Eosinophilic esophagitis, or EoE, is an allergic inflammation of the esophagus that usually results from a food allergy. This is a chronic condition. Rarely the inflammation can cause narrowing of the esophagus. This condition is more common in children who might have other allergic problems like known food allergy, eczema, asthma and seasonal allergy.
The symptoms vary by age. Infant and toddlers might present with symptoms very similar to Gastroesophageal reflux disease (GERD) like vomiting, poor weight gain or abdominal pain. Children can have feeding difficulties like difficulty advancing to age appropriate foods, coughing when they are trying to swallow solids or liquids. Older children usually complain of difficulty swallowing or they can present with impaction of food which might cause them to experience significant pain and spitting up of saliva. This would require urgent attention.
An upper endoscopy is necessary to make the diagnosis. This is a procedure done under anesthesia and passing a thin flexible tube with camera down from the mouth into the esophagus, stomach and initial part of the small intestine. During the procedure the physician might see abnormalities in the esophagus like deep lines called furrows, rings or collection of white spots ( usually allergic cells) or the esophagus can even look normal. The tissue samples from the esophagus are examined under the microscope for allergic cells called eosinophils. The child might get an x-ray called an Upper GI or Barium esophagram to make sure there is no narrowing of the esophagus and rule out other conditions that can affect the esophagus.
The treatment usually involves dietary changes. This might mean eliminating foods that a child is allergic to. Allergy testing can help in identifying foods that are problematic. The child might need to avoid one or several foods. The six most allergenic foods are cow’s milk, soy, eggs, nuts, fish and wheat. Sometimes completely broken down formulas called amino-acid based formulas can be given to a child if they are allergic to multiple foods or have poor growth. Medications are considered if dietary therapy fails or is not feasible. These include proton pump inhibitors and oral and topical corticosteroids.
Our multidisciplinary clinic provides a collaborative and comprehensive evaluation for children diagnosed with eosinophilic esophagitis (EoE).
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