Eosinophilic Esophagitis (EoE)

When the esophagus becomes swollen and inflamed due to a food or environmental allergy, it is a condition known as eosinophilic esophagitis. This causes the child to have difficulty in swallowing and belly pain.

Eosinophils are white blood cells that help the body fight off attacks from infection. They are useful in keeping our bodies healthy, but when they are produced in high numbers, they can cause what is called an eosinophilic disorder. Eosinophil production increases normally due to a food allergy or environmental reaction. When high numbers occur in the esophagus, it can result in EoE. The infiltration of these specialized white blood cells normally cause the throat to swell and include these symptoms:

• Problems swallowing and food getting stuck in the throat
• Failure to thrive/reduction in weight/height
• Pain in the belly and chest
• Lack of appetite, nausea and sometimes vomiting
• Insomnia
• Often, the child will have skin allergies or asthma

How is EoE diagnosed?
The best and most definitive way to diagnose this condition is through an examination of the esophagus using upper endoscopy. Prior to having an upper endoscopy, the child may be prescribed medication for reflux to first see if this will control the symptoms

This test, which involves light sedation, is normally done in an outpatient setting. The tube is run down the throat, esophagus, stomach and duodenum, taking multiple biopsies to confirm the presence of eosinophil concentration. Many times, the esophagus will look normal, but under microscopic examination, the doctor may find high numbers of eosinophils.

If EoE is confirmed, the gastroenterologist will recommend food allergy testing where the skin is pricked and exposed the most common food allergies to check for a reaction.

How is EoE treated?
Most children can be effectively treated with dietary modifications and medication. The clinical dietitian can work with you and your family to ensure that you are eliminating the suspected allergens from your child’s diet. The dietitian may recommend food trials, elimination diets or elemental diets to get the best results for your child.

Normally, dietary modification is the first step and medication is added if the child’s symptoms are not controlled. If additional measures are needed to help relieve your child’s symptoms, the doctor may prescribe steroids to control the swelling and reduce the number of eosinophils.