What is Eosinophilic Esophagitis (EoE)?

Eosinophilic Esophagitis, also known as EoE may be a term that you have heard in recent years due to its increase in prevalence. EoE is a chronic, inflammatory medical condition that affects the esophagus and is considered a rare disease.  Found in 1 out of 2,000 people, it affects all ages, genders, and ethnicities but is slightly more common in males. It occurs due to an allergic response to food and/or environmental allergens which causes increased numbers of eosinophils in the esophagus.  Eosinophils are types of white blood cells that are not typically found in the esophagus and when present in increased amounts, cause inflammation and in some cases damage to the esophagus. What does this possibly mean for a child with EoE? It means that he or she may respond to EoE symptoms by avoiding or refusing foods, complaining of discomfort, developing altered mealtime behaviors, and in some cases, a caregiver or health care provider may notice poor growth or weight loss.

What are Some Signs and Symptoms of Eosinophilic Esophagitis?

It can be difficult to identify symptoms of EoE in children because they can vary in different age groups and they are not always consistent from one person to the next. Common symptoms often include:

• Reflux
• Difficulty swallowing or pain when swallowing
• Nausea and/or vomiting
• Poor weight gain, weight loss, or failure to thrive
• Stomach and/or chest pain
• Poor appetite and/or feeding refusal
• Food impactions (food getting stuck in esophagus)

While these symptoms can appear in any patient, some are more common in specific age groups. Younger children, such as infants and toddlers often have poor growth due to food aversions or food refusal. These children may also show signs of reflux and do not usually respond to acid suppression medication. In school aged children, stomach pain that doesn’t go away or pain and difficulty when swallowing foods is more common. Older children may experience something called a food impaction, where food becomes stuck in the esophagus due to narrowing of the esophagus. Vomiting can occur in all age groups and may cause confusion for parents due to commonly occurring viral illnesses in children – aka “stomach bugs”- that often cause similar symptoms.  So, the question becomes, how can you distinguish EoE from other GI related ailments?

How can I know for Sure if My Child Has EoE?

If you suspect EoE based on any of these symptoms, it is recommended to meet with a gastroenterologist who can help to reach a proper diagnosis. If there is a family history of EoE or swallowing difficulties or if your child is also experiencing eczema, food allergies, and/or asthma, there is increased concern for EoE complications. While an endoscopy can seem extreme, it may be recommended by your child’s allergist or gastroenterologist and is necessary for confirmation of diagnosis of EoE. An endoscopy is a procedure in which a flexible lighted instrument is used to examine different parts of the GI tract, such as the esophagus, stomach, and portions of the intestine. During the endoscopy, the doctor will look for signs of EoE- swelling and inflammation, rings, masses of cells, or narrowing. There will also be small tissue samples – known as biopsies – taken and these tissues will be observed under a microscope. If the child has at least 15 eosinophils per high powered microscope field in addition to other symptoms of esophageal dysfunction, there is a high possibility of EoE.¹  After it has been determined that there are no other sources contributing to increased eosinophils and dysfunction in the esophagus, a diagnosis of EoE can be made.

How do you Treat Eosinophilic Esophagitis?

A diagnosis for EoE can be overwhelming and so can the treatment options. EoE can be managed by medications, diet therapy, dilation, or a combination of these treatments. Challenges may arise with all treatment options; therefore, the response to treatment may help drive the decision.

Medication

• Proton Pump Inhibitors (PPI)
  • PPIs are acid suppression medications that are commonly used to treat reflux. They are often used initially in the treatment of EoE, due to their overall safety and ease of use. Although PPIs are often chosen as initial therapy, they may not be effective on their own.²
• Topical Steroids
  • These are administered by swallowing a steroid medication from an inhaler, commonly used to treat asthma or by drinking a mixture containing the medication, known as a slurry. This medication option is often chosen if PPIs haven been shown to be ineffective. There has been some concern for adrenal function or growth suppression with long term use; however, short term studies have shown swallowed steroids to be a safe treatment option for EoE.²

Dilation

• A procedure done to stretch the narrowed portion of the esophagus. This is often done if food has become stuck in the esophagus and is more commonly performed in older children or adults where the symptoms are often more progressed. While this procedure is effective for resolving food impactions, it does not treat the underlying inflammation.

Dietary Management

• Diet therapy can be challenging as there are no current tests to determine specific EoE food triggers. There are many things to consider when choosing the appropriate diet treatment for EoE and it is important to ensure that adequate nutrition and growth goals are achieved while following these restricted diets. Diet treatment is individualized based on input from the patient and health care provider and it can be very beneficial to have a registered dietitian experienced in working with patients who have EoE to help implement this treatment.³
  • Empiric Elimination Diet: A treatment that removes the most common food allergens. Different variations of this diet have been proven to be effective for certain individuals. One form of the diet recommends removing six food groups, another four food groups, two food groups, and even milk alone.
  • Test-directed Elimination Diet: This type of elimination diet is directed by the results of food allergy testing (skin prick or patch test).
  • Elemental Diet: This form of diet treatment requires the avoidance of food proteins by essentially removing all foods from the diet and relying on an amino acid-based formula, like Cambrooke’s EquaCare Jr. and Essential Care Jr. to meet all nutritional needs. While this diet can have a significant negative impact on quality of life, it is effective in inducing remission for a majority of children with EoE.

How can an amino acid-based formula support a child with EoE?

Regardless of treatment choice, an amino acid-based formula such as EquaCare Jr. or Essential Care Jr. can be beneficial to ensure adequate nutrient intake during periods of food restriction, food avoidance, or poor weight gain and growth. There can be a lot of questions and feelings of uncertainty with a diagnosis of EoE; however, children and their families can take comfort in knowing that amino acid-based formulas provide safe and complete nutrition without the risk of an EoE trigger. Cambrooke’s EquaCare Jr. and Essential Care Jr. formulas offer healthy, more affordable amino acid-based formula options for the parents of children with eosinophilic esophagitis as well as other food allergies and GI disorders. Learn more about each of these beneficial amino acid-base formulas visiting us online today or calling 1-833-377-2773.

1. https://www.choc.org/programs-services/eosinophilic-esophagitis/eoe/
2. https://www.gastrojournal.org/article/S00165085(20)302651/pdf
3. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/March-2017-EoE-dietary-management.pdf