Eosinophilic esophagitis (EoE) in children

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus that primarily affects children and adolescents. It is characterized by the presence of an abnormally high number of eosinophils, a type of white blood cell, in the lining of the esophagus. EoE can lead to various symptoms and complications related to swallowing and esophageal function. Here are key points about EoE in children:

Causes: The exact cause of EoE is not fully understood, but it is believed to involve an immune response triggered by exposure to certain foods or environmental allergens. Genetics may also play a role, as EoE tends to run in families.

Symptoms: Symptoms of EoE in children can vary in severity and may include:

• Difficulty Swallowing (Dysphagia): Children with EoE may have trouble swallowing solids or liquids, which can lead to food becoming stuck in the esophagus (food impaction).
• Food Impaction: Episodes of food impaction can cause severe chest pain and require medical intervention to remove the blockage.
• Heartburn and Reflux Symptoms: Children with EoE may experience symptoms similar to gastroesophageal reflux disease (GERD), such as heartburn, regurgitation, and stomach pain.
• Failure to Thrive: Some children with EoE may have difficulty gaining weight and growing at a normal rate due to feeding difficulties.
• Vomiting: Recurrent vomiting or spitting up may occur, particularly in younger children.

Diagnosis: Diagnosing EoE in children typically involves a combination of the following:

• Endoscopy: A gastroenterologist may perform an upper endoscopy, during which a thin, flexible tube with a camera is inserted into the esophagus to visualize the tissue lining. Biopsies are taken from the esophagus to assess the eosinophil count.
• Biopsy: Tissue samples obtained during endoscopy are examined under a microscope to confirm the presence of eosinophils and assess the degree of inflammation.
• Elimination Diet: In some cases, an elimination diet is used to identify trigger foods that may be causing the inflammation. Specific foods are eliminated from the child’s diet for a period, and then reintroduced to assess the response.
• Allergy Testing: Allergy testing, such as skin prick tests or blood tests, may be conducted to identify potential allergens contributing to EoE.

Treatment: The management of EoE in children involves several strategies, often tailored to the individual’s specific needs:

1. Dietary Management:
   • Elimination Diet: Identifying and eliminating specific trigger foods from the child’s diet is often the initial approach.
   • Elemental Diet: In severe cases or when dietary restrictions are challenging, an elemental formula (composed of amino acids) may be used as the primary source of nutrition.
2. Medications:
   • Proton Pump Inhibitors (PPIs): These medications may help reduce stomach acid and alleviate reflux symptoms.
   • Topical Steroids: Corticosteroid medications, typically in the form of a swallowed aerosolized medication, can reduce esophageal inflammation.
3. Dilation: In cases where the esophagus has become significantly narrowed due to scarring, a procedure called dilation may be necessary to widen the esophagus.
4. Long-Term Management: Many children with EoE require ongoing management to control symptoms and prevent complications. This often involves periodic endoscopic evaluations and dietary adjustments.

EoE is a chronic condition, and the goal of treatment is to achieve and maintain symptom control while minimizing inflammation and esophageal damage. Regular follow-up with a pediatric gastroenterologist is essential for monitoring the child’s progress and making necessary adjustments to their management plan. Early diagnosis and appropriate treatment can help children with EoE lead normal, healthy lives.