Eosinophilic Oesophagitis

Key points about eosinophilic oesophagitis

• eosinophilic oesophagitis is a rare condition that causes tamariki and rangatahi to have difficulties with their swallowing tube (oesophagus)
• it is more common in tamariki with allergies, asthma and eczema
• eosinophilic oesophagitis is diagnosed by gastroscopy 
• the treatment for eosinophilic oesophagitis is dietary changes or medicines

What is eosinophilic oesophagitis?

The oesophagus (the food pipe) is the tube that connects the mouth to the stomach. When the oesophagus becomes inflamed, it's called oesophagitis. In eosinophilic oesophagitis, certain types of white blood cells, called eosinophils, build up in large numbers in the lining of the oesophagus. 

What causes eosinophilic oesophagitis?

The cause of eosinophilic oesophagitis has not yet been fully worked out. 

Tamariki and rangatahi with eosinophilic oesophagitis are more likely to have other allergic conditions like asthma, eczema and hay fever. 

Some tamariki and rangatahi with eosinophilic oesophagitis may be allergic to certain foods. Sometimes those foods can make the eosinophilic oesophagitis worse. 

What are the symptoms of eosinophilic oesophagitis?

The symptoms of eosinophilic oesophagitis may be different in tamariki and rangatahi. 

Common symptoms in tamariki

