Eosinophilic esophagitis, or EoE, is a rare condition that occurs in about one out of every 2,000 people. It is a relatively new disease, and one that can cause significant GI symptoms.
"To care for a child with EoE, you need to be well informed about the diagnosis and treatment options for this condition," says Aakash Goyal, M.D., Co-Director of the Dallas Eosinophilic GI Diseases and Esophagitis Program (DEEP) at Children's Health℠ and Assistant Professor at UT Southwestern. "Although research around EoE is ongoing and we're still uncovering aspects of the condition, we work with parents so they understand the likely complications of the condition and different treatment options to help their child."
What causes EoE?
EoE is a chronic condition that occurs when eosinophils (a type of white blood cell) accumulate in the esophagus and cause inflammation known as esophagitis. The condition is linked to food allergies and sometimes environmental allergies, but its cause isn't fully understood yet.
How is EoE diagnosed?
To diagnose EoE in children, a pediatric gastroenterologist performs an upper endoscopy. While a child is sedated, the GI doctor inserts an endoscope into the esophagus, allowing the doctor to examine the esophageal lining and take biopsies of esophageal tissue.
Next, the biopsy is examined in a lab. If your child has a high number of eosinophils (>15/per high power field of microscope) in their tissue, and other reasons for high eosinophils have been excluded, they are diagnosed with EoE.
How is EoE treated?
The best treatment for EoE is highly individualized. It may depend on your child's age, activity level and ability to change their diet. There are three primary methods used to treat EoE.
"We use the 3-D approach to EoE," explains Dr. Goyal. "Drugs, diet and dilations."
Treating EoE with medicine
The most commonly used medicines to treat EoE are proton-pump inhibitors (PPIs). PPIs are medications that work to decrease acid in the stomach as well as inflammation in the esophagus. After 8-12 weeks of therapy, your child will have another scope to check if inflammation improved with PPI. If inflammation is gone, then this medicine alone may be enough to protect their esophagus.
Children who continue to have inflammation are given the options of swallowed steroids or dietary elimination. The steroids come in a liquid form that is mixed with hypoallergenic powder to become a slurry (thick liquid), which is swallowed to coat the esophagus.
"The steroids we use are in very small doses," says Dr. Goyal. "Because the dose is so small, children avoid steroid side effects, which allows a child to use the medicine for a longer period of time."
Many older children prefer steroids so they don't have to make a change in their diet. Those patients who do not choose steroids try the dietary elimination approach.
Treating EoE with diet
To treat EoE with diet, a child will eliminate foods that commonly cause allergies, including:
- Peanuts/tree nuts
After eliminating the above foods or some foods from the group, a repeat endoscopy is done after 8-12 weeks. Once a child's EoE is in remission, you can start to introduce foods, with a rescope after each food reintroduction. This process is repeated until you determine exactly which foods cause problems.
An EoE elimination diet helps find triggering foods so that only those foods are removed from your child's diet, helping them to avoid nutritional deficiencies. Once you know what foods trigger your child's EoE, it is important that they avoid that food for the rest of their lives.
Before starting any EoE diet with your child, it is vital that you work with your allergist, pediatric gastroenterologist and a registered dietitian. Children still need plenty of nutrition to grow and develop; these health care providers can ensure your child's EoE diet plan is balanced and healthy.
Treating EoE with dilations
Dilation is a minimally invasive surgical procedure to help stretch the esophagus. The procedure is reserved for patients who have narrowing of esophagus also known as stricture. Untreated EoE can narrow the esophagus over time, making it difficult to swallow. That's why early treatment is so important, even if your child doesn't show many symptoms of EoE. Fortunately, most children with EoE do not need this procedure if they take recommended treatment.
"We see children earlier in the disease process, so we can prevent narrowing by providing appropriate therapies," says Dr. Goyal.
As research around EoE continues, more information about the causes and treatments of this newly defined condition will emerge. With a collaborative approach and a coordinated plan, families can feel confident that their child can thrive after an EoE diagnosis.
As the only comprehensive pediatric EoE program in Dallas-Fort Worth, the Dallas Eosinophilic GI Diseases and Esophagitis Program (DEEP) at Children's Health provides leading-edge care for children with EoE. Patients receive support from a multidisciplinary team including pediatric gastroenterologists, an allergist, dietitian and psychologist. Learn more about our program and services.
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