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Definition

Eosinophilic esophagitis is an inflammation in the esophagus, 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 a build up of eosinophils in the esophagus. Eosinophils are a type of white blood cell. They gather in tissue during an allergic reaction and cause swelling. Eosinophils should not be found in the esophagus.

It is not clear why this happens. It is a problem with the immune system that may be a reaction to things in the air or an allergy to some food.

Risk Factors

The risk of eosinophilic esophagitis may be higher in those with:

Symptoms

Symptoms may include:

  • Hard time swallowing
  • Food gets stuck in the esophagus
  • Nausea and vomiting
  • Poor weight gain
  • Unexplained weight loss
  • Babies may refuse to breastfeed or take a bottle
  • Burning in throat similar to heartburn
  • Stomach ache

Diagnosis

The doctor will ask about child’s symptoms and past health. A physical exam will be done.

An endoscopy may be done. The doctor can use the scope to examine the esophagus. A sample of tissue may also be taken. The lab can look for signs of problems such as eosinophils.

A specialist may be needed for diagnosis or treatment. An immunologist focuses on allergies.

Treatment

Eosinophilic esophagitis cannot be cured. Treatment can help manage the symptoms. Steps may include:

Find and Avoid Allergens

Some foods or allergens like mold, pollen, or dust can make swelling worse. Allergy tests can help to find what is causing problems. An elimination diet may help to find what foods are making swelling worse. This type of diet works best if done with a dietitian or doctor.

Once allergens are known, steps can be taken to avoid or reduce contact with them. This can decrease swelling and other symptoms.

Medicine

Medicine will be based on each persons needs. Some medicine that may help includes:

  • Steroid medications may help control swelling in the esophagus. It may be taken as pills or inhaled mist.
  • Proton pump inhibitors to treat gastroesophageal reflux disease (GERD) if present.

Prevention

There are no steps 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

Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA, American College of Gastroenterology. (ACG) clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013 May;108(5):679-92.

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, 2020.

Eosinophilic esophagitis in children. EBSCO DynaMed website. Available at:  https://www.dynamed.com/condition/eosinophilic-esophagitis-in-children  . Accessed August 22, 2020.

Papadopoulou A, Koletzko S, Heuschkel R, et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Eosinophilic Esophagitis Working Group and the Gastroenterology Committee. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr. 2014 Jan;58(1):107-18.

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