• Eosinophilic Esophagitis—Child

    Definition

    Eosinophilic esophagitis is an inflammation in the esophagus due to an overreaction of the immune system. The esophagus is the tube that delivers food from your mouth to your stomach. The swelling can make it difficult to swallow.
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    Causes

    Eosinophilic esophagitis is caused by the presence of eosinophils in the esophagus tissue. Eosinophils are a type of white blood cell that are part of the immune system associated with allergies. These cells are not normally found in the esophagus. High amount of eosinophils can cause swelling in the tissue.
    It is not completely clear why eosinophils appear in the esophagus. It is believed to be associated with a reaction to environmental or food allergens.

    Risk Factors

    Eosinophilic esophagitis is more common in males but can occur in females.
    Factors that may increase your child’s risk of eosinophilic esophagitis include:

    Symptoms

    Symptoms may include:
    • Difficulty swallowing
    • Food getting stuck in the esophagus
    • Nausea and vomiting
    • Poor weight gain
    • Unintended weight loss
    • Refusing food—babies may refuse to breastfeed or take a bottle
    • Burning in throat similar to heartburn
    • Stomach ache
    Heartburn (gastroesophageal reflux disease) can also cause swelling and similar symptoms. However, the swelling should decrease once the heartburn is managed. The swelling will continue with eosinophilic esophagitis.

    Diagnosis

    You will be asked about your child’s symptoms and medical history. A physical exam will be done.
    If eosinophilic esophagitis is suspected or the cause of symptoms is not clear the doctor may recommend an endoscopy. An endoscopy uses a special scope to view the tissue of the esophagus. The doctor can also take samples of tissue, called a biopsy, from the esophagus. The sample is then examined at a lab, where eosinophils can be seen.
    Your child may also be sent to a specialist for diagnosis or treatment.

    Treatment

    Eosinophilic esophagitis cannot be cured but certain steps can help manage the symptoms. Options include:
    Identifying and Avoiding Allergens
    Eating certain foods or swallowing and inhaling allergens like mold, pollen, or dust can worsen swelling. Skin prick testing, patch tests, and blood tests may help identify specific food and environmental allergies. An elimination diet may also help determine if foods are causing the swelling. This type of diet works best if supervised by a dietitian or physician.
    It’s not always possible to avoid environmental allergens but steps can be taken to decrease exposure. Avoiding trigger foods may also help manage eosinophilic esophagitis.
    Medication
    There is no specific treatment for eosinophilic esophagitis. Medications that may be used include:
      Steroid medications may help control swelling in the esophagus.
      • Oral steroids may be used for severe reactions.
      • Swallowing of inhaled forms of steroids may help milder symptoms or ongoing treatment.
    • Proton pump inhibitors to control acid production if gastroesophageal reflux disease is also present, which decreases inflammation and eosinophils

    Prevention

    There are no current guidelines to prevent eosinophilic esophagitis.

    RESOURCES

    American College of Allergy, Asthma & Immunology http://www.acaai.org

    National Organization for Rare Disorders http://www.rarediseases.org

    CANADIAN RESOURCES

    Canadian Allergy, Asthma, and Immunology Foundation http://www.allergyfoundation.ca

    Health Canada http://www.hc-sc.gc.ca

    References

    Eosinophilic esophagitis. American Academy of Allergy, Asthma, and Immunology website. Available at: http://www.aaaai.org/conditions-and-treatments/related-conditions/eosinophilic-esophagitis.aspx. Accessed August 22, 2017.

    Eosinophilic esophagitis. American College of Allergy, Asthma, and Immunology website. Available at: http://acaai.org/allergies/types/food-allergies/types-food-allergy/eosinophilic-esophagitis. Accessed August 22, 2017.

    Eosinophilic esophagitis. Cincinnati Children’s website. Available at: http://www.cincinnatichildrens.org/health/e/eosinophilic-esophagitis-ee/. Updated July 2014. Accessed August 22, 2017.

    Eosinophilic esophagitis. National Organization for Rare Disorders website. Available at: http://rarediseases.org/rare-diseases/eosinophilic-esophagitis/. Published 2016. Accessed August 22, 2017.

    Eosinophilic esophagitis in children. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T435298/Eosinophilic-esophagitis-in-children. Updated October 26, 2015. Accessed August 22, 2017.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Michael Woods, MD, FAAP
    • Review Date: 09/2017
    • Update Date: 10/03/2016
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