A disease that hampers eating

The disease is new and, so far, incurable. It is increasingly common and can occur at any age. It typically involves an allergic reaction to foods - in severe cases, all foods - and can turn the pleasurable act of eating into a torment of swallowing problems, pain, vomiting, and choking.

If this is the first time you've heard of eosinophilic esophagitis (ee-oh-sin-oh-FILL-ic es-offa-JI-tis), it won't be the last. Add "EoE" to the growing list of ways in which the immune system can go horribly haywire for no apparent reason.

The mutineers in EoE are infection-fighting white blood cells called eosinophils. They infiltrate the esophagus - the muscular tube that connects the throat to the stomach - causing swelling, irritation, thickening, and permanent damage in the long term.

Fortunately, most patients get better by identifying and eliminating problem foods.

"Now, I can eat everything but three things. Before, I couldn't eat anything," said Eric Molchen, 14, of Morgantown, who was wasting away when he was diagnosed with EoE five years ago at Children's Hospital of Philadelphia.

In the 16 years since a groundbreaking study of EoE was published, awareness and research have exploded.

Still, there are more questions than answers, including: Does EoE signal a change in our food, our immune systems, or both?

Too much of a good thing

Eosinophils play a big role in the digestive tract. Sometimes they help engulf and kill invading microorganisms. For invaders too big to be gobbled up Pac-Man style, eosinophils carry toxic "granules" that they can thrust onto the enemy.

Eosinophils also help the immune system manage inflammatory disorders such as asthma and food allergies such as lactose intolerance.

But with eosinophils, as with other immune cells, too much of a good thing can be bad. A number of perplexing disorders, including ulcerative colitis, are associated with too many eosinophils.

EoE is yet another.

In biopsies of esophageal tissue taken from EoE patients, "not only are there too many eosinophils, but some have extruded their granules into the tissue," wrote Margaret Collins, a pathologist at Cincinnati Children's Hospital, the first in the country to set up a center dedicated to eosinophilic disorders. "This implies that substances . . . in the granules may contribute to the patient's symptoms."