Eosinophilic esophagitis (EoE) is a chronic immune/allergen-mediated disease characterized by symptoms of esophageal dysfunction and eosinophilic inflammation of the esophageal epithelium. Nicotine from vaping and dipping or chewing tobacco causes reflux by the exact mechanism.
Full Answer
Does vaping increase the risk of esophagitis?
Although tobacco smoking is well-known to increase esophageal acid exposure by augmenting the number of reflux events, the effects of vaping on the gastrointestinal tract have not yet been elucidated. Our objective is to report a case of severe esophagitis associated with vaping, which is the first in the literature to our knowledge.
What is eosinophilic esophagitis (EoE)?
EoE is an allergic inflammation of the esophagus that causes a range of symptoms. Adolescents and adults most often experience it as difficulty swallowing, sometimes feeling like food moves too slowly through the esophagus and into the stomach. In some cases, food actually gets stuck (and may require urgent removal).
Are there modifiable risk factors for eosinophilic esophagitis?
There are few data exploring modifiable risk factors for eosinophilic esophagitis (EoE). We aimed to determine if smoking, alcohol consumption, and nonsteroidal anti-inflammatory drug (NSAID) use were risk factors for EoE, and to assess their impact on EoE phenotypes and treatment outcomes.
Does alcohol and cigarette smoking increase the risk of esophageal obstruction?
We also predicted that patients with exposure to alcohol and cigarette smoking would be more likely to have a fibrostenotic EoE phenotype as defined by esophageal narrowing, strictures, or need for esophageal dilation, and would be less likely to have histologic response to treatment.
What is the most common cause of eosinophilic esophagitis?
EoE is caused by an allergic reaction to certain foods or environmental allergens.
Can vaping cause gastrointestinal issues?
Touted by makers as a “healthy” alternative to traditional nicotine cigarettes, new research indicates the chemicals found in e-cigarettes disrupt the gut barrier and trigger inflammation in the body, potentially leading to a variety of health concerns.
Can vaping cause ulcers in throat?
Some people develop bloody sores in their mouths and very sore throats after vaping. Some dentists have even reported lesions in the mouth that appear to be caused by burns from e-cigarettes.
What does eosinophilic esophagitis feel like?
The symptoms of eosinophilic esophagitis are variable, especially in people of different ages. Common symptoms include difficulty swallowing (dysphagia); food getting stuck in the throat (impaction); nausea; vomiting; poor growth; weight loss; stomach pain; poor appetite; and malnutrition.
Can vaping damage your esophagus?
E-cigarettes contain nicotine and other chemicals that may damage the esophagus. They may also cause or worsen the symptoms of gastroesophageal reflux disease (GERD).
What are the symptoms of vaping too much?
Symptoms include:Persistent cough.Chest pain.Shortness of breath.Some users may even experience diarrhea, vomiting, nausea and fatigue before any breathing problems develop.
Can a doctor tell if you vape?
Medical tests can detect nicotine in people's urine, blood, saliva, hair, and nails. Nicotine is the addictive substance in tobacco, cigarettes, and vapes or e-cigarettes.
What is Vaper's tongue?
Vaper's tongue (also known as vaper's fatigue) is a term that covers taste-related ailments. Often this happens from frequent use of a single, individual flavour. So, if you've been vaping the same flavour for a few weeks. you'll probably start to notice the difference in taste or lack thereof.
How much vaping is too much?
Even today, many high-profile sources list the toxic dose of nicotine (the LD50 – or the dose that will kill about half of people exposed) as between 30 and 60 mg. To put this in context of vaping, this would be about 4 ml of 12 mg/ml e-liquid. d.
How I cured my eosinophilic esophagitis?
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.
Does EoE qualify as a disability?
With eosinophilic esophagitis, a veteran may be eligible if they are awarded the 60 percent rating, OR if their rating for eosinophilic esophagitis helps them reach a combined rating of 70 percent. Veterans who do not meet these qualifications may be eligible for extraschedular TDIU.
How serious is eosinophilic esophagitis?
In some people, eosinophilic esophagitis can lead to the following: Scarring and narrowing of the esophagus. This makes it difficult to swallow and more likely that you will have food get stuck. Damage to the esophagus.
Can vaping cause bowel inflammation?
E-cigarettes trigger gut inflammation The major discovery we report in this work is that chronic repetitive, but not acute, exposure to e-cigarette aerosols disrupts the gut epithelial barrier, increases the susceptibility of the gut lining to bacterial infections, and triggers gut inflammation (Right; Figure 6).
Can vaping give you diarrhea?
This is because concentrated nicotine in the liquids used by e-cigarettes is poisonous. Nicotine can cause nausea, abdominal pain, vomiting and diarrhea.
