The diagnosis in reserve that changed Adi's life from end to end - voila! health

Adi Goldberg (Photo courtesy)

The past year for Adi Goldberg, a lawyer from Ra'anana, has undoubtedly been a year of upheaval. Adi, who has a prosperous career, and in the past was even a parliamentary adviser, went through years of suffering, and misdiagnoses, until she finally received the official diagnosis - she suffers from EoE disease (Eosinophilic Esophagitis) - a disease that is almost unknown in Israel.

In her 20s, Adi began to experience strange phenomena while eating, such as difficulty swallowing or drinking, food stuck in the esophagus, etc. She didn't know the explanation for these phenomena, and naturally got nervous. "At first I thought maybe I wasn't chewing the food well, and so did everyone telling me. For many years I believed it, I avoided certain foods like meat, at the end of every meal I had to drink, and I even missed family events because the food was stuck in my throat, and it was accompanied by vomiting and trying to get the pieces of food out, and I couldn't make it."

Later, the situation worsened, and the difficulty in eating and drinking increased. One day, while hanging out with her friend, the food literally got stuck in her throat and she had to be evacuated to the ER. "When I arrived, I felt that I wasn't being treated according to my situation. They sent me for several tests, and only the next morning did they manage to remove the piece that got stuck in my throat. Finally, there for the first time the possibility and suspicion arose that I was suffering from EoE, but nevertheless they could not definitively diagnose it."

Met the No. 1 expert in the reserves

After being informed of the suspicion, she decided to read and expand her knowledge about the disease as much as possible. At that time, she arrived in the reserves as a routine in Battalion 55, where she discovered that the person serving with her was none other than Dr. Noam Zavit, director of the Eosinophilic Diseases Clinic of the Gastrointestinal System at the Institute of Gastroenterology, Nutrition, and Liver Diseases at Schneider Children's Medical Center of the Clalit Group, and among the few in Israel who specialize in this specific disease, and he is the one who wrote all the articles she read on the Internet herself.

"Noam and I have known each other for many years, and come to reserve duty together a lot, but I never thought to approach him about it, until that moment." She turned to him for help, and together, after many thorough tests, came the final and accurate diagnosis.

Adi Goldberg (Photo courtesy)

Difficulty swallowing and chest pain

The disease, eosinophilic esophagitis, or EoE for short, is caused in most patients by an impaired response of the immune system to various food factors, which causes inflammation along the esophagus manifested by the presence of cells called eosinophils, characteristic of many allergic conditions. The inflammation impairs esophageal motility and as a result causes difficulty swallowing, food jamming and chest pain. Also, chronic inflammation that is not treated properly causes, over time, irreversible scars, which can cause significant narrowing of the esophagus that can cause food to get stuck in the esophagus - an emergency situation that requires arriving at the emergency room and removing the food invasively in a procedure called endoscopy. Stenosis can also cause the patient to be unable to swallow solid food, in which case he will have to undergo an expansion of the esophagus.

There is a significant gap between the estimated number of patients and the number of patients diagnosed, and it is assumed that this gap stems from significant underdiagnosis. "Today, the medical world is not familiar with this disease in depth, and certainly not the methods of diagnosis and treatment, which sometimes leads to erroneous diagnoses such as eating disorders or reflux among those who suffer from it, and Adi is one of those who is misdiagnosed," explains Dr. Noam Zavit.

A disease that has been known in the world for only 30 years

EoE disease has been known around the world for only 30 years, and in Israel there was no one who dealt with the subject or the field. Therefore, Dr. Zavit decided to "pick up the gauntlet", specialize and research the subject, and explains that the disease suffers from underdiagnosis. "In my opinion, the low awareness stems from the fact that not enough doctors know and identify the disease and its accompanying symptoms, which come in different configurations at different ages," explains Dr. Zavit.

