Family members should be tested if they have symptoms. Do children outgrow EoE? There is limited data on long-term outcomes of EoE. Can inflammation of the esophagus be cancerous? Limited adult data suggests that inflammation does not lead to cancer, but it is too early to know for sure. Any inflammatory process that persists from childhood to the adult years must be of concern. EoE reactions may not happen immediately. Are the symptoms of EoE the same in adults and children?
Symptoms are similar, but adults typically have difficulty swallowing or food getting stuck in the esophagus. Adults are more likely to have strictures that need to be dilated.
What is a stricture? EoE can cause changes in the tissue lining the esophagus that may result in a stricture, or narrowing of the esophagus.
This is thought to occur as a result of inflammation in some children and adults with EoE. Food may not be able to pass from the mouth to the stomach when a stricture forms.
How are strictures treated? Esophageal strictures are usually treated by dilation or stretching the esophagus. To do this, a long cylindrical rubber tube into the mouth and esophagus or by placing an inflatable balloon through the endoscope into the esophagus. These procedures can cause pain and tears in the esophagus. Patients and their families should discuss these procedures and understand the risks.
How is EoE diagnosed? Children with EoE usually show high numbers of eosinophils in the esophageal tissue. Greater than 15 eosinophils per high power field is generally considered suggestive of EoE. The endoscopist may mention seeing trachealization or furrowing rings in the esophagus, which is also suggestive of EoE. EoE can resemble other medical conditions.
Eosinophils may be seen in the esophagus in lower numbers in GERD patients. What is an endoscopy? An endoscopy, also referred to as upper endoscopy, esophagogastroduodenoscopy and EGD, is a test using a special camera to look at the lining of the esophagus, stomach and duodenum.
Small tissue samples, called biopsies, are taken to evaluate under a microscope. Sedation is usually required to perform the procedure. Learn more about endoscopy. What is a biopsy? In the case of EoE diagnosis, a biopsy is a small tissue sample taken from the lining of the gastrointestinal tract that can be looked at under a microscope to help diagnose EoE and other disorders.
How many biopsies should be taken to diagnose EoE? EoE is a patchy disorder, so usually four to six samples are taken to increase the likelihood of finding the disease if it is present. Is there a way to diagnose EoE without invasive tests or through a simple blood test? Medicines can also help manage and reduce symptoms associated with EoE.
Your doctor may first prescribe a proton pump inhibitor PPI , such as omeprazole. PPIs can help keep eosinophils from collecting in the esophagus in children as young as 1 year old.
They are commonly used for several weeks. Corticosteroids can help reduce the swelling in the esophagus. Fluticasone and budesonide are an inhaled corticosteroid ICS often used for asthma but when they are used for EoE, instead of being inhaled, they are swallowed.
When using an ICS like fluticasone for EoE, a spacer or valved holding chamber is not needed or recommended. When using budesonide for EoE, the nebulizer machine is not needed or recommended. The goal is to get the medicine into the esophagus by swallowing and not into the lungs by inhaling.
Schedule follow-up visits with your doctor to discuss the best plan. Visits should be every one to three months after diagnosis. The number of visits will depend on how severe the disease is. Once on a treatment plan, follow-up visits may be every six months to one year.
These visits will focus on answering your questions and how well treatment is working. This includes symptoms and response to medications. The doctor will check your child's weight and overall nutrition. At each visit, discuss how well diet therapy is working. If symptoms have been better for six months to a year, you or your child may be ready for a food trial. Ask if it is time to add restricted food back into the diet, or to change elemental formulas. A gastroenterologist or allergist can work with you to help make these decisions.
Review the medicines you or your child are taking with the allergist. PPIs are used for four to eight weeks. They can be stopped when you or your child feel better but may be needed in the future if symptoms come back. Corticosteroids can also be decreased and stopped when symptoms improve and resolve. You can also work with your doctor to decide if another endoscopy is needed. If there are problems with swallowing or food impactions, follow-up scopes may be needed for ongoing monitoring and treatment.
An EoE diagnosis can be overwhelming. Researchers are not certain about the exact cause of EoE. Certain genes may also play a role in EoE. There is no cure for EoE. Treatments can manage your symptoms and prevent further damage. The two main types of treatments are medicines and diet. Which treatment your health care provider suggests depends on different factors, including your age.
Some people may use more than one kind of treatment. Researchers are still trying to understand EoE and how best to treat it. If your treatment is not working well enough and you have narrowing of the esophagus, you may need dilation. This is a procedure to stretch the esophagus. This makes it easier for you to swallow. The information on this site should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.
What is eosinophilic esophagitis EoE? What causes eosinophilic esophagitis EoE? This test detects IgE circulating in the blood stream directed against an allergen and can be helpful in certain conditions linked to IgE-mediated food allergies. As previously noted, there are limitations to both prick skin testing and blood testing for IgE-mediated sensitivities in EoE in regard to accurately identifying foods that cause EoE. Unfortunately, serum specific immune assays that check for IgG antibodies to a large number of foods are also not helpful in identifying the foods that cause EoE.
Food patch testing is another type of allergy test that was previously thought to be useful in identifying foods triggering EoE in some patients. The patch test is done by placing a small amount of a fresh food in a small aluminum chamber called a Finn chamber. The food in the chamber stays in contact with the skin for 48 hours. It is then removed and the allergist reads the results at 72 hours. Areas of skin that came in contact with the food and became inflamed were thought to possibly identify a positive delayed reaction to the food.
Patch testing is no longer recommended for routine use in the evaluation of EoE. It is important to understand that skin prick tests, allergy blood tests and food patch tests can have false positive tests. This means that these tests may suggest you are sensitized to a food that you can tolerate and does not cause your EoE. They can also have false negative results, meaning that the test is negative to a food that is actually causing EoE.
Elimination diets, where foods suspected of causing EoE are removed from the diet, are an effective method for treating EoE see below. A small percentage of people develop an IgE-mediated food allergy to a food that has been removed from their diet for a long time to see if it causes their EoE.
These people can have an immediate allergic reaction when they eat the food again. Food Test-Directed Elimination Diets If you are noted to have specific food sensitivities after prick skin testing your doctor may remove specific foods from your diet to see if there is a reduction in EoE symptoms. In some individuals this helps control their EoE, though this type of diet has not shown to be very successful in research studies. Empiric Elimination Diets Eliminating the major food allergens from the diet is considered an acceptable treatment of EoE.
These diets have been shown to be very helpful in treating EoE, although they can be very difficult to follow, especially without the help of a dietitian with experience in dealing with EoE.
Foods are typically added back one at a time with follow up endoscopies to help determine which specific foods are causing EoE. Elemental Diets In this strict elimination diet, all sources of allergens are removed from the diet. The patient receives their nutrition from an amino acid formula alone or sometimes while allowing one to two simple foods chosen based on their low likelihood to trigger EoE. All other foods are removed from the diet.
A feeding tube may be needed in very young children treated with this diet, since they are often unable to drink enough of the formula to get adequate nutrition. This approach is generally reserved for children with multiple food allergies who have not responded to other forms of treatment.
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