Can vaping cause diarrhea and vomiting?
Vaping-related illness initially mimics a progressive pneumonia, with onset over several days to months. Symptoms include increasing shortness of breath, cough, wheezing, chest pain and coughing up blood. Also seen are fever, chills, fatigue and muscle aches, nausea, vomiting, diarrhea and headache.
Can nicotine cause stomach problems?
Smoking can harm your digestive system in a number of ways. Smokers tend to get heartburn and peptic ulcers more often than nonsmokers. Smoking makes those conditions harder to treat. Smoking increases the risk for Crohn's disease and gallstones.
How does vaping affect the gastrointestinal tract?
Although tobacco smoking is well-known to increase esophageal acid exposure by augmenting the number of reflux events, the effects of vaping on the gastrointestinal tract have not yet been elucidated. Our objective is to report a case of severe esophagitis associated with vaping, which is the first in the literature to our knowledge.
What is the stain on a distal esophageal biopsy specimen?
Histological image of the distal esophageal biopsy specimen. Hematoxylin and eosin stain of the patient’s distal esophageal mucosal biopsy specimen demonstrating granulation tissue with acute on chronic inflammation. Photograph provided by Dr. Vikram Deshpande (Massachusetts General Hospital)
Does vaping cause acid reflux?
Although tobacco smoking is well- known to increase esophageal acid exposure by augmenting the number of reflux events [ 5 ] , the effects of vaping on the gastrointestinal tract have not yet been elucidated.
Is vaping a gastrointestinal problem?
This patient’s presentation illustrates a serious gastrointestinal consequence of vaping, the long-term consequences of which warrant additional studies. Like smoking, the mechanism of injury in vaping may be, at least in part, due to the effects of nicotine. As prevalence of vaping continues to rise, clinicians should be aware of this complication and carefully solicit a patient’s vaping history as a simple denial of “smoking” can be misleading.
Does vaping cause esophagitis?
Vaping, or e-cigarettes, heat nicotine and other chemicals to create a vapor that is inhaled. The practice has gained rapid popularity with 41 million people globally reporting regular or occasional use [ 1 ]. Although tobacco smoking is well-known to increase esophageal acid exposure by augmenting the number of reflux events [ 5 ], the effects of vaping on the gastrointestinal tract have not yet been elucidated. Our objectives are to report a case of severe esophagitis associated with vaping, which is the first in the literature to our knowledge.
American Partnership for Eosinophilic Disorders
The EOS Connections Eosinophilic Disorders Support Community connects patients, families, friends and caregivers for support and inspiration. This community is sponsored by the American Partnership for Eosinophilic Disorders, an Inspire trusted partner.
About this Community
The EOS Connections Eosinophilic Disorders Support Community connects patients, families, friends and caregivers for support and inspiration. This community is sponsored by the American Partnership for Eosinophilic Disorders, an Inspire trusted partner.
Why is eosinophilic esophagitis increasing?
At first, researchers thought this was due to an increase in awareness among doctors and greater availability of tests.
What is the reaction of eosinophils?
Eosinophils are a normal type of white blood cells present in your digestive tract. However, in eosinophilic esophagitis, you have an allergic reaction to an outside substance. The reaction may occur as follows: Reaction of the esophagus. The lining of your esophagus reacts to allergens, such as food or pollen.
What is the term for inflammation of the lining of the esophagus?
Esophagitis is inflammation that damages the lining of the esophagus. An endoscope — a long, flexible tube equipped with a camera — may be used to see inside your esophagus. This endoscopic image of eosinophilic esophagitis shows rings of abnormal tissue (esophageal rings) resulting from chronic inflammation.
Why does endoscopy cause tears?
Because of inflammation of the esophagus, endoscopy can cause perforation or tears in the tissue that lines the esophagus. Tearing can also occur in connection with retching that some people experience when they get food stuck in the esophagus. By Mayo Clinic Staff. Eosinophilic esophagitis care at Mayo Clinic.
What are the symptoms of a swollen esophagus?
Symptoms. Signs and symptoms include: Adults: Difficulty swallowing (dysphagia) Food getting stuck in the esophagus after swallowing (impaction) Chest pain that is often centrally located and does not respond to antacids. Backflow of undigested food (regurgitation) Children: Difficulty feeding, in infants.
What happens to the lining of the esophagus?
The lining of your esophagus reacts to allergens, such as food or pollen. Multiplication of eosinophils. The eosinophils multiply in your esophagus and produce a protein that causes inflammation. Damage to the esophagus.
Is eosinophilic esophagitis more common in males than females?
