Childhood Eosinophilic Esophagitis
Childhood eosinophilic esophagitis (EE) is an inflammatory condition where the esophagus fills with eosinophils, a type of white blood cell.
What are eosinophils?
Eosinophils are white blood cells made in the bone marrow that promote inflammation. They are usually caused by food allergies and because of this eosinophils are usually most commonly found in the organs that come in contact with the food allergen such as the stomach, esophagus and small intestine.
Symptoms of Eosinophilic Esophagitis
Symptoms of EE include:
4. Throat pain
6. Swallowing problems
7. Stomach pain
Tests to Diagnose EE
EE is an under diagnosed condition that is often overlooked by physicians because it has symptoms similar to other conditions such as reflux. It is difficult to diagnose and a definitive diagnosis can only be made by upper endoscopy and esophageal biopsies.
The youtube video below talks to a real family dealing with this disease and what it means in day to day life.
Dietary treatment for Childhood Eosinophilic Esophagitis
Since food allergies are the main cause of EE, removal of these allergens from a child’s diet is the most important form of treatment to allow the esophagus to heal. These diets are very challenging to follow however, because in order for them to work they need to be strictly followed.
In some cases children with EE will have no positive test results to food allergens, indicating falsely that they have no food allergies. This makes it difficult for practitioners and families to determine which foods are allowed and which need to be eliminated. Because of this an elemental diet that uses an amino acid based formula for the child’s sole nutrition is the most successful treatment of EE. When followed carefully, an elemental diet cures 95% of children with EE.
Another popular dietary treatment of EE is the elimination of the six most common food allergens, appropriately called the six food elimination diet. This diet eliminates soy,milk,egg, peanuts, wheat, and seafood. This diet is a little easier to follow because some solid food is allowed, however it is still a challenge for a child to follow such as strict diet.
It is important to consider the pros and cons of each diet carefully. To make sure your child's diet is nutritionally adequate it is important to consult a dietitian.
Medications to Treat Childhood Eosinophilic Esophagitis
Drug therapy includes the use of inhaled steroids that can be used through an inhaler and swallowed. Flovent and Pulmocort have been traditionally used to effectively treat asthma and is now being used to successfully treat EE. It is often used in conjunction with dietary treatment to produce the best effects.
Flovent is taken by puffing the inhaler and swallowing, and Pulmicort is used with a nebulizer and mixed with other ingredients to make a substance which is swallowed. To be the most effective, children should not eat or drink anything for 30 minutes after taking it to provide the best coating of the most possible. It is also recommended to have your child brush his teeth after each treatment.
As with all medications, steroids need to be prescribed by a physician. Dosage depends on age and weight.
Eosinophilic esophagitis is a difficult disease to recognize. If you feel your child may have this, speak to your doctors about tests to determine if he has it or not, and follow a treatment plan that includes and strict diet and/or medication to help get the disorder under control.