms and medical history. They may recommend tests such as:

• Upper GI endoscopy to look at the esophagus and stomach lining with a tiny camera.
• Biopsy to check a small tissue sample.
• X-Ray to take pictures of the upper digestive system.
• Esophageal pH test to measure how often acid backs up the esophagus and how long the acid stays there.
• Esophageal manometry to check how well your esophagus moves food when you swallow.
• Transnasal esophagoscopy to look for damage to the esophagus by using a small tube with a camera.

Most people can manage GERD with lifestyle changes and medicine. In rare cases, surgery is needed.

Lifestyle changes can include:

• Eating smaller meals and avoiding lying down for at least 2-3 hours after eating
• Avoiding foods that trigger symptoms, such as spicy foods, chocolate, caffeine, or fatty foods
• Losing weight if needed
• Raising the head of your bed
• Quitting smoking

Medicines can include:

• Over-the-counter medicines, such as antacids
• Prescription medicines

If not treated, GERD can cause problems like inflammation of the esophagus, scarring, or changes in the tissue lining (Barrett's esophagus). It can also worsen asthma or cause chronic (long-term) cough or hoarseness.

You may be able to improve symptoms of GERD by:

• Avoiding alcohol and trigger foods
• Eating smaller meals
• Not eating close to bedtime
• Wearing loose-fitting clothes
• Sleeping on your left side or raising the head of your bed
• Maintaining a healthy weight

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Herpes is an infection that is caused by a herpes simplex virus (HSV). Oral herpes causes cold sores around the mouth or face. Genital herpes affects the genitals, buttocks or anal area. Genital herpes is a sexually transmitted infection (STI). It affects the genitals, buttocks or anal area. Other herpes infections can affect the eyes, skin, or other parts of the body. The virus can be dangerous in newborn babies or in people with weak immune systems.

There are two types of HSV:

• HSV type 1 most commonly causes cold sores. It can also cause genital herpes.
• HSV type 2 is the usual cause of genital herpes, but it also can infect the mouth.

HSV spreads through direct contact. Some people have no symptoms. Others get sores near the area where the virus has entered the body. They turn into blisters, become itchy and painful, and then heal.

Most people have outbreaks several times a year. Over time, you get them less often. Medicines to help your body fight the virus can help lessen symptoms and decrease outbreaks.

Candida is the scientific name for yeast. It is a fungus that lives almost everywhere, including in your body. Usually, your immune system keeps yeast under control. If you are sick or taking antibiotics, it can multiply and cause an infection.

Yeast infections affect different parts of the body in different ways:

• Thrush is a yeast infection that causes white patches in your mouth
• Candida esophagitis is thrush that spreads to your esophagus, the tube that takes food from your mouth to your stomach. It can make it hard or painful to swallow.
• Women can get vaginal yeast infections, causing vaginitis
• Yeast infections of the skin cause itching and rashes
• Yeast infections in your bloodstream can be life-threatening

Antifungal medicines get rid of yeast infections in most people. If you have a weak immune system, treatment might be more difficult.

Eosinophils are a type of white blood cell. They help fight off infections and play a role in your body's immune response. They can also build up and cause inflammation.

Normally your blood doesn't have a large number of eosinophils. Your body may produce more of them in response to:

• Allergic disorders
• Skin conditions
• Parasitic and fungal infections
• Autoimmune diseases
• Some cancers
• Bone marrow disorders

In some conditions, the eosinophils can move outside the bloodstream and build up in organs and tissues. This can happen in many different parts of the body, including the esophagus, heart, lungs, blood, and intestines. Treatment of eosinophilic disorders can vary, depending on the cause and which part of the body is affected. Steroids are often part of the treatment.