Eosinophilic esophagitis (EoE) is an inflammatory disorder where the esophagus accumulates a large number of eosinophils, a type of white blood cell. This condition leads to inflammation and swelling in the esophagus causing symptoms such as difficulty swallowing, chest or abdominal pain, nausea, regurgitation, and vomiting. Over time, EoE can narrow the esophagus, sometimes causing food to get stuck, necessitating emergency removal or dilation of the esophagus.
In young children, EoE symptoms often resemble those of gastroesophageal reflux disease (GERD), including feeding problems and poor weight gain, which can lead to a misdiagnosis. Accurate diagnosis is crucial to prevent lifelong complications.
What is Eosinophilic Esophagitis (EoE) in Children?
Quick Facts about Eosinophilic Esophagitis
- Predominantly affects white males (75% of cases).
- Occurs in about 1 in 10,000 people.
- The exact cause is unknown but is linked to food allergies.
- More common in individuals with other allergic conditions like asthma or eczema.
- Recently identified, and much is still unknown about the disease.
EoE shares many symptoms with GERD, particularly in children. Common symptoms include:
- Nausea
- Swallowing difficulties (dysphagia)
- Vomiting
- Stomach pain
- Chest pain
- Heartburn
- Weight loss
- Food impaction
Younger children often exhibit GERD-like symptoms, whereas adolescents and adults typically experience swallowing difficulties and food impaction.
If your child exhibits these symptoms, consult your family doctor or a pediatric gastroenterologist.
The classification of Crohn’s disease hinges on the specific segment of the digestive tract that is involved and can also be categorized based on its severity. The terminal ileum (end of the small intestine) and the colon (large intestine) are commonly affected regions.
Dietary Changes
The primary treatment for EoE involves dietary adjustments. Identifying and avoiding trigger foods is crucial. Common allergens include dairy, eggs, nuts, wheat, fish, shellfish, and soy. Children may have one or multiple food triggers
Diet Types
Elimination Diet:
Removes known and suspected allergenic foods while ensuring nutritional balance.
Elemental Diet:
Eliminates all protein sources, replacing them with an amino acid-based formula supplemented with fats, vitamins, minerals, and sugar. Sometimes, tube feeding is necessary.
If the child improves on these diets, foods are reintroduced gradually under medical supervision. Follow-up endoscopies and biopsies may be required.
Notable risk factors include a family history of IBD, prior appendix removal surgery, maternal smoking, and early-life antibiotic exposure.
Not all children, or families, are able to successfully eliminate foods that drive EoE from their diets. Fortunately, there are a number of pharmacologic options to successfully treat EoE. Currently, medications like proton pump inhibitors, corticosteroids, and Dupilumab are used effectively when diet therapy fails.
Coping with Eosinophilic Esophagitis
Managing EoE and its dietary restrictions can be challenging, especially for children. Support your child by:
- Encouraging open communication about their feelings.
- Emphasizing that their new diet will enable a healthy, normal life.
Reassuring them that it’s okay to feel sad or anxious and to discuss
their emotions with a parent or doctor.