Eosinophilic Esophagitis in Children
Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory condition of the digestive system where white blood cells inflame the esophagus. The condition makes swallowing food difficult or even painful.
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A Comprehensive, Multidisciplinary Approach to Your Child’s Care
At our EoE-dedicated clinic, pediatric digestive health specialists work closely with pediatric allergists and registered dietitians to diagnose and treat this condition. Our multidisciplinary approach helps cultivate ongoing collaborative communication between the physicians caring for your child. This cooperation results in a robust care plan that can reduce trips to the hospital for you and your child.
What Is EoE?
Children with EoE often have a hard time swallowing food and can experience such symptoms as:
- Pain
- Nausea
- Acid reflux
- Vomiting
As a result, children with EoE may have trouble gaining weight and may even refuse to eat. In addition, EoE can cause food to become stuck on its way to the stomach, which can be a serious condition requiring emergency care.
Eosinophilic esophagitis symptoms can mimic those of acid reflux and are sometimes misdiagnosed. Evaluation by our multidisciplinary team of pediatric gastroenterologists, pediatric allergists and registered dietitians will help ensure your child’s diagnosis is accurate. Children with EoE often have other allergic conditions, including:
How Is EoE Diagnosed?
We’ll review your child’s health record with you and perform a physical exam as part of the diagnostic process. We may also perform certain tests, including:
- Regular Upper Endoscopy
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A regular upper endoscopy, also called an esophagoscopy, is performed by inserting a small tube with a camera at one end through the mouth to examine the esophagus, stomach and small intestines. Our pediatric sedation experts safely sedate children under general anesthesia for this procedure.
- Transnasal Endoscopy (TNE)
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TNE, also called transnasal esophagoscopy, is a type of endoscopy that assesses the upper part of the gastrointestinal tract, but is performed without anesthesia or deep sedation via the nasal route using a thin endoscope less than 1/4 to 1/8 of an inch in diameter. Because TNE is performed without anesthesia or deep sedation, patients can go back to school, sports activities or normal daily routine almost immediately after the procedure is completed. This procedure is for select patients with EoE. It is appropriate for follow-up once an individual is diagnosed with EoE.
- pH Impedance Test
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In a pH impedance test, a thin, small tube with a device on the tip that senses acid is gently passed through the nasal passage into the esophagus to measure how much and how often a child experiences reflux in a 24-hour period in order to rule out acid reflux.
What is Transnasal Endoscopy?
Transnasal Endoscopy is a safe, quick, nonsurgical procedure in which a thin tube with a camera at one end passes through the nose to examine the esophagus. Unlike other techniques used to look into the esophagus, TNE does not require anesthesia or deep sedation.
How is EoE Treated?
Eosinophilic esophagitis in children is usually treated with medication or an elimination diet. Since EoE is an inflammatory condition similar to asthma or eczema, anti-inflammatory drugs or steroids can be effective when administered locally in the esophagus. Specialists may also prescribe medications that suppress or reduce acid in the digestive system.
Because food is a common trigger, many patients can control their EoE symptoms simply by eliminating certain foods from their diet. However, identifying which food or foods are triggering the inflammation can be tricky. Our registered dietitians also provide recipes and meal ideas to make the transition a little easier on the child and caregivers.
Identifying Food Triggers to Improve EoE Symptoms
At UH Rainbow Babies & Children’s specialized EoE Clinic, dietitians, pediatric gastroenterologists, and pediatric allergists work together to identify what’s triggering the reaction. Once the reaction has been identified, it can be eliminated from the child’s diet. We begin by using the 4-Food Elimination Diet, which requires patients to stop eating:
- Milk/dairy
- Eggs
- Wheat
- Soy
After two to three months on the EoE diet, these foods are added back into the diet one at a time. In this way, we can identify which one produces a reaction based on follow-up testing. In some cases, children may also be asked to refrain from eating fish and nuts, as these are the next most common food allergens.
Beginning these restricted diets can be difficult and even overwhelming for children. This difficulty is the reason our registered dietitians continue working with parents to teach them about foods their kids can eat. Our registered dietitians also provide recipes and meal ideas to make the transition a little easier on both the child and those responsible for preparing the child’s meals.