Eosinophilic Esophagitis (EoE)

Eosinophilic Esophagitis (sometimes called EoE or EE) is 10 times more common than it was just 20 years ago. In the same way that asthma can be an allergic conditions of the lungs and eczema can begin as allergies affecting the skin, EoE is an allergic condition of the esophagus (the tube that transports food from the mouth to the stomach). In fact, EoE has been called  “eczema of the esophagus” that comes from allergies, most often from foods.  

Symptoms

  • Choking
  • Difficulty swallowing
  • Chest pain
  • Poor or picky eating
  • Abdominal pain
  • Vomiting

Because many of these symptoms are similar to acid reflux, the two conditions can be confused. But difficulty swallowing (and choking on food) are the most common features of EoE. That's why many kids have difficulty swallowing breads, rice, meat and apple peels. Some children and young adults will even get food stuck in their esophagus, requiring a procedure (an upper endoscopy) to remove this food. And on questioning, family members may report that they've needed that procedure or a "stretching" of their esophagus in the past.

Diagnosis and Treatment

The only reliable test for EoE is an upper endoscopy and the pinch biopsies from the lining of the esophagus. They show swelling (inflammation) and eosinophils which are not usually seen in rhe esophagus. Children with acid reflux also may have a few eosinophils in their biopsies, in smaller numbers than usually seen in EoE.    

EoE can get better with treatment, but the inflammation will likely return if treatment is stopped. Treatment consists of removing the foods (and environmental factors) the child might be allergic to. At least in the beginning, blocking the acid that may be coming up from the stomach seems to help although steroids that work directly on the esophagus and the eosinophils are often required as well.

EOSINOPHILIC GASTRITIS AND GASTROENTERITIS

Eosinophilic Gastritis and Eosinophilic Gastroenteritis are rare disorders (compared to Eosinophilic Esophagitis).  The white blood cells that are increased in allergic conditions, eosinophils, gather in the lining of the stomach alone (gastritis) or the stomach and intestine (gastroenteritis). The esophagus is usually spared.

Symptoms

The eosinophils are indicators of inflammation and they may actually cause part of the injury. That can lead to

  • Abdominal pain
  • Nausea, vomiting
  • Diarrhea,
  • Weight loss
  • Poor growth
  • Anemia (low blood counts)  
  • Fatigue and difficulty performing well at school
  • Malnutrition
  • Low protein and vitamin levels

These do not all occur in every patient.

Diagnosis and Treatment

Adults and children with these conditions may have environmental and particularly food allergies, that can trigger the problems and make it harder to treat. As a result, patients often need to undergo a battery of blood tests, allergy studies, upper endoscopy and often a colonoscopy for evaluation. Pinch biopsies from the lining of the esophagus, stomach and intestine are examined to look for inflammation and the presence of eosinophils.

If either Eosinophilic Gastritis or Gastroenteritis is present, treatment attempts to lessen inflammation, protect the stomach and intestine and reverse nutrient losses. This often requires medication and dietary treatment involving  an allergist and pediatric gastroenterologist, a dietitian and occasionally a psychologist to determine and maintain the diet, avoid nutrient deficiencies and bring your child to his optimal health so that he or she can return to a normal life.