What is eosinophilic esophagitis?

Related links:

• Our services: Caring for children with eosinophilic esophagitis

Related tests and treatments:

• Allergy testing
• Barium swallow study
• Biopsy
• Gastrostomy
• Enteral nutrition
• Esophageal dilation
• Upper endoscopy
• Transnasal Endoscopy/unsedated endoscopy

About eosinophilic esophagitis

Also known as EoE for short, this condition affects the esophagus, which is the tube that connects the throat to the stomach. In EoE, a child’s immune system responds abnormally to certain foods, and immune cells called eosinophils cause damage and swelling in the esophagus.

What causes eosinophilic esophagitis?

Doctors don’t yet know what causes this abnormal immune response, but it’s believed that some children may be genetically predisposed.

How often does eosinophilic esophagitis occur?

This condition affects about 1 in 10,000 children.

How does eosinophilic esophagitis develop?

This condition can come on at any time. Children could have a mild case or a very severe case.

What are the symptoms of eosinophilic esophagitis?

Symptoms in children could include:

• Feeding problems
• Slow weight gain
• Vomiting
• Reflux
• Chest or stomach pain
• Swallowing problems (also known as dysphagia)
• Food getting stuck in the esophagus

Who is at risk of developing this condition?

Anyone can get it, but this condition is more common in school-age children and boys of all ages. A child with a family history of allergic conditions such as asthma, hay fever, food/seasonal allergy and eczema may also be at higher risk.

Why is eosinophilic esophagitis a concern?

In infants this condition can lead to trouble eating and problems gaining weight at a point of critical growth. But it’s a serious concern for patients of any age because it can cause stricture, a narrowing of the esophagus that can lead to food getting stuck. The risk of this happening is higher the longer the disease goes untreated. In severe cases, a child may be completely unable to eat.

How is eosinophilic esophagitis diagnosed/evaluated?

If your child’s doctor suspects EoE based on your child’s medical history and risk factors, the doctor will use a barium swallow study and an upper endoscopy to examine the esophagus. An endoscopy is the only way to know for sure if your child has this condition. The doctor will take a biopsy from the esophagus, and the pathologist will analyze the tissue sample for evidence of EoE.

What is the treatment for eosinophilic esophagitis?

Diet changes are one of the ways to manage EoE, and your child’s doctor will recommend a food elimination plan to determine which foods are causing your child’s allergic reaction.

Foods that often cause EoE include:

• Milk
• Soy
• Egg
• Peanut/tree nut
• Wheat
• Seafood/fish

The doctor will use endoscopy to see if the esophagus improves after removing certain foods from your child’s diet. Foods can then be added back to the diet one at a time. A number of endoscopies will be necessary to figure out which foods are safe for your child to eat.

Although allergy tests are sometimes used to determine which foods your child is reacting to, these tests are not always accurate. Viewing your child’s esophagus with endoscopy is the only way to know for sure if the diet is working. However, allergy tests can help identify other allergic conditions such as hay fever, as well as food allergies not related to EoE that may require treatment.

Children who are very allergic to foods or who already have feeding tubes may require what’s known as an elemental diet or enteral nutrition therapy, in which age-appropriate liquid formula replaces food. These formulas are pre-digested and “invisible” to the immune system. The formula has all the nutrition your child needs for growth and development. A feeding tube may be needed to help your child meet his or her nutrition needs.

Medications are also used to treat EoE. Topical steroids such as those used for asthma work directly on the inflamed area in the esophagus and have minimal side effects. If the topical steroids are not enough to control the inflammation, dupilumab (dupixent) can be used. Dupilumab can block the allergic pathyway which can help EoE and other allergic conditions such as asthma, eczema, and hay fever. If symptoms are severe or your child’s esophagus has narrowed, your child’s doctor may recommend an endoscopic procedure called esophageal dilation to stretch the narrowed esophagus.

What happens after treatment?

Your child will also undergo additional endoscopies to see if the treatments are working.

When should you contact a physician?

Talk to your pediatrician if your child shows any of the warning signs of EoE, including frequent vomiting, poor weight gain, refusal to eat, slow eating or the sensation of food getting stuck when swallowing.

What is the long-term outlook for eosinophilic esophagitis?

Children do not grow out of EoE, but long-term diet changes and medications can control the disease and prevent complications.

How do I live with eosinophilic esophagitis?

Patients sometimes stop treatment once they start feeling better, but it’s important to adhere to the treatment plan because symptoms will reemerge and get worse if untreated. It can be helpful to connect with support groups and monitor your child for depression or anxiety if he or she is struggling with the required lifestyle changes. Asthma and allergies are likely to go along with EoE, and making sure those conditions are under control will also help your child feel better.