Eosinophilic esophagitis is more common in males than in females. Family history. Doctors think that eosinophilic esophagitis may run in the family (have a genetic component). If your family members have eosinophilic esophagitis, you have a greater chance of being diagnosed. Allergies and asthma.
What are the risk factors for eosinophilic esophagitis?
We aimed to determine if smoking, alcohol consumption, and nonsteroidal anti-inflammatory drug (NSAID) use were risk factors for EoE, and to assess their impact on EoE phenotypes and treatment outcomes. We performed a case-control study analyzing data collected from a prospective cohort of adults undergoing upper endoscopy for symptoms of esophageal dysfunction. Incident EoE cases were diagnosed via consensus guidelines. Exposure data were collected via standardized patient questionnaire. Follow-up assessments for cases were made after treatment, with histologic response defined as <15 eosinophils per high-power field (eos/hpf). Exposures were compared between EoE cases and controls, among EoE cases with and without fibrostenosis, and among EoE responders and nonresponders. A total of 115 cases and 225 controls were analyzed. Cases were less likely to have ever smoked cigarettes (23% vs. 47%, P < 0.001) or currently use NSAIDs (17% vs. 40%, P < 0.001) compared to controls. These relations persisted after multivariate analysis. Although alcohol use was more common among cases (75% vs. 51%, P < 0.001), the effect was abrogated after multivariate analysis. Smoking, alcohol, and NSAID use were not associated with the fibrostenotic phenotype. There was a trend toward improved histologic response among EoE patients concomitantly using NSAIDs (87% vs. 63%, P = 0.08; aOR 6.97 (95% CI: 0.81–60.3). In conclusion, NSAID and smoking were inversely associated with EoE compared to endoscopy-based controls. Alcohol use was more prevalent in the EoE cases, although not an independent risk factor. Concomitant NSAID use may improve treatment response and is worthy of future study.
How to treat EoE?
EoE cases were treated at the clinical discretion of their gastroenterologist. At UNC, first-line treatment options included swallowed/topical corticosteroids (either a viscous budesonide suspension at 2 mg/day or fluticasone multidose inhaler at 1760 mcg/d) or dietary elimination (six-food elimination diet). 25 After 8 weeks of clinically indicated treatment with topical steroids or 6 weeks of treatment with dietary elimination, patients underwent repeat upper endoscopy and biopsy, with repeat collection of the endoscopic and histologic data noted above. For the purposes of the present analysis, histologic treatment response was defined as a posttreatment biopsy with <15 eos/hpf. 26
What are the biopsies used for EoE?
15 Gastric and duodenal research biopsies were also collected to exclude eosinophilic gastroenteritis. Clinical biopsies were taken at the discretion of the endoscopist. After biopsy specimen collection, the study pathologists quantified the esophageal eosinophil count using previously validated methods. 22, 23 To summarize, slides were masked to case/control status, digitized, and reviewed with Aperio ImageScope (Aperio Technologies, Vista, CA). Pathologists did not have access to endoscopy reports or clinical findings. Five microscopic fields were examined from each of the research biopsies to determine the maximum eosinophil density (eosinophils/mm 2 ). Maximum eosinophil densities were converted to eosinophil counts (eos/hpf) to compare the results to prior studies by using the hpf size of 0.24 mm 2, which is the most commonly used field size in the literature. 24 Other histologic findings associated with EoE were recorded, such as eosinophilic degranulation, eosinophilic microabscesses (cluster of ≥4 eos), basal zone hyperplasia, spongiosis, and lamina propria fibrosis (only if adequate subepithelial stroma was present).
What is EoE in medical terms?
Eosinophilic esophagitis (EoE) is a chronic immune/allergen-mediated disease characterized by symptoms of esophageal dysfunction and eosinophilic inflammation of the esophageal epithelium. 1, 2 EoE was rarely recognized before the 1990s, but is now considered a significant cause of upper GI morbidity in both children and adults. 3, 4 More than half of patients presenting to the emergency department with a food impaction are later diagnosed with EoE. 5 – 7 The current estimated prevalence of EoE in the United States is 56.7 cases per 100,000 people and it is most commonly found in Caucasian male adults under the age of 50. 8 – 10 Despite the increasing prevalence and recognition, little is known about risk factors that predispose to EoE, including modifiable behaviors and habits.
What are the limitations of the EoE study?
