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EOE and Pregnancy
EOE and Pregnancy – Eosinophilic esophagitis (EOE) is an inflammatory condition of the esophagus that involves a build-up of eosinophils, a type of white blood cell, in the lining of the esophagus. This build-up leads to inflammation, irritation, difficulty swallowing, and other gastrointestinal symptoms.
EOE often develops in childhood or adolescence but can occur at any age. It is estimated that about 1 in 2000 adults have EOE. While the condition is more commonly diagnosed in males, females with EOE who become pregnant need special consideration of how the condition may uniquely impact pregnancy and vice versa. (EOE and Pregnancy)
Symptoms of EOE During Pregnancy
The hallmark symptoms of EOE are trouble swallowing, food getting stuck in the esophagus, and heartburn. Pregnant women often experience similar symptoms as a result of hormonal changes and gastrointestinal changes happening during pregnancy, which can make diagnosing EOE challenging.
Some signs during pregnancy that could indicate EOE rather than general pregnancy GI issues include:
- Food impactions that do not resolve on their own
- Persistent or worsening difficulty swallowing that is not improving
- Reflux symptoms that do not respond to antacids or acid reducers
- Need to chew food extensively to prevent it from feeling stuck
- Pain or irritation when swallowing that feels unrelated to reflux or nausea
If symptoms are worsening or severely interfering with nutrition and hydration despite efforts to manage them, it warrants bringing them to the attention of your physician or gastroenterologist for evaluation. Getting a confirmed EOE diagnosis during pregnancy can help guide treatment. (EOE and Pregnancy)
Impacts and Risks of EOE During Pregnancy
For those already diagnosed with EOE, complications from active disease or flares can pose issues during pregnancy in a few key ways:
Nutrition: Nausea, vomiting, and altered appetite happen frequently during pregnancy. When combined with trouble swallowing or pain from EOE, achieving proper caloric intake and nutrition balance becomes much harder. This can increase the risks of nutritional deficiencies, which impact both the mother and the developing baby.
Hydration: Vomiting associated with severe EOE symptoms poses the risk of dehydration, which can be dangerous during pregnancy for both mom and baby. Staying hydrated is essential.
Eating Difficulties: Someone with frequent impactions from food getting stuck may avoid eating/drinking enough out of fear of another episode or due to pain while swallowing. Monitoring overall intake is important.
Weight Gain Issues: Poor nutrient and calorie intake, along with alterations in metabolism, can make appropriate pregnancy weight gain difficult. Too little or too much weight gain in pregnancy heightens the risks of complications.
Acid Reflux and Heartburn: EOE can worsen or be confused with heartburn, a nearly universal complaint during pregnancy. This often leads to overuse of antacids, which some studies suggest should be minimized during pregnancy. Finding the right balance is key.
Esophageal Perforation: A severely impacted food in the esophagus must be carefully cleared by an endoscopist to avoid the risk of perforation (tear). Perforation heightens the risk of infection, which can provoke preterm contractions.
Oral Steroid Risks: Topical steroids used to manage EoE symptoms may elevate risks like gestational diabetes or preeclampsia. Risk vs benefit balance should be considered.
Preterm Labor or Delivery: Complications from poor nutrient intake, weight issues, edema, infection from perforation, etc., can potentially increase the chance of early onset labor.
The risks above are based on theoretical complications and case reports described in the literature, but overall, the evidence about the impacts of untreated EOE, specifically during pregnancy, remains uncertain. More research is still needed. (EOE and Pregnancy)
Treating EOE During Pregnancy
The core goals when treating EOE during pregnancy are maintaining adequate nutrition for mom and baby along with hydration and managing pain or discomfort enough to allow normal eating. There are several approaches physicians who specialize in EOE may use:
Diet Change: Eliminating trigger foods is a first-line approach, including the “6-Food Elimination Diet” to determine triggers, followed by food reintroduction to tailor an individualized diet. Though tricky during pregnancy when many foods may already be avoided.
Acid Blockers: Medications like antacids, H2 blockers, or PPIs (proton pump inhibitors) help reduce acid reflux that potentially worsens inflammation but should be minimized when possible during pregnancy.
Pain Medication: For significant odynophagia (pain while swallowing), short-acting pain relief may be used to manage during eating/drinking.
Esophageal Dilation: Gentle expansion of narrowed esophagus using gradual dilation technique. Performed only by gastroenterologist. It may provide longer-term symptom relief until postpartum. Repeat procedures may still be required.
FLUTD (Flovent): Inhaled glucocorticoid medication may provide a topical anti-inflammatory effect. Often used long-term to manage EOE recurrence risk. Considered fairly low risk, but evidence in pregnancy is limited. (EOE and Pregnancy)
Emerging biologic agents (monoclonal antibodies) may be an option for severe refractory cases not well controlled by other therapies. There is extremely limited data about their safety profile during pregnancy; thus not typically recommended.
After giving birth, more intensive steroid regimens can be resumed if needed to reset the inflammation in the esophagus since risks postpartum are minimalized. However, caution must be exercised if breastfeeding an infant.
In all cases of treating EOE, pregnant patients must see a gastroenterologist who has expertise in managing EoE to determine the right treatment plan for their case based on a careful consideration of both risks and benefits during pregnancy. (EOE and Pregnancy)
Living With EOE During Pregnancy
Learning to manage EOE well in pregnancy involves preparation, patience, monitoring symptoms closely, modifying diet as able, and working as a team with your family, gastroenterologist, and maternal health providers.
Be sure to report any difficulty eating or drinking, painful swallowing, concerning weight changes, or other red flags immediately to stay ahead of any issues. It can also be helpful to:
- Drink fluids separately between meals if eating solidarity foods is difficult
- Maintain a diary of foods that are triggers or hard to swallow
- Chew foods to a smooth consistency
- Have fluids with meals to wash food down more easily
- Remain upright for at least 30 minutes after eating
- Learn abdominal massage techniques to help move food prior to impaction’s
Stress can exacerbate EoE, so be aware of anxiety and use meditation, yoga, or other relaxation techniques to remain calm. Seek emotional and psychological support if needed from counselors.
Joining a local or online EOE community to find solidarity and tips from other patients can also be extremely helpful when dealing with such a complex condition in the midst of all the significant changes happening during pregnancy.
Just remember that you are not alone, and there are solutions to manage EoE successfully, even during pregnancy. Working closely with your care team is key to the best possible outcomes.
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