How we help children with eosinophilic esophagitis (EoE) and allergic gastrointestinal problems
Eosinophilic esophageal disorder (EoE) is a long, tongue-twisting name that is perhaps fitting for this very complicated disorder. Sometimes referred to as a food allergy of the esophagus, it is a chronic problem that has to be carefully managed by a team of experts over a long period of time.
Symptoms that may indicate EoE
For children suffering from EoE, the journey to a diagnosis can often feel like a long one, in part because the symptoms can mimic many other digestive problems and because the diagnosis is made almost exclusively by a pediatric gastroenterologist, so care from a specialist is imperative.
Children may experience symptoms similar to reflux, and may have even received a previous diagnosis of gastrointestinal reflux disease (GERD).
These symptoms may include:
- Frequent regurgitation or vomiting after a meal
- Recurrent stomach or chest pain
- Difficulty swallowing dry or dense foods
- Wet burps
- Crying after eating
- Refusal to eat or eating only small amounts
- Poor growth
In infants, the symptoms may manifest themselves as:
- Frequent spit-ups
- Arching back or crying during meals
- Wheezing or coughing
- Blood in spit up
- Increase in intensity and frequency of spit-up
- Decrease in wet or dirty diapers
As the disease progresses and damage to the esophagus occurs, it can become difficult to swallow and food may become lodged in the esophagus. This is known as a food impaction and is a medical emergency.
How is this problem diagnosed?
The only way to know for sure that a child is suffering from EoE is through an endoscopy and biopsy of the esophagus. A specialist will perform a medical procedure that allows him or her to view the inside of the esophagus and tissue samples will be analyzed for the presence of white blood cells (eosinophils) in the esophagus.
How is the disorder treated?
In the majority of patients (but not all), EoE is the result of a food allergy, mediated by the immune system. Most EoE patients also suffer from other disorders of the immune system such as allergic rhinitis, eczema, asthma or have a family history of these. EOE can also be affected by environmental allergies to things such as pollen, dust mites, pet dander and others.
Due to the multi-faceted aspects of the disease, care for EoE patients must involve a team of specialists working together. That’s where the care our patients receive at Arnold Palmer Hospital stands apart from the rest. Treatment is addressed by experts from every angle to ensure maximum benefit for the child- a gastroenterologist tends to the physical needs of the GI tract, an allergist treats and addresses the allergic component of the disease, and a registered dietitian helps the child and family manage the dietary needs of treatment and recovery.
Once diagnosed, the gastroenterologist may determine the need for medications such as steroids to decrease the inflammation in the esophagus. The gastroenterologist may employ other medications as well, such as a proton pump inhibiter which rid the esophagus of the eosinophils and may protect the GI tract from further damage. The allergist will likely employ allergy testing to determine which allergens may be causing problems- this can be in the form of blood tests, skin prick testing or food patch testing.
The EoE center at Arnold Palmer Hospital is very active in research to help find less invasive methods of monitoring the disease than frequent endoscopy and biopsies. The center is also involved in many clinical trials of new drugs for EoE.
The only way to know for sure that a child is suffering from EoE is through an endoscopy and biopsy of the esophagus.
How a dietitian plays a key role in successfully treating EoE
Unfortunately, there is no known cure for EOE. Treatment for most patients involves a lifelong balance of medical care, allergy management and dietary interventions. For many patients, though, EOE can be successfully controlled if the offending allergen is properly identified and eliminated from the diet. Ask any family of food allergy sufferers, though- this is no small task. That’s where the skill and expertise of a registered dietitian who specializes in GI disorders becomes indispensable.
Arnold Palmer Hospital employs dietitians dedicated to the needs of these patients. They help educate families on the dietary components of the disease, aid in implementation of dietary restrictions necessary for testing or treatment, and help coordinate food reintroduction. Dietitians also can play a key role in helping children meet their nutritional needs in the face of challenging food restrictions or who have developed food aversions due to the pain associated with their disease. The importance of a dietitian in helping families with EOE overcome the practical, everyday challenges associated with food and nutrition cannot be underestimated.
The key to successful management of EOE often lies in the successful coordination of a team of experts. This may not be a team that you as a patient or a parent ever desired to join, but this teamwork is essential in management of the disease. Facing EOE is a daunting task, but with the help of the right experts, there is hope.