Eosinophilic Esophagitis (EoE)

What Is Eosinophilic Esophagitis (EoE)?

Eosinophilic esophagitis is a long-standing allergic inflammatory disease of the esophagus, the tube that delivers food from the mouth to the stomach. Now called EoE, in the past it was referred to as EE.    

What Causes Eosinophilic Esophagitis (EoE)?

Eosinophils are a kind of white blood cell that have a vital role in the immune system, mostly in the blood and intestinal tract. If they appear in large numbers in other parts of the body, they cause problems. In the nose, they are related to seasonal allergies. In asthma, they are in a patient’s lungs.

In eosinophilic esophagitis, these specialized white blood cells build up in the esophagus (the tube that connects the throat to the stomach) as a reaction to certain foods, allergens, or the backup of stomach acid. The resulting inflammation can lead to scarring and constriction of the esophagus, causing problems with swallowing.    

What Are the Signs and Symptoms of Eosinophilic Esophagitis (EoE)?

Children who have EoE frequently have other allergic disorders such as atopic dermatitis (eczema), seasonal allergies, and asthma.

In children, signs and symptoms include:

• Difficulty feeding, in infants
• Difficulty eating, in children
• Vomiting
• Abdominal pain
• Difficulty swallowing (called dysphagia)
• Food getting stuck in the esophagus after swallowing (called impaction)
• Poor response to medications that relieve gastroesophageal reflux disease
• Failure to thrive — malnutrition, weight loss, and poor growth

How Is Eosinophilic Esophagitis (EoE) Diagnosed?

There are three steps to arriving at a diagnosis of EoE. The pediatric gastroenterologists at Hasbro Children’s Division of Pediatric Gastroenterology, Nutrition and Liver Diseases will consider your child’s symptoms. A procedure called an endoscopy will be done to allow the doctor to see the condition of the esophagus. During the endoscopy, a sample of tissue will be taken (a biopsy) for evaluation by a pathologist, a doctor who specializes in determining the cause of diseases by examining these samples.

The number of people diagnosed with EoE has risen steeply in the last 10 years. Research indicates that this increase parallels the rise in asthma and allergy cases.

What Treatment Is Available for Eosinophilic Esophagitis (EoE)?

Because it is a chronic disease, most patients who have eosinophilic esophagitis will need continuing treatment. Your child’s diet may be restricted in order to identify a food trigger.

Common problem foods are:

• Milk
• Wheat
• Eggs
• Soy

Allergy tests may be used to identify a trigger food or elimination diets may be advised based on the most common food trigger.

Medications are used to manage EoE:

• Swallowed corticosteroids reduce inflammation in the esophagus during active treatment. Or, another choice is a topical steroid in a liquid form. It is swallowed to coat the lining of the esophagus and calm the inflammation. It may only be minimally absorbed from the bloodstream, so it is unlikely to cause the side effects associated with oral steroids.
• Physicians usually start by prescribing a proton pump inhibitor, an acid blocker such as Prilosec (omeprazole), or Protonix (pantoprazole). These can help some patients. 

Learn about treatment at Lifespan for more pediatric asthma and allergy conditions