Eosinophilic Esophagitis (EoE) Program
The Eosinophilic Esophagitis (EoE) Program at Nationwide Children’s Hospital provides expert diagnosis and care to children and adolescents with EoE. The multidisciplinary team at Nationwide Children’s combines a wide range of specialties to provide state-of-the-art care for the unique needs of children of all ages diagnosed with EoE.
Nationwide Children's Hospital is ranked by U.S. News & World Report for Gastroenterology and GI Surgery.
What Is Eosinophilic Esophagitis?
White blood cells are an important part of a healthy immune system, helping to fight off disease and infection. In some individuals, however, white blood cells can attack harmless substances that enter the body, including certain foods. This can cause inflammation and other allergy symptoms.
Eosinophilic esophagitis (EoE) is a chronic (long-term) allergic condition in which large numbers of eosinophils, a type of white blood cell, build up inside the esophagus and cause inflammation. EoE can occur anywhere between the mouth and the entrance to the stomach.
EoE is part of a group of diseases known as eosinophilic gastrointestinal (GI) disorders. Although these conditions are rare, EoE is the most common type.
Meet Our Team
The EoE Program at Nationwide Children’s relies on a multidisciplinary team to provide expertise for eosinophilic esophagitis. Our team includes:
- Allergy and Immunology, which offers diagnosis, consultations, and treatment of allergic diseases, including those that may accompany EoE
- Gastroenterology, Hepatology & Nutrition, which provides comprehensive patient care for a broad range of gastrointestinal and nutritional problems
- Social work, which provides advocacy and emotional support to families and patients and helps link them to community resources, and works with families to identify and address barriers to wellness
- Clinical Nutrition, which includes registered dieticians who provide consultation, assessment, and education to help aid patient nutrition, growth, and development
- GI Psychology, which offers mental health care for patients with various GI disorders
Diagnosis & Treatment of EoE
EoE can affect children of all ages, but it is most often found in adolescents. Symptoms may differ depending on a child’s age. For example, young children may have feeding issues or failure to thrive. Adolescents are more likely to experience trouble swallowing or food getting stuck in the esophagus.
Symptoms that may indicate EoE include:
- Feeding issues
- Difficulty swallowing, also known as dysphagia
- Failure to thrive
- Weight loss
- Heartburn or chest pain
- Abdominal pain
- Food getting stuck in the throat
- Vomiting or regurgitation
Untreated EoE can cause further complications, including scarring and narrowing of the esophagus. This can make symptoms worse and interfere with eating and nutrition.
EoE can be difficult to diagnose based only on symptoms. If a child’s symptoms suggest EoE, the pediatrician will refer you to a GI specialist. An endoscopy is performed to help make the diagnosis.
During an endoscopy, the patient is placed under full sedation. The physician inserts a camera attached to a long, thin tube into the mouth and throat. This allows the physician to get a closer look at the esophagus for signs of inflammation or injury. The physician may also perform biopsies by removing small samples of tissue from the esophagus. The samples are sent to a lab for study under a microscope.
There is currently no cure for EoE, but the condition can be treated to help control symptoms and prevent further damage and potential scarring to the esophagus.
Treatment and management for EoE usually include:
- Elimination diet to remove dietary triggers
- Medications, such as proton pump inhibitors and steroids
- Dilation of the esophagus (the patient’s esophagus is so narrow that food gets stuck, requiring stretching of the esophagus)
Any approach to managing EoE must be tailored to each family’s unique needs. Patients should be monitored regularly to determine the effects of any dietary changes or medication.
Transnasal Endoscopy (TNE) for Monitoring EoE
Nationwide Children’s offers transnasal endoscopy (TNE), a type of endoscopy that can be used for monitoring patients with EoE. TNE is only used after confirming an EoE diagnosis with traditional endoscopy.
TNE is an outpatient procedure in which the endoscope is inserted through the nose rather than the mouth. This method does not require sedation and can be completed faster than traditional endoscopy. This reduces the amount of time that patients spend in the hospital and the need for repeat sedation. Nationwide Children’s is one of only a few pediatric centers that currently offer TNE. This option will be available soon for children aged 8 years and older.
Resources for Families
What Research Is Being Done on EOE?
Experts at Nationwide Children’s are working to contribute to the scientific knowledge and discussion of EoE and other eosinophilic GI disorders. Here are a few of our publications:
- Erwin EA, James HR, Gutekunst HM, Russo JM, Kelleher KJ, Platts-Mills TAE. Serum IgE measurement increases detection of food allergy among pediatric patients with eosinophilic esophagitis. Annals Allergy Asthma Immunol 2010;104:496-502.
- Erwin EA, Asti L, Hemming T, Kelleher KJ. A brief report on hospital discharges related to eosinophilic esophagitis over the last decade. J Pediatr Gastroenterol Nutr 2012;54:427-9.
- Erwin EA, Tripathi A, Ogbogu PU, Commins SP, *Slack MA, Cho CB, Hamilton RG, Workman LJ, Platts-Mills TA. IgE antibody detection and component analysis in patients with eosinophilic esophagitis. J Allergy Clin Immunol Pract 2015;3:896-904.
- Kruszewski PG, Russo JM, Franciosi JP, Varni JW, Platts-Mills TA, Erwin EA. Prospective, comparative effectiveness trial of cow’s milk elimination and swallowed fluticasone for pediatric eosinophilic esophagitis. Esophagus 2016 29(4):377-84.
- Erwin EA, Kruszewski PG, Russo JM, Schuyler AJ, Platts-Mills TA. IgE antibodies and response to cow’s milk elimination diet in pediatric eosinophilic esophagitis. J Allergy Clin Immunol 2016;138:625-8.
- Erwin EA, Rhoda DA, Redmond M, Ly JB, Russo JM, Hill ID, Platts-Mills TA. Using serum IgE antibodies to food to predict esophageal eosinophilia in children. J Pediatr Gastroenterol Nutr 2017;65:520-5.
- Schuyler AJ, Wilson, JM, Tripathi A, Commins SP, Ogbogu PU, Kruszewski PG, Barnes BH, McGowan EC, Workman LJ, Lidholm J, Rifas-Shiman SL, Oken E, Gold DR, Platts-Mills TA, Erwin EA. Specific IgG4 antibodies to cow’s milk proteins in pediatric eosinophilic esophagitis. J Allergy Clin Immunol 2018;142:139-48.
- Erwin EA, Navalpakam A, Singla R, Bolender, J, Workman LJ, Platts-Mills TA. Distinct clinical characteristics of boys and girls with eosinophilic esophagitis. J Allergy Clin Immunol Pract 2020;8:1452-5.