Eosinophilic Esophagitis

Eosinophilic Esophagitis (EoE) is a disorder of the esophagus, the tube that moves food from your mouth to your stomach. This disorder is different than acid reflux. Reflux esophagitis is due to injury from food and acid coming back up after eating. EoE is caused by inflammation in the esophagus triggered by many factors including food allergies; our understanding of all the reasons for this disorder is incomplete. Many children with EoE are identified due to difficulty swallowing. We have seen children with difficulty swallowing small pieces of rice or meat or children with coughing and choking any time they try to swallow solid foods. The diagnosis requires that an upper endoscopy be performed. With an endoscopy, your doctor takes tiny samples of tissue from the lining of the esophagus so that he/she can examine the specimen under the microscope; this identifies both the inflammation of the esophagus and the presence of eosinophils.

An eosinophil is a type of white blood cell that is an important part of the immune system. Eosinophils are found in small quantities in the blood and intestine, but are not normally found in the esophagus. Eosinophils help fight off certain types of infections such as parasites and are involved in allergic reactions. This white blood cell is also common in other allergic disorders like asthma. In fact, there is good evidence that allergy plays a very important role in EoE. We often see children who have asthma, eczema, food allergies and EoE. 70% of people with EoE may respond to elimination diets - avoiding foods like cow's milk, eggs, soy protein, fish, nuts and wheat.

The symptoms of EoE may vary with age. The symptoms of EoE may be confused with reflux especially in younger children. Infants often present with vomiting, irritability and poor weight gain. In the older child and adolescent, difficulty swallowing and food obstruction (or impaction) in the esophagus may be more common. Other symptoms may include reflux not responsive to standard medical therapy, nausea, vomiting, abdominal or chest pain, poor appetite, and sleeping difficulties.

Diet changes can be difficult for many reasons. First of all, many patients have delayed reactions up to a week after taking a food that damages the esophagus. This makes it difficult to know which foods are causing problems. Secondly, allergy testing, while helpful, is often inconclusive in this disorder. Many patients who are allergic to foods will test negative and many patients may test positive for foods that are not causing problems. Thirdly, small quantities of allergic foods can be 'hidden' in many other foods; even careful label reading may not completely eliminate some exposures. In addition, many children may 'sneak' foods without the parents knowledge. Finally, many patients have multiple food groups which can make diet changes quite confusing.

This is a complicated disorder and if your child has EoE, our staff will work with you to understand the options for treatment. At this time, many patients are treated with anti-inflammatory medications (budesonide, or fluticasone) or receive changes in their diet. In many cases, therapy is coordinated with an allergist to help determine the optimal approach. Most individuals undergo followup endoscopy to determine if their treatment is working well.

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