Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a long term (chronic) immunologic disorder or inflammatory condition of the esophagus.

If your child has EoE, when your child eats or breaths in an allergen it triggers an immunologic or inflammatory response. The walls of their esophagus become filled with a type of white blood cell called an eosinophil. Eosinophils are a part of the immune system and help to heal diseases and infections. But, when your body makes too many eosinophils, parts of the body can swell and be inflamed.

Because EoE causes swelling of the esophagus, someone with EoE can have difficulty swallowing. For some people with EoE, over time, the swelling can cause the esophagus to narrow. If this happens to your child, food may get stuck, or impacted, in their esophagus. Your child may need to go to the emergency room to have this food removed.

In young children, many of the symptoms of EoE, like formula intolerance, feeding trouble, poor weight gain, abdominal pain, and vomiting, are like gastroesophageal reflux disease (GERD). Your child may be mistakenly diagnosed with GERD. But if your child has EoE it is important that they are diagnosed because the condition can affect their quality of life if undiagnosed.

Children of different ages tend to experience different symptoms.

• Infants may have formula intolerance, vomiting often, GE reflux symptoms, not gain enough weight, or grow more slowly than expected.
• Children 1 to 3 years old may have belly pain, vomiting, GE reflux, not want to eat, have trouble trying new foods, and have a hard time keeping their weight.
• Children 4 to 11 years old may have, GE reflux, vomiting, belly pain, not want to eat, eat very slowly, not feel hungry or have a hard time keeping their weight.
• Children 12 years old and older may have, GE reflux symptoms, difficulty swallowing solid foods (dysphagia), and food getting stuck in the throat/esophagus (food impaction).

If your child’s healthcare provider thinks they have EoE they will refer you to Pediatric GI for an Endoscopy. An Endoscopy is when a small camera is put into through the mouth, and down into the esophagus while your child is under anesthesia. During the Endoscopy, the doctor will take biopsies of your child’s esophagus. These biopsies are small samples of the lining of the esophagus (mucosa) that are sent to the pathologist for testing.

The tissue cells will be tested for the presence of eosinophils. If an EoE diagnosis is confirmed, your child’s healthcare provider will likely discuss options for treatment including dietary modification, swallowed medications, or injectable therapy.

An effective treatment of EoE involves changes to your child’s diet. If your child is diagnosed with EoE, their healthcare provider will work with you and your child to find which foods are causing the problem so that your child can avoid them.

The most common foods that trigger this immune response are cow’s milk, eggs, wheat, peanuts, tree nuts, fish, shellfish, and soy, but many other foods may also be a factor in EoE. Some children with EoE may also be allergic to foods and may require allergy testing.

Allergy tests are often unable to pinpoint which foods are causing Eosinophilic Esophagitis. Your child may need to temporarily stop eating (eliminate) some foods from his or her diet and gradually reintroduce them. If that’s the case, your child may need to follow an elimination diet or an elemental diet for a few months.

Elimination diet

This type of diet removes all foods that are known to cause an immune reaction, as well as other foods that are suspected to cause problems. The remaining foods are monitored to ensure a balanced diet.

We do not recommend an elimination diet before a diagnosis of EoE.

Elemental diet

This diet removes all sources of protein and introduces a formula made up of amino acids, fats, vitamins, minerals, and sugar. It may be recommended that your child start liquid feedings (tube feedings) to help with growth and weight gain.

If your child improves after following an elimination or elemental diet for a few months, foods will slowly be reintroduced one at a time. Your child’s provider will monitor your child to make sure they can tolerate each food. Your child may need another endoscopy with biopsy to determine if they are responding well to the reintroduced foods.

If an inhaled allergen is determined to be the cause of your child’s EoE, your allergist will work with you and your family on eliminating or treating the environmental allergen.

Medicines like acid suppression (reflux medications), swallowed topical steroids, and biologic agents that bind to a receptor in the immune system to block the eosinophilic inflammatory response which will decrease the swelling of the esophagus. Dietary changes remain an effective long-term treatment for EoE.