Pediatric Eosinophilic Esophagitis

Pediatric eosinophilic esophagitis is a rare disorder in which the esophagus (“food tube” connecting the mouth to the stomach) becomes swollen (inflamed). The inflammation can damage the esophagus, which can lead to scarring and narrowing over time.

Eosinophils are a type of white blood cell that defend the body against allergic reactions to substances such as certain foods, like peanuts and dairy, as well as parasites or pollen. However, too many eosinophils can cause inflammation (swelling) inside the body.

In EoE, eosinophils gather in the lining of the esophagus in reaction to allergens or gastroesophageal reflux disease (GERD), causing inflammation. EoE can make swallowing difficult, which can affect your child’s ability to eat, drink and swallow medications.

• Difficulty swallowing (dysphagia) and eating
• Food getting stuck in the esophagus (impaction)
• Oral aversion
• Abdominal pain
• Chest pain
• No improvement after taking medications for GERD
• Difficulty sleeping

Our pediatric gastroenterologists (specialists in digestive disorders) evaluate children with symptoms of EoE to rule out other conditions and confirm a diagnosis. Our team begins by performing a complete physical exam of your child. We also ask you about your child’s personal and family medical history.

The main test we use to diagnose EoE is an upper gastrointestinal (GI) endoscopy . During this test, your child’s doctor puts a scope (thin tube with a light and camera) down your child’s throat. Your child will receive anesthesia for their comfort before the endoscopy begins. The doctor uses the scope to take images and tissue samples (biopsies) of your child’s esophagus and, in some cases, of their stomach and small intestine.

Our doctors may diagnose EOE if:

• The biopsy shows 15 or more eosinophils in your child’s tissue sample
• The endoscopic images show redness, swelling, small white masses or grooves in your child’s esophagus

Our team may also perform an allergy test, where we inject a very small amount of various allergens into your child’s back or arm to see if they have a reaction. This test helps us identify what may be triggering your child’s EoE.

The causes of EoE aren’t fully known, but scientists believe that the condition develops as a reaction to certain allergens. Foods most often trigger EoE inflammation, but pollen may also trigger it. Males are more likely to experience EoE than females. Certain genes may also play a role.

EoE is a type of eosinophilic gastrointestinal disorder (EGID) and is closely related to other EGIDs, including:

• Eosinophilic gastritis (EG), which affects the stomach
• Eosinophilic gastroenteritis (EGE), which affects the small intestine
• Eosinophilic colitis (EC), which affects the large intestine

EGIDs are often associated with other conditions, such as:

• Food allergies
• Asthma
• Atopic dermatitis

The pediatric specialists at the Dallas Eosinophilic GI Diseases and Esophagitis Program (DEEP) at Children’s Health are experts in caring for children who have digestive disorders. We tailor our approach using child-friendly language, equipment and amenities to help children feel comfortable and at ease.

When we see your child for the initial visit, you can expect us to thoroughly review medical records, including previous surgeries, endoscopies, blood tests and allergy testing. We will engage our entire team in developing a treatment plan.

At DEEP, our treatment options for eosinophilic esophagitis include:

• Dietary changes. We usually start your child’s treatment with a food elimination diet or other changes to avoid certain foods that are common causes of allergies.
• Medications. We may also prescribe steroids to reduce inflammation or acid blockers to reduce acid in the esophagus.
• Dilation. If your child’s esophagus is severely narrowed, we perform an endoscopy to dilate (stretch or widen) the esophagus.