Patient finds relief in treatment for inflamed esophagus

For David the simple act of eating had become a fear-inducing experience. David suffers from eosinophilic esophagitis, a chronic allergic immune condition that causes his esophagus to become inflamed. At any given moment, the tube that sends food from his mouth to his stomach can swell, making swallowing difficult and extremely painful. When the inflammation is most severe, food gets lodged in his esophagus. The only remedy is an emergency endoscopy.

“Once you’ve had a couple of these episodes, there’s always this fear when you’re eating that you’re going to have another episode,” said David. “You get to a point where you’re very careful about what you eat and how well you chew. But even then, you never know when it’s going to happen again.”

“Eosinophilic esophagitis is a chronic inflammatory disease,” said Fernandez-Becker, MD, PhD, Clinical Assistant Professor, Gastroenterology & Hepatology at Stanford Health Care. Inflammation causes the esophagus to become stiffer and narrower over time, and some patients develop scar tissue, which leads to food blockages.

According to David, managing his condition for the past 10 years has been a series of trial and error, working with multiple doctors unsuccessfully to resolve the issue. His general practitioner suggested he see Dr. Fernandez-Becker at Stanford Health Care because of her extensive experience treating this condition.

“My experience with Dr. Fernandez-Becker has been nothing but positive,” said David, who began his care at Stanford in 2012. “The first time I came here, I quickly realized I was in the right place,” he said. “She was somebody who got it. She understood what I was going through. She had the background, and there was no question that I was in the right spot.”

In that first appointment, Dr. Fernandez-Becker and David discussed the frequency of his swallowing difficulties and food blockages. They talked about what triggers might be at play,and considered further allergy testing or an elimination diet. To confirm the diagnosis of eosinophilic esophagitis, Dr. Fernandez-Becker adhered to an evidence-based approach, taking a tissue sample of David’s esophageal lining, examining it under a microscope for the presence of eosinophils, and then correlating those findings with his medical history and symptoms.

“For a lot of these patients, I’m the fourth or fifth gastroenterologist they’ve seen, so they don’t come in completely naïve,” said Fernandez- Becker, who uses her PhD training in molecular genetics to tease out factors that may be causing the inflammation. “I have a very frank discussion with them about what’s happened before, why I think they’re having these symptoms and what the plan is for us to sort it out.”

Discovering the cause of the allergic reaction can be difficult. Allergy testing is often inconclusive, she said, which is why she also prefers having patients undergo a six-month elimination diet. But David, who travels extensively for work, worried that he wouldn’t be able to adhere to a strict diet. Instead, Fernandez-Becker put him on a proton pump inhibitor (PPI), a medication commonly prescribed for patients with acid reflux. The medication has been found to help some patients with eosinophilic esophagitis.

“Fortunately for me, the proton pump inhibitor seems to have helped manage it,” said David, who has only had two food blockages since going on the medication more than five years ago.

Because the condition is chronic, and requires constant management, Becker follows patients like David for years. “Every time I meet a new patient, it’s a great journey,” she said. “I get to know them as a person, which is a real privilege.

They feel like family.” “I feel like she cares about me personally as a patient,” said David. “When I’m there, I have her undivided attention. She knows me, she knows my history and she remembers it all.”

Today, David’s quality of life is improved and his condition is mostly under control. “I’m no longer walking around all the time concerned that this is going to happen again,” he said. “It’s something that Dr. Fernandez-Becker and I are managing together right now."