Eosinophilic Esophagitis (EoE)
Eosinophilic esophagitis, or EoE, is a condition where specific white blood cells called eosinophils build up in the lining of the esophagus (the tube that carries food to the stomach). Since there are normally no eosinophils located in the esophagus, the result of their presence is inflammation and pain.
Both children and adults can develop EoE. The exact cause is not known, but it is likely an allergic reaction to certain foods or substances in the environment, such as dust mites or pollen. People who have asthma, eczema or hay fever are more likely to develop EoE. Some people with this condition eventually develop chronic scarring called strictures, which cause the esophagus to narrow.
Allergists, gastroenterologists, registered dietitians and others play a role in treating this condition. At Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition, our experts treat children and adults with EoE.
Symptoms
Young children may react to EoE differently than older children or adults. Infants and young children often present with symptoms suggestive of reflux while older children and adults often have difficulty swallowing. Eoe is a problem for all age groups and symptoms may vary. For example:
Infants and toddlers may have feeding problems and vomiting. They also may fail to gain weight or grow properly.
Older children and teens may have abdominal pain and vomiting, along with trouble swallowing. This can lead to a poor appetite and in some cases, choking on food.
Older children and adults may also have trouble swallowing, and food may get stuck in their esophagus (impacations). Heartburn and chest pain are also symptoms of EoE in older children and adults.
Many of the symptoms of EoE in young children resemble those of gastroesophageal reflux disease (GERD). It is important to be seen by digestive health experts to get an accurate diagnosis.
Diagnosis
How Is Eosinophilic Esophagitis Diagnosed?
Your specialist at Pediatric Eosinophilic Esophagitis and Allergic Disorders Clinic will ask about your child’s symptoms and do a physical exam. Your family history is also important, since EoE can sometimes run in families.
If your specialist suspects that your child may have EoE, they will recommend an upper endoscopy, which is the only way to diagnose this condition accurately. With this test, the doctor passes a thin, flexible tube with a camera through the mouth and into the esophagus. This allows the doctor to examine the area for furrows or multiple white plaques, which are typical signs of EoE.
During the upper endoscopy, the patient is sedated and the doctor will take several tissue samples that will be examined in a lab. These biopsies show if there are eosinophils present in the tissue, which is the definitive sign of EoE.
For older children, we provide the option of transnasal endoscopy, a procedure in which the flexible tube with a camera is passed from the nose to the esophagus while the patient is awake, eliminating the need for sedation. This approach reduces the risks associated with sedation and allowing for a quicker recovery. Our skilled team ensures a safe and supportive environment for your child during the procedure.
Upper endoscopies also may be done after treatment to determine if they have been effective. Allergy tests, such as skin-prick tests, skin-patch tests or blood tests, may be used to help to find out which foods might be triggering your child’s EoE and to evaluate for other allergic conditions that may coexist with EoE.
Treatments
What Are the Treatments for Eosinophilic Esophagitis?
While EoE can’t be cured, a number of treatments can help relieve symptoms. A type of medication called proton pump inhibitors (PPIs) controls the amount of acid in the stomach and can reduce inflammation and the number of eosinophils in the esophagus. Steroids also decrease inflammation, and leukotriene inhibitors can treat allergic reactions. These must be used with care in children, since they can have serious side effects.
For patients who have not responded or failed to see improvement on the above therapies, Dupixent is available as a treatment option. This is a monoclonal antibody that targets the underlying inflammatory pathways that contribute to EoE, effectively reducing esophageal inflammation. It is usually prescribed as a long-term treatment to manage chronic symptoms and prevent disease progression.
If strictures have narrowed the esophagus, medicines can sometimes relieve the problem. If medicines are not sufficient, we may use a procedure called endoscopic dilation to stretch the esophagus. If food becomes stuck in the throat, we use an emergency endoscopy to remove it quickly.
Since EoE is related to food allergies, many children and adults need to restrict their diets. At Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition, we start with a nutritional evaluation to determine which type of restriction will be best.
Depending on the results, your specialist may suggest one of the following:
Elimination diet. Removing foods that allergy testing has identified as causing a reaction.
Common allergen elimination diet. This removes the foods most likely to cause an allergic reaction. They include dairy foods, wheat, eggs, nuts, beef, fish, shellfish, corn and soy. These foods may be added back in one at a time. If so, an endoscopy may be done after each addition to make sure EoE is still controlled.
Elemental diet. This uses a hypoallergenic formula of simple sugars, oils and amino acids. The patient eliminates all foods except this formula for one to three months while their esophagus heals.
With any diet, we support your child with a blueprint for reintroducing foods in the future along with coaching and personalized care if a particular food causes problems.
Next Steps
Our Multidisciplinary Approach for Eosinophilic Esophagitis
EoE is a complex condition that requires expert care. At Orlando Health Children's Arnold Palmer Hospital Center for Digestive Health and Nutrition, our specialists in gastroenterology, allergy and nutrition combine skills to provide the most accurate diagnosis and effective care possible.
With full time experienced registered pediatric dieticians in our clinic, your family always has access to expert advice about specific foods and other nutritional issues. Count on us for a detailed treatment plan that is personalized for your child.
Since EoE is a lifelong condition, we’re with you along the way with regular follow-up appointments. We understand how stressful EoE can be for your child and your family, and we use every resource to help your child live a happy, healthy life.
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