Eosinophilic Esophagitis

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An eosinophil (eh-oh-SIN-oh-fil) is a type of white blood cell that usually helps fight certain types of infections from parasites or other germs. It can also occur with other allergic disorders.

Allergic disorders can cause high numbers of eosinophils in the blood. Eosinophils are not normally found in the esophagus, which is the tube that connects the mouth to the stomach (Picture 1). When there are 15 or more eosinophils in the esophagus, this is called eosinophilic esophagitis (eh-soff-uh-JIE-tis), or EoE.

CausesThe GI Tract

People with EoE often have other allergy conditions, such as seasonal allergies, asthma, or eczema. EoE can be due to a delayed type of food allergy. This delayed food allergy in EoE is different than anaphylaxis, which is a more serious allergy that comes on shortly after eating food. Common foods that lead to delayed food allergy are: dairy, eggs, wheat, soy, nuts, fish, and shellfish. A small number of cases may be related to things in the environment like pollen, mold, or dust mites. Some studies show that there could be a genetic (inherited) reason behind EoE.

Signs and Symptoms

People’s symptoms vary from one another and by age. It can take days or weeks for the first signs of food allergies to appear in people with EoE. Common symptoms include:

  • heartburn (stomach contents backing up into the throat or mouth) that does not get better or go away with antacids
  • frequent vomiting, especially in younger children
  • dysphagia (hard time swallowing)
  • food getting stuck in the esophagus, especially in older children or adults
  • pain in the chest or abdomen (belly)
  • poor weight gain or failure to thrive
  • trouble feeding, including refusing to eat or drink
  • spitting out chewed food, especially solid foods

Diagnosis

The diagnosis of EoE is made by a test called an upper endoscopy and taking biopsies. This test is done as an outpatient in the hospital by a gastroenterologist (GI doctor). When a biopsy is done, small samples of tissue are taken from the esophagus. The samples may show a high number of eosinophil cells.

If a diagnosis of EoE is made, your child is typically referred to an allergist. Allergy testing may help you understand more about their allergies and treatment plan.

Treatment

Treatment is not the same for each child. It depends on how severe the symptoms are, the child’s response to treatment, and family preferences. Treatment may include:

  • Medicines
    • Your health care provider may prescribe an acid blocker called a proton pump inhibitor as a first step. This is a medicine your child takes by mouth 1 or 2 times each day. It can be in the form of a pill, liquid, or a tablet that melts.
    • A steroid spray or liquid solution (the same kind of medicine used to treat asthma) may be needed. This may be in addition to or instead of the acid blocker to get rid of eosinophils in the esophagus. Your child will swallow the liquid or spray the medicine into their mouth without using a spacer. They cannot rinse or brush their teeth, eat, or drink for 30 minutes. This lets the medicine mix with saliva (spit) in their mouth before it is swallowed. The medicine goes down the esophagus and clears out the eosinophils.
  • Diet
    • Your child may need to avoid certain foods to treat EoE. This may be recommended even if they do not have a specific food allergy. Removing foods from the diet that are most likely to trigger EoE can make eosinophils go away. Your child’s provider will tell you what foods to avoid. In more severe cases, children are put on a hypoallergenic diet. This is when a regular diet is replaced with a certain formula or special drink.

Long-term

Your child’s health care provider will order another endoscopy to see if their eosinophilic esophagitis is improving after treatment. This is generally done a few months after the diagnosis or treatment change. Older children may have this check done by having a scope put in their nose. This is called a transnasal endoscopy (TNE). Most people need long term medicines or diet restrictions to keep EoE under control. If you stop the treatment the eosinophils can come back.

If not treated, your child’s esophagus may become narrower. This can cause food to get stuck in the esophagus. If this happens, your child may need emergency treatment.

If you have any questions, be sure to ask your child’s health care provider.

Eosinophilic Esophagitis (EoE) (PDF)

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