Pediatric Eosinophilic Disorders
Eosinophils are types of white blood cells that play an important role in the body's response to allergic reactions, asthma and parasitic infections.
An eosinophilic disorder is one in which an excess of eosinophils build up in the esophagus, the stomach, or the colon, causing inflammation. EoE is often seen in patients who have other allergic disorders, such as asthma, eczema and food allergies. If left untreated, it can lead to growth failure as it causes difficulty in swallowing foods and narrowing – and even scarring – of the esophagus over a period of time.
Eosinophil disorders are rare, affecting around 1 in 1,500 children. They account for less than 7% of circulating white blood cells. These cells have a role in the protective immunity against parasites but also contribute to inflammation that occurs in allergic disorders of the GI tract.
There are three types of gastrointestinal eosinophilic disorders. The location of the inflammation determines which kind it is:
- Eosinophilic colitis: inflammation caused by excess eosinophils in the large intestine
- Eosinophilic esophagitis: inflammation caused by excess eosinophils in the esophagus
- Eosinophilic gastroenteritis: inflammation caused by excess eosinophils in the stomach or small intestine
Eosinophilic disorders occur when an allergic disorder, such as asthma or hay fever, triggers the immune system to produce an excess of eosinophils. This condition sometimes runs in families. Family members should be tested if they have symptoms.
- Abdominal pain (in combination with another allergy condition, such as eczema, allergic rhinitis, asthma or food allergies)
- Chest pain
- Choking or gagging on certain foods
- Difficulty swallowing (dysphagia)
- Feeding difficulties
- Food impaction in food pipe (esophagus)
- Oral aversion and picky eaters
- Slow growth
Other associated conditions:
If you think your child may have EoE, talk to your pediatrician.
Tests and Diagnosis
There are several tests to diagnose eosinophilic disorders. A doctor will go over your child's medical history and perform a physical exam. Your healthcare provider may also perform one or more of the following tests:
- Allergy testing: tests that can provide information about possible allergy triggers. There are three types of allergy testing for eosinophilic disorders:
- Skin prick testing
- Blood testing
- GI Procedures
- Colonoscopy with biopsy: a test that uses a thin flexible tube with a small camera attached to examine the entire colon, rectum and ileum. A small amount of tissue is removed during the test for examination under a microscope
- EGD with biopsy: a test in which a thin tube with a camera on the end is inserted through your child’s mouth, then passed into the esophagus, stomach and small intestine. A small amount of tissue is removed during the test for examination under a microscope.
- Flexible sigmoidoscopy with biopsy: a test that uses a thin flexible tube with a small camera attached to examine the lower colon and rectum. A small amount of tissue is removed during the test for examination under a microscope.
Not every child needs all of these tests. Your physician will tell you exactly what the next steps are.
Treatments to remove triggers may include:
- An allergen elimination diet (aka six food elimination diet): removes common trigger foods such as milk, soy, eggs, peanuts, wheat and seafood from your child's diet
- A targeted elimination diet: eliminates foods your child is allergic to, as determined by allergy testing
- An elemental diet: a liquid formula diet used as your child’s primary source of nutrition in which the protein (allergen component) is completely broken down.
Treatments to reduce or eliminate inflammation may include:
- Proton pump inhibitors: oral medications that reduce stomach acid and helps with inflammation
- Swallowed topical steroids: swallowing steroid medication (that is usually inhaled) can reduce inflammation in the esophagus
- Esophageal dilatation: stretching a narrowed part of the esophagus using an endoscope