LIsa Thornton, a pregnant woman in her early 30s, noticed a blockage in her esophagus, the muscular esophagus that connects the mouth to the stomach. “She thought she was just pregnant at the time,” says Thornton, now 50 and living in the New Forest, Hampshire. She said, “I thought everything was pushing up. But after a few years, things started to get worse.”
While having a roast with her family on Sunday, a chunk of broccoli suddenly got stuck in her throat, causing a seizure that lasted several hours. I tried rinsing it off with water, but the liquid kept coming back and it didn't work. Thornton drove to a nearby drop-in center, where doctors tried to relieve the blockage with muscle relaxants, but were unsuccessful.
Almost 20 hours later she arrived at A&E. “I was put on an IV and the doctors started talking about surgery to stretch my esophagus to relieve the blockage,” she recalls. “In a last attempt, a young doctor gave me morphine. [which has a muscle relaxant effect as well as being a painkiller]. I woke up to find that the lump had finally disappeared after 36 hours. It was a violent and traumatic experience, but no one seemed to know why or how. ”
But this was just the beginning. It took another decade and more incidents before Thornton was finally diagnosed. It was a little-known disease called eosinophilic esophagitis (EoE), or esophageal asthma.
Few people think about how much we rely on our esophagus every day. Typically, it is less than a centimeter wide when relaxed, but it can stretch more than three times its width to accommodate particularly large chunks of food.
“It's common to swallow solid objects that are 2 to 2.5 centimeters in size,” says consultant gastroenterologist Professor Stephen Atwood. “The esophagus needs elasticity to open and allow food to pass.”
But for patients like Thornton, the lining of the esophagus becomes chronically inflamed, hard, swollen and unable to stretch, making it easier for food to get stuck. This condition is caused by an exaggerated immune response caused by specialized white blood cells known as eosinophils. We need to eliminate harmful intestinal bacteria and parasites in these cells, but a miswired immune system can cause allergic reactions and eczema.
When Atwood first identified EoE in the late 1980s, it was vanishingly rare, with an estimated incidence of less than 10 per 100,000 people. However, like food allergies, which are also mediated by eosinophils, EoE is becoming increasingly common in all age groups, from infants to those over 70, although the reasons are not fully understood. Is not …
The British Society of Gastroenterology estimates that around 63 out of 100,000 people are currently affected by the disease, which is technically enough to make it a 'common disease'. Atwood says.
One study conducted in Sweden in 2022 even suggests that more than 1 in 1,000 people, or twice as many people, may be affected. “This is the highest estimate to date, but it's perfectly consistent with what we see on a daily basis,” Atwood says. “More and more patients are requiring evaluation for this dysphagia, and we are finding that it is being diagnosed more frequently.”
So what's going on? Hannah Hunter, an allergy nutritionist at Guy's and St Thomas' NHS Foundation Trust, has been seeing patients with EoE for the past 10 years and has seen a number of symptoms including allergies, asthma, eczema and a rise in hay fever. points out a theory. . The most discussed is the hygiene hypothesis, which suggests that the increase in EoE is due to modern cleanliness, resulting in fewer childhood infections to train the immune system, which in turn causes the immune system to become abnormal. It is thought that it is getting easier.
Long-term damage to the sensitive cells lining the esophagus from modern diets and common chemicals such as pesticides and detergents has also been discussed as a plausible explanation.
“The data suggests there has been a real increase that cannot be explained by increased awareness alone,” Hunter says. “There are many theories as to why this is, including low exposure to microorganisms during childhood, low vitamin D levels, and high exposure to highly processed foods containing additives, preservatives, sweeteners, and emulsifiers. are mentioned.”
However, although EoE is on the rise, awareness among many GPs is limited. Reports say it takes an average of six years for a patient to be correctly diagnosed. Although effective drugs known as budesonide, with trade names such as Jolbeza, are now available, many patients are misdiagnosed with indigestion or gastroesophageal reflux disease.
If left untreated for many years, EoE can progress to the point where a patient has thick scars all over their esophagus, making it impossible for them to eat normally or even swallow small pills. there is.
Professor Camilla Hawthorne, president of the Royal College of General Practitioners, said it was not easy for doctors to spot such symptoms. She says: 'General medicine has the broadest curriculum of any specialty, but the training program is the shortest at three years. [of EoE] A thorough examination and sampling of the esophagus is required in the secondary care setting. ”
Diagnostic companies are now working on ways to make it easier for doctors to detect EoE without requiring a full endoscopy, which involves inserting a long, thin tube with a small camera into a patient's throat. In December, Cambridge-based gastrointestinal health company Cyted announced that it would be testing the UK's The company has announced that it has received a £1 million grant from Innovate UK, the innovation agency. Esophageal cancer) For EoE.
“This allows patients to undergo a test that is faster, less uncomfortable, and with the same accuracy as endoscopy,” said Marcel Gehrung, CEO and co-founder of Cyted. I am.
Hunter says we still need to understand more about the role of various foods, most commonly milk, wheat and eggs, that cause the underlying inflammation that causes EoE. Although EoE is very different from the reactions commonly associated with food allergies, it is known that certain foods can worsen symptoms.
“It's good to know more about the role of diet in inflammation, not just specific foods as triggers,” says the allergy nutritionist. “There is evidence that the way we eat can affect our immune system and affect our EoE. Highly processed foods, sugar, and trans fats can have negative effects.”
For Thornton, EoE meant that her entire life quickly became centered around avoiding various foods, especially in social situations, and worsening anxiety around eating. She had been misdiagnosed for a long time, and until she met Mr. Atwood by chance two months ago through a patient group, she didn't know there was a new drug to treat the disease.
Based on Atwood's recommendation, she switched to a new consultant, recently started taking Jolbeza, and has already seen noticeable improvements in her life.
“It should be diagnosed sooner because it has a huge impact on people's lives,” she says. “I've been taking Jolbeza since just before Christmas, and it's made a huge difference. I actually ate a steak last week, which I would never have eaten before.”
