Eosinophilic Esophagitis

Eosinophilic Esophagitis (EE) is a disease that impacts the esophagus and is mainly caused by food allergies. Some cases of EE are caused by inhaled allergens such as pollen. Since food allergies are the cause, the treatment is removal of the offending foods.

The diets used to treat EE include the elemental diet and the six food elimination diet. These diets have a very high success rate. Steroids are also commonly prescribed and helpful in treating childhood eosinophilic esophagitis.

Eosinophilic Esophagitis is still an under diagnosed condition because of a variety of reasons. First of all, it is commonly mistaken for GERD. Next, many parents make excuses for their children’s problems, thinking they have trouble swallowing because they don’t chew well enough or pay attention to what they are eating. The kids often quit complaining after parents downplay the problem, so a real issue is not detected in the doctor’s office. Many times a doctor is not tuned into the disease and will think it is a behavioral feeding issue even if the parent complains their child will not eat enough.

Symptoms of EE are consistent with those of acid reflux and may include:

  • Pain swallowing
  • Food Refusal
  • Failure to Thrive
  • Constant vomiting
  • Reflux
  • Dysphagia (trouble swallowing)
  • Cough
  • Food Impaction (food gets stuck in the throat)

What tests are needed to confirm a diagnosis of Eosinophilic Esophagitis?

Since food allergies are the main cause of EE, food allergy testing is important in diagnosing foods to avoid. This would include an allergy blood test, skin prick test and patch testing. Please keep in mind however, that many children with EE are allergic to foods but will test negative to being allergic to that food. It is for this reason an elemental diet which omits all possible offending allergens is recommended.

To get a definitive diagnosis of EE, an upper endoscopy and esophageal biopsies are necessary. An upper endoscopy is done after the child has been on a medication called a proton pump inhibitor for about 2 months.

An endoscopy is a test that uses a tiny, flexible camera with a light to look at the upper GI tract. A flexible tube is used to go down the throat and into the upper digestive tract to take pictures. During this time a biopsy of the esophagus is taken to look at under a microscope once the upper GI is finished. The main point of the biopsy is to look for eosinophils, which will give you the definitive diagnosis of EE. The test is usually conducted in a hospital, and patients receive local anesthetic to numb the throat, as well as a sedative through the arm.

I think my child may have Eospinophilic Esophagitis. What is the next step?

If you suspect your child has Eosinophilic Esophagitis, it is important to call your gastroenterologist and discuss it with him. It is helpful to keep a food diary for your appointment and list the symptoms and reasons why you think your child may have this disorder.

In the meantime, try to relax when feeding your child. While it is very important that she gain weight and thrive, can you really blame them for not wanting to eat if they feel terrible? Once the diagnosis is made, you will need to be very strict with what they eat, so it’s important to be empathetic now and gently encourage her to eat well.

If your child has EE and you need dietary guidance, make an appointment with us!



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