What is Eosinophilic Esophagitis (EoE)?
Eosinophilic esophagitis (EoE) is a rare disease of the esophagus. The esophagus is the tube that connects the mouth to the stomach. With EoE, there are a large number of white blood cells, called eosinophils, in the esophagus. These cells can cause injury and irritation in the esophagus.
EoE affects people of all ages. Both males and females get EoE, but it is more common in males. People with EoE commonly have other allergic conditions such as rhinitis (runny nose), asthma and / or eczema (skin rashes).
Causes of Eosinophilic Esophagitis
The exact cause of EoE is not known. EoE symptoms are typically caused by an immune response to food. People with a personal or family history of allergic conditions may be at higher risk of having EoE.
Eosinophilic Esophagitis Diagnosis
Your child’s doctor may do some tests to find out if there are eosinophils in the esophagus. These tests include an endoscopy. We also call this an upper scope. During this procedure, your child is placed under anesthesia. The scope is done as an outpatient visit in same-day surgery. Your child’s doctor will insert a small tube down the esophagus and into the stomach and part of the small intestine. Small tissue samples from each section of the upper gastrointestinal (GI) tract will be collected. These are called biopsies. A doctor will review the biopsies under a microscope to see if there are eosinophils and what the tissue looks like.
If there are 15 or more eosinophils per high-powered microscopic field, a diagnosis of EoE is considered. A doctor will look at all of the following to diagnose EoE:
- Symptoms
- Medical history
- What the doctor saw during the scope
- Pathology report (eosinophil levels, what the tissue samples look like under the microscope)
High eosinophil levels can occur in many conditions. EoE cannot be diagnosed with eosinophil levels alone.
Eosinophilic Esophagitis Symptoms
- Trouble swallowing
- Vomiting
- Abdominal pain
- Food getting stuck in the esophagus
Young children may also have slow or poor growth.
Eosinophilic Esophagitis Treatment
Changes in Diet
- Empiric elimination diet– removes the most common food allergens: milk, egg, soy, wheat, fish / shellfish, and peanuts / tree nuts. This is also called a Six-Food Elimination diet (6FED).
- Elemental diet – amino acid-based formula that supplies the child’s caloric and nutritional needs. A dietitian will help make sure your child is getting proper nutrition.
Food Trials
Many people with EoE avoid foods that trigger their disease. Food trialing is a process used to determine which foods are safe for a patient to eat. Patients first remove several foods from their diet that may cause EoE and then add these foods back into their diet one at a time. Your child's doctor will lead this process. Patients eat a food that they want to add into their diet in a very systematic way. After several weeks, the patient is scoped to see if that food caused an increase in eosinophils and disease symptoms. If eating the food causes a patient’s EoE to worsen, patients then avoid that food. If it did not impact their disease state, it is considered a "passed" food trial and the patient can continue to keep this food in their diet.
Prescription Medications
- Proton Pump Inhibitors - acid-reducing medicines
- Swallowed steroids – most common are fluticasone (Flovent) or budesonide (Pulmicort)
- Biologics – dupilumab (Dupixent)
Investigational Medications
Clinical trials to study how these medicines can help children with EoE are ongoing.
Treatment helps the symptoms of EoE but does not cure it. EoE is a lifelong condition. Having scopes with tissue samples regularly is needed to check EoE and to see if the treatment is working.
