[ad_1]
lIsa Thornton was pregnant and in her early 30s when she noticed the sensation of a blockage in her esophagus, the muscular esophagus that connects the mouth to the stomach. “At the time I thought it was just pregnancy,” says Ella Thornton, now 50 and living in the New Forest, Hampshire. “I thought everything was pushing up. But a few years later, things started to get worse.”
During a Sunday roast with his family, a piece of broccoli suddenly lodged in his throat, causing spasms that persisted for hours. Any attempt to wash it with water failed as the liquid simply rose again. Thornton drove to a nearby shelter, where doctors tried, unsuccessfully, to release the blockage with muscle relaxants.
After almost 20 hours, he ended up in the ER. “They put me on a drip and the doctors started talking about an operation to stretch my esophagus and release the blockage,” she recalls. “As a last attempt, a young doctor prescribed me morphine (which has a muscle relaxing effect as well as an analgesic). I woke up to find that after 36 hours, the lump was finally gone. “It had been a violent and shocking experience and no one seemed to know why or how.”
But this was just the beginning. It would be another decade and more incidents before Thornton finally received a diagnosis: a little-known condition called eosinophilic esophagitis (EoE), or esophageal asthma.
Few of us think about how much we depend on our esophagus on a daily basis. It is typically less than a centimeter wide when relaxed, but can stretch more than three times its width to accommodate particularly large pieces of food.
“It is common to swallow a piece of solid that is between two and two and a half centimeters long,” says consultant gastroenterologist Professor Stephen Attwood. “The esophagus must have that elasticity to be able to open and allow food to pass through.”
But in patients like Thornton, the lining of the esophagus becomes chronically inflamed, making it stiff, swollen and unable to stretch, and prone to food blockages. The condition is caused by an excessive immune reaction, driven by specialized white blood cells known as eosinophils. We need these cells to eliminate harmful intestinal bacteria and parasites, but when the immune system breaks down, they can trigger allergic reactions and eczema.
When Atwood EoE first identified in the late 1980s, was extremely rare, with estimated rates of less than 10 per 100,000 people. But like food allergies, which are also mediated by eosinophils, EoE has become increasingly common in all age groups, from young children to those over 70, for reasons we don’t fully understand.
Estimates from the British Society of Gastroenterology suggest it now affects around 63 in every 100,000 people, which Attwood says is enough to technically make it “a common disease”.
One Study 2022 in Sweden He even suggested it could affect more than one in 1,000 people, twice as many. “That’s the highest current estimate, but it’s totally in line with what we see in daily practice,” Attwood says. “More and more patients need evaluation for this swallowing difficulty and we know we are diagnosing it more frequently.”
So what is going on? Hannah Hunter, allergy dietitian at Guy’s and St Thomas’ NHS Foundation Trust, has been seeing EoE patients for the last decade and points to several theories, which have also been linked to the rise in cases of allergy, asthma, eczema and hay fever. . . Among the most discussed is the Hygiene hypothesiswhich attributes the increase in EE to modern cleanliness, resulting in fewer childhood infections to train the immune system and therefore make it more susceptible to failure.
Prolonged damage to the sensitive cells that line the esophagus from modern diets and common chemicals such as pesticides and detergents They have also been discussed as a plausible explanation.
“The data suggests that there has been a genuine increase that is not explained solely by increased awareness,” says Hunter. “There are many theories as to why: less exposure to microorganisms at a young age, low levels of vitamin D, and more exposure to highly processed foods that include additives, preservatives, sweeteners, and emulsifiers.”
But while EoE is on the rise, awareness among many GPS It is limited. Reports suggest that it takes an average of six years for patients to be correctly diagnosed. While an effective medication known as budesonide is now available, brand names including Jorveza, many patients are misdiagnosed with indigestion or gastroesophageal reflux disease.
If left for many years without proper treatment, EoE can progress to the point where patients are left with thick scars throughout the esophagus, preventing them from eating normally or even swallowing a small tablet.
Professor Kamila Hawthorne, president of the Royal College of General Practitioners, says detecting such a condition is not easy for doctors: “GPs have the broadest curriculum of any medical specialty, but the shortest training programme, of only three years. “Full diagnosis (of EoE) requires a thorough examination and sampling of the esophagus in secondary care settings.”
Diagnostic companies are now working on ways to make it easier for doctors to detect EoE without the need for a full endoscopy, in which a long, thin tube containing a small camera is inserted into the patient’s throat. In December, the Cambridge-based gastrointestinal health company Cyted announced it had received a £1 million grant from Innovate UKthe British innovation agency, to expand the use of its EndoSign sponge-in-capsule test (commonly used to diagnose and monitor Barrett’s esophagus, a precursor to esophageal cancer) for EoE.
“This would allow patients to be tested more quickly and with less discomfort than an endoscopy but with the same precision,” says Marcel Gehrung, CEO and co-founder of Cyted.
Hunter says we still need to understand more about the role of different foods in triggering the underlying inflammation that drives EoE, most commonly cow’s milk, wheat and eggs. While EoE is very different from the reactions commonly associated with food allergies, it is known that certain foods can potentially exacerbate symptoms.
“It would be good to know more about the role of diet in inflammation beyond specific food triggers,” says the allergy dietitian. “There is evidence that the way we eat can influence our immune system and therefore may have an effect on EoE. “Highly processed foods, sugar and trans fats can have a detrimental effect.”
For Thornton, EoE meant that her entire life soon became focused on avoiding different foods and worsening anxiety around food, particularly in social situations. After being misdiagnosed for so long, she didn’t know there was a new medication for this condition until she had a chance encounter with Attwood two months ago, mediated through a patient organization.
Following Attwood’s recommendations, he switched to a new consultant and recently started taking Jorveza, which has already markedly improved his life.
“It should be diagnosed much faster, as it has a huge impact on life,” he says. “I have been taking Jorveza since just before Christmas and it has made a big difference. “I actually had a steak last week, which is something I would never have done before.”
Source link
