If your child complains of a burning sensation in his chest, chest pain or tightness, regurgitation, trouble swallowing or that it feels like something is stuck in his throat, you may wonder if he has gastroesophageal reflux disease (GERD). But these symptoms may also be caused by a condition called eosinophilic esophagitis (EoE).
What is EoE?
EoE is a disorder where white blood cells (eosinophils) build up in the esophagus, causing inflammation. The exact causes are not completely understood, but it appears to be triggered by food allergens and/or airborne allergens.
“If left untreated or not properly controlled, patients with EoE will develop fibrosis [scarring] along the esophagus, which will cause the esophagus to narrow and the patient to experience severe difficulty swallowing,” says Edaire Cheng, M.D., Pediatric Gastroenterologist and Medical Research Director of Dallas Eosinophilic GI Diseases and Esophagitis Program (DEEP) at Children’s Health℠, and Assistant Professor and Pediatric Team Leader of the Esophageal Diseases Center at UT Southwestern.
In addition, when EoE is left untreated, food will get stuck in the esophagus more often, and sometimes will require endoscopic removal of the food. There is also an increased risk of tearing or perforation of the esophagus.
“The relationship between EoE and GERD is quite complex, and the two diseases may not be mutually exclusive,” Dr. Cheng says. “Therefore, both diseases are under high consideration as the gastroenterologist evaluates the patient.” Endoscopy with biopsy (a minimally invasive procedure) is a necessary diagnostic test.
Similar symptoms, but different treatments for EoE and GERD
GERD arises from acid reflux, and treatment is directed toward minimizing the amount and/or intensity of acid refluxing.
EoE, on the other hand, is thought to be an allergic process, and treatment is directed toward controlling the allergic inflammation and/or avoiding the triggers.
Some patients may experience symptoms of EoE several hours after exposure to a trigger; others may not experience symptoms until they have had days or weeks of repeated exposures.
A dietary therapy, where trigger foods are eliminated, is a common approach to treating EoE. “Together with an allergist, the medical team tailors a dietary therapy to the individual, based on the individual’s allergy testing and history of allergic disorders,” Dr. Cheng says.
Other non-invasive treatments include:
- Medications traditionally used to reduce stomach acid
- Swallowed topical steroids
In some cases, if the fibrosis is very severe and causes extreme narrowing of the esophagus, a dilation procedure by endoscopy may be needed to provide therapeutic relief,” says Dr. Cheng. The dilation procedure is done to stretch the narrowed portion of the esophagus.
It is possible for a patient to have both GERD and EoE at the same. How much each disease contributes to the other disease process is unclear, and areas of research are dedicated to answering these questions.
The Dallas Eosinophilic GI Diseases and Esophagitis Program (DEEP) at Children’s Health is a multidisciplinary clinic for patients with eosinophilic esophagitis (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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