Question:

My symptoms began exactly two years ago, when I suddenly started experiencing reflux problems — or at least what I believed to be reflux. At first, I thought it was the flu or a virus, but then the situation did not improve and I began to worry. I had just gone through several months of severe and persistent bronchitis.
A few months later, I underwent a gastroscopy, which was negative and only showed quiescent gastritis. The H. pylori test was negative, as was the genetic test for coeliac disease. I then had further tests, including:

• intolerance tests, which were positive for lactose, fructose and sorbitol;

• allergy tests, which were positive for milk, nickel, sodium nitrate, citric acid and egg white, although IgE levels were within the normal range;

• abdominal ultrasound, showing a large amount of intestinal gas and an enlarged liver;

• thyroid ultrasound and scintigraphy, which showed two small “hot” nodules, with normal TSH levels. TSH was low in only one blood test.

I then saw two other gastroenterologists who continued to focus on GERD, changing my PPI treatment — I switched to Lansox — and suggesting various diets, but essentially without resolving my problem.

I then decided on my own to undergo high-resolution esophageal manometry, as well as 24-hour pH monitoring and pH-impedance monitoring. I had these tests in September 2017, and the following findings emerged:

• the tracing was compatible with nutcracker esophagus and impaired relaxation of the lower esophageal sphincter;
• pH-impedance monitoring showed numerous weakly acidic reflux episodes.

I now need to undergo a gastroscopy to investigate possible eosinophilic esophagitis.

I have always suffered from bronchial hyperreactivity, chronic rhinitis and allergic asthma — initially related to cats, although over time this seems to have resolved, as my own cats have never caused me any problems — and, since November 2015, from NSAID sensitivity.

RAST testing showed a mild allergy to milk and egg white, and my blood tests have consistently shown eosinophil levels above the normal range for the past two years.

Could allergies perhaps have caused this possible inflammatory condition? Could the cat allergy also be involved?

Answer:

The inflammation that is characteristic of eosinophilic esophagitis may also be triggered by inhaled allergens, such as pollen, dust mites, and others, in addition to food allergens.

These allergens act only as “triggers” or “activators”, but they are not the underlying cause of the disease itself.

In any case, we recommend that you discuss this with your treating physician, so that you can receive more detailed information on how to identify and, where appropriate, reduce or avoid these possible triggers in your diet and/or lifestyle.

dott. Salvatore Oliva
(UOC di Gastroenterologia ed Epatologia Pediatrica Dipartimento di Pediatria Sapienza – Università di Roma)

Please remember that the answers provided are opinions and do not constitute medical advice. They cannot replace a consultation, a medical examination, or the review of the patient’s medical documentation.