There are several limitations of this study. First, this was a single-center study at a referral institution, which could impact generalizability of the results. However, the enrolled EoE population has similar characteristics to those reported at other centers, and the requirement to enroll only incident (and therefore treatment naïve) EoE cases helps to counter this limitation. Second, exposure data were self-reported and we lacked data on dose, frequency, and timing of NSAID use, which was not included when the original questionnaire was created. Therefore, we were not able to perform dose-response analyses or explore the effects of different NSAIDs. There is no reason to suspect that exposure reporting would be differential between cases and controls, particularly because exposure data were collected prior to the known diagnosis of EoE. Additionally, misclassification of exposures would likely bias toward the null. Partial exposure data was missing for some of the patients but the size of the study population minimizes the potential effect on the results. Follow-up to assess treatment response was available on only 86 of our 115 patients. We also used an endoscopic determination of fibrostenosis, but it has been noted that endoscopy may not be as sensitive as barium esophagram for findings of esophageal narrowing. 34 While it is a potential limitation that our control group was not population-based and included GERD patients in whom smoking and alcohol could be though to be more common, it is notable that the controls with GERD had similar rates of smoking than controls with non-GERD symptoms or diagnoses, and that alcohol use was actually more common in EoE patients on unadjusted analysis. In addition, by focusing on patients undergoing upper endoscopy with upper GI symptoms, the non-EoE controls were felt to represent the sampling base for the cases. We also note that with this case-control study design, we can only report associations and not causal relationships.
What are the risks of smoking cigarettes?
11 – 17 Alcohol and smoking have been shown to be risk factors for gastroesophageal reflux disease (GERD) and esophageal squamous cell carcinoma and may exacerbate erosive esophagitis and esophageal strictures. 11 – 15 In contrast, NSAIDs may offer some protection from Barrett's esophagus and both histologic types of esophageal cancer. 16, 17 These factors, however, have not been extensively investigated as risk or mitigating factors in EoE, 11 and the impact of these habits and medications on the presentation and outcomes of EoE is unknown.
Do EoE patients smoke?
EoE cases were less likely to have ever smoked cigarettes compared to the endoscopy-based non-EoE controls (23% vs. 47%, P < 0.001) and to currently use NSAIDs (17% vs. 40%, P < 0.001 (Table 2; Fig. 1 ). These relations were slightly attenuated, but persisted after multivariate analysis adjusting for potential confounding factors (Table 3 ). Of note, controls with GERD did not have higher rates of smoking than controls with non-GERD symptoms or diagnoses. The aOR for EoE in NSAID users was 0.36 (95% CI: 0.17–0.76) and the aOR for ever smoking was 0.47 (0.24–0.92). Current alcohol use was more common among EoE cases (75% vs. 51%, P < 0.001) (Table 2 ), but the effect was abrogated after multivariate analysis (Table 3 ).
What is the name of the condition that affects the esophagus?
Today, we call this condition eosinophilic esophagitis (EoE).
How to treat EoE?
Patients may also opt to identify their food trigger and eliminate it from the diet, and this represents a more definitive treatment approach. Unfortunately, currently available allergy testing does not accurately predict the foods that cause EoE. Trigger foods generally need to be identified using a process of food elimination and reintroduction. Wheat and dairy are the two most common triggers for EoE, and patients will often start by eliminating these two foods for about eight weeks. At that point, their symptoms are reassessed, and they also undergo a repeat endoscopy with biopsies to determine if the eosinophils have disappeared in response to the dietary changes.
How common is EoE?
EoE can affect both men and woman of any age, but it appears to be most common in men in their 30s and 40s. It is currently estimated that EoE may affect up to one in 2,000 adults in the US, and evidence suggests that the numbers have been growing. A recent review of nearly 30 studies in Europe and North America found that there has been a progressive increase in the number of new EoE cases, especially since the early 2000s.
Why is EoE on the rise?
Why might EoE be on the rise? The exact reasons for the rise of EoE are unknown, and it is especially puzzling that in many cases EoE results from an allergic sensitivity to a food that has been well tolerated up to that point. There are several hypotheses about why EoE is increasing.
What is the first test for EoE?
When EoE is suspected, generally the first test is an upper endoscopy, in which a flexible tube with a small camera and a light on one end is used examine the esophagus. The endoscopy usually reveals characteristic features of EoE, such as concentric rings and linear furrows or vertical lines, as well as small white spots or plaques.
How many people have EoE?
It is currently estimated that EoE may affect up to one in 2,000 adults in the US, and evidence suggests that the numbers have been growing. A recent review of nearly 30 studies in Europe and North America found that there has been a progressive increase in the number of new EoE cases, especially since the early 2000s.
Can EoE cause severe abdominal pain?
Children and some adults primarily experience reflux symptoms and abdominal pain rather than difficulty swallowing. In most cases, EoE develops as an allergic response to certain foods including wheat, milk, egg, soy, nuts, and seafood. If it is not properly diagnosed and treated, EoE may lead to permanent scarring or strictures ...
