Eosinophilic esophagitis (EoE) is a newly recognized disease that is associated with soreness and swelling of the esophagus (the swallowing tube between the mouth and stomach). The swelling is due to inflammation from eosinophils which are not usually found in the esophagus.
Eosinophils are white blood cells which are also referred to as “allergy cells” since they are frequently associated with allergic inflammation. Eosinophils are not usually found in the esophagus, but can be found in other parts of the digestive system or gut because they can help fight infections from parasites as well.
The symptoms of EoE vary with age. In infants and toddlers, you may notice that they refuse their food or are not growing properly. School-age children often have recurring abdominal pain, trouble swallowing or vomiting. Teenagers and adults most often have difficulty swallowing, particularly dry or dense, solid foods.
There may be a need to do an endoscopy (a test under anesthesia using a light with a camera to look into the esophagus) and take biopsies (tissue samples) from the esophagus to find out if you have the allergy cells in the esophagus.
Learn more about testing we perform for eosinophilic esophagitis.
There are two main ways to treat EoE:
Because EoE can be caused by food allergies, the Allergists may do allergy testing to find out if your child is allergic to any foods. There are 2 types of diets that Allergists use for EoE patients: the elimination diet and the elemental diet.
The elimination diet is a restricted diet. Your child may be asked to avoid particular foods that may be causing the eosinophils to be present in the esophagus. These food allergies are usually identified by allergy testing. If your child is allergic to many foods which need to be eliminated, a dietitian will help make sure your child is getting the necessary appropriate nutrition.
The elemental diet consists of a hypoallergenic highly specialized, nutritionally complete formula as the only source of food. These formulas have amino acids which are the building blocks of proteins so there are no whole or partial proteins that may lead to food allergy and hence, EoE. They also have fats, sugars, vitamins and minerals to provide all of the calories and nutrition your child needs. The elemental diet may be used if the elimination diet does not work. In some instances, patients on the elimination diet may have so many food restrictions, that they may require this formula as a supplement to meet all of their nutritional needs.
Because reflux can cause EoE and EoE can cause reflux symptoms, we usually recommend our patients take medications for reflux. Sometimes we may give medications to help with symptoms of food getting stuck in the esophagus. This may include steroids by mouth (but only for a brief period) or a steroid inhaler used for asthma that the child swallows instead of inhales. After the swallowed steroid is given for 3 months, there may be a need of endoscopy to see if the eosinophils are still present.
Yes, after foods are reintroduced into the diet, EoE can come back which is why there may be a need to perform endoscopy with biopsy periodically when foods are being reintroduced.
Some children may outgrow EoE and their food allergies, but others may only partially outgrow it and may still have some food allergies. There are also some children who may not outgrow the EoE. It is hard to determine which children will outgrow EoE and which children will not.
Some children may not completely outgrow their EoE and food allergies so they will continue to be followed by your physician. Regardless, your child should be able to lead a normal life. We don’t know all of the long-term effects of EoE, but studies do not show that these children develop cancer of the esophagus. If not treated, patients may develop strictures (narrowing or tightening of the esophagus) that cause swallowing difficulties.
Pinpointing what is causing a patient (adult or a child) child’s EoE may be a challenging journey. It will take time to walk through each step of the work-up, treatment and trial periods. Every patient is very important to us and we make every effort to always be available to help patients and their families through the process. Because each patient is different, so are the treatment options. EoE may be treated through food avoidance of offending allergens and/or through the use of medications. If you think you (or your child) may have EoE, contact AllergyCorp Group to discuss your symptoms.