"In small children, you can notice a lack of weight gain, or vomiting and ejaculation over time. In slightly older children it may appear as severe abdominal pain in the upper abdomen, while in teenagers and adults the common complaints are that the food gets stuck in the esophageal area, and that it cannot be swallowed, or that the food comes off only with drinking at the end of each bite. Adults also change their eating behavior by chewing food to the point of chewing food or avoiding certain food textures without realizing that they have a problem and that it is worth seeking clarification, thus delaying the diagnosis even further." Dr. Zavit adds that "due to the fact that the existence of the disease is not always suspected, there are people who walk around for years with the symptoms without accurate diagnosis and without treatment."

He remembers the fateful encounter with Adi well. "Adi and I have been serving in the reserves together for years, and during one of the exercises, late at night we sat and talked, and she told me about the symptoms she was experiencing. I immediately suspected the disease, and I recommended that she undergo gastro tests aimed at this disease," and she did indeed undergo various tests, at the end of which it was determined that she suffered from EoE disease.

Difficulty swallowing and pain (Photo: ShutterStock)

It is important that you know the symptoms

Today, Adi can finally live better than before. "I make sure to go for periodic check-ups and check-ups every few months, and take medication that helps me a lot to maintain my routine. My family and partner accompany me and help, of course, and in addition, I am part of the community of the "Lehadua" association, which is intended for all patients with EoE, and provides them with comprehensive support and advice."

Adi and Noam are working hard to promote the issue and raise awareness, and have even tried to promote legislation on the labeling of allergens in Israel, a critical matter for allergy sufferers and of course for some EoE patients. The world of treatments for the disease today is wide and there are a variety of effective options, and here too Dr. Zavit emphasizes the importance of contacting doctors and comprehensive examinations, in order to match the most effective and correct drug to each patient.

"In some patients, it is possible to treat with nutritional methods and thus avoid the need for chronic drug treatment, by trying to locate the food or foods that trigger the disease. Unfortunately, the existing allergy tests do not help with EoE. The current method is to remove foods from the menu for several weeks and re-evaluate the disease activity in gastroscopy with biopsies, a kind of trial and error. But due to the fact that these will often be the food groups most consumed by people, such as dairy, wheat or eggs, many patients fail to withstand a process that usually does not fit in with their life span, and sometimes fail to identify the food group that causes the phenomenon."

Possible treatment

The drug treatments, explains Dr. Zavit, are divided into several options, the oldest of which is drugs from the "hydrogen channel blockers" family, PPI, which are intended to balance stomach acidity, but over the years have also been found to be effective in influencing EoE. The second group is various topical steroids, which were previously concocted and taken in a special form only by pharmaceutical preparations. Today, this form of administration is still available to children up to the age of 18, but for adults there is a drug for the treatment of EoE that is sold by prescription and without the need for pharmaceutical preparation. This drug provides a safe and effective response to the vast majority of patients (an efficacy of about 85% has been found in clinical studies).

"In addition, there are also drugs, which are intended for those for whom other treatments do not help, and these are biological drugs, which are given as injections. This method has been found to be very effective, about 80% of its patients indicate remission of symptoms, and for the first time in the past year, such a drug was registered with the FDA," adds Dr. Zvit.

For Dr. Zavit, the subject is very important, and he uses this platform to convey critical messages to the public: "It is very important that pediatricians and family doctors also become familiar with the disease and its symptoms. At the end of the day, these are the doctors on the front line for the patients, and they are the ones who will guide the patients' way in the world of clarification and diagnosis. Any suspicion that arises - it is important to refer to a specialist gastroenterologist. Due to the fact that the disease is not uniform, and can be active even when the esophagus has a normal appearance, when the symptoms meet the criteria, it is important to refer to gastroscopy, and request that biopsies be taken throughout the esophagus even if the appearance is normal." He adds that "this is a chronic disease that in most cases patients will need treatment over the years, and therefore the importance of raising awareness of its existence and symptoms is great," emphasizes Dr. Zavit.

"Unfortunately, the disease is not well known, and I went through a lot until I reached the appropriate treatment and the accurate diagnosis. It is important that everyone who feels the symptoms go and get tested, and receive the help they deserve," Adi concludes.

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• digestion
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• oesophagus