Eosinophilic Oesophagitis

What is Eosinophilic Oesophagitis?

Eosinophilic oesophagitis also known as EoE, is a relatively newly recognized disease that is characterized by eosinophils (allergy cells) building up in the lining of the oesophagus.

The eosinophils cause inflammation in the oesophagus, which may cause the following symptoms:

  • Difficulty feeding, including feeding refusal and feeding intolerance

  • Poor weight gain

  • Decreased appetite

  • Chest pain

  • Abdominal pain

  • Reflux-like symptoms

  • Vomiting

  • Trouble swallowing

  • Food impaction (when food gets stuck in the throat)

The reasons why some people have EoE are not fully understood. Research has shown a strong connection between food allergies and EoE.  Environmental allergens may also play a role in this disease but more research is needed. What we do know is that EoE is a chronic disease that can be managed through diet and/or medical treatment. EoE is not life threatening; however, if left untreated it may cause permanent damage to the oesophagus.

Many patients with EoE also experience gastroesophageal reflux disease (GORD), a chronic digestive disorder that is caused by the abnormal flow of gastric acid from the stomach into the oesophagus. It is not uncommon for a patient to receive treatment for GORD while also undergoing treatment for EoE.

Children are probably not born with EoE but develop it over time. They may be born with a predisposition to the disorder.

Adults get EoE as well. It can develop in childhood and persist into adulthood. Some people first experience EoE as an adult or only receive a diagnosis once in adulthood. Overall increased awareness of the disorder has improved disease recognition and the need for endoscopic biopsies.

symptoms of EoE in infants
Infants with EoE usually have symptoms similar to reflux, including spitting up, irritability, vomiting and feeding refusal. Some children may also experience growth problems.

Symptoms  of EoE in toddlers
EoE symptoms in toddlers are similar to those in infants, but they may also complain of abdominal pain or have trouble transitioning to solids.

Symptoms of EoE in school-aged children

School-aged children may have reflux-like symptoms and may also vomit intermittently. They may have difficulty swallowing but this may be hard for them to explain.

Symptoms of EoE in older children and teens
Symptoms in older children and teens are similar to all of the other age groups, but may also include complaints about difficulty swallowing or food getting stuck in the oesophagus.

Diagnosis of EoE
EoE is diagnosed by a gastroscopy. Children with EoE usually show typical high numbers of eosinophils in the oesophageal tissue. Greater than 15 eosinophils per high power field is generally considered suggestive of EoE. The endoscopist may mention seeing macroscopic features such as oedema or furrowing in the oesophagus, which is also suggestive of EoE.

Is there a way to diagnose EoE without invasive tests or through a simple blood test?
Unfortunately, an endoscopy is the only way to positively diagnose EoE. Blood tests and stool tests may be necessary to help exclude other disorders, but no blood test is available to diagnose a primary eosinophilic disorder.

Treatment of  EoE
For children with EoE, the primary goal of treatment is to insure normal growth and development.  Steroids and/or dietary modifications are the most common therapies. Treatment regimens are often difficult to maintain and must be individualized according to each family’s concerns and lifestyles. 

What medications help EoE?
Some patients with EoE take “swallowed steroids” to destroy the eosinophils, fight inflammation and allow healing to take place. The products that are used for EoE treatment were originally studied in asthmatics. They are approved for use in children. In fact, some of the steroids are approved for children as young as 12 months. Some patients with EoE may also have allergy symptoms that require daily medications. Not every patient with EoE will need allergy medicine.

Are there side effects from topical steroids such as fluticasone and budesonide?
The human mouth and throat contain many organisms including bacteria and yeast. Sometimes when medications like these are taken, small amounts of residue remain on the surface of the mouth and throat. This change can allow yeast organisms to multiply and cause soreness and trouble swallowing.  This side effect can be eliminated by gargling with water and spitting after each use.



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