Although a rare diagnosis, the number of children diagnosed with Eosinophilic Esophagitis (EoE) is increasing. In the United States, approximately 10-50 children out of every 10,000 are being diagnosed per year. Because there are cases when difficulty eating is the first sign of EoE, we asked our colleague and expert in EoE, Dr. Sabina Mir, to write the following information for our patients.
What is Eosiniophilic Esophagitis (EoE)? Eosinophilic (e-o-sin-o-filek ) (e-so-fa-gitis) is a chronic allergic inflammatory condition of the esophagus. The esophagus is the food pipe that connects the mouth to the stomach. In EoE, there is a build up of too many white blood cells, called eosinophils, in the esophagus.
What causes EoE? Food allergies are one of the most common causes of EoE. Approximately 50%–80% of children with EoE have other allergic diseases such as eczema, asthma and/or allergic rhinitis. EoE can also run in families.
What are the symptoms of EoE? The symptoms of EoE are non-specific and are similar to many other conditions (abdominal pain, vomiting, heartburn, feeding refusal). Feeding difficulties are not uncommon in kids eventually diagnosed with EoE. Infants/toddlers may present as slow feeders, may limit volumes of foods and liquids and/or may have difficulty transitioning from liquids to solid foods. Older children may avoid foods with harder textures (beef, bread) and prefer softer foods. These children may also chew for long periods of time and be labeled as “slow eaters”. Adolescents may experience food impactions where food gets stuck in the esophagus.
How is EoE diagnosed? EoE cannot be diagnosed definitely without an upper endoscopy, performed by a gastroenterologist. There are certain clues to the diagnosis that the gastroenterologist can see with his/her eyes during the procedure (rings, furrows, narrowing of the esophagus). However, the diagnosis is made based on a specific number of white blood cells (eosinophils) seen only under a microscope. Biopsies (small pieces of tissue) are taken at the time of the upper endoscopy and reviewed by a pathologist.
What are the treatments for EoE? There are two main forms of treatment, medical and dietary. Sometimes a combination of both may be required.
Medical: Topical oral steroids, available in two forms, are delivered directly to the esophagus, where the irritation and inflammation exists:
- liquid budesonide (usually made to be inhaled into the lungs for asthmatics) where a “slurry” is made with Splenda to be swallowed
- fluticasone inhaler where the released vapor is swallowed instead of inhaled
* Both types of steroids require strict oral care following the treatment to prevent yeast from developing in the mouth and esophagus*
Dietary: Since food allergies are thought to be the main factor driving the inflammation in EoE, food elimination is an important part of treatment. Diet therapy can be a combination of 1, 2, 4 or more food group elimination. The most common triggering foods include dairy, wheat, eggs, soy, peanuts, tree nuts, fish, shellfish, beef and corn.
Repeating an upper endoscopy is often necessary to monitor the effectiveness of the treatment. The usual recommended time frame between scopes is between 8-12 weeks until remission of the disease is reached (less than 15 eosinophils per high powered field under the microscope). At that time, yearly endoscopies are often recommended unless a new symptoms or change in treatment occurs.
Age appropriate treatment with a multidisciplinary team consisting of a gastroenterologist, an allergist, a dietician and a speech therapist is critical in developing the best treatment plan for children with EoE.
Dr. Sabina Mir is an Assistant Professor of Pediatrics at the University of North Carolina at Chapel Hill’s School of Medicine. She is the Director of Endoscopy and Expert in Eosinophilic Esophagitis within the Division of Pediatric Gastroenterology at the NC Children’s Hospital. We are deeply appreciative of all of the outstanding education she provides for our team and the time she took to write this informative piece for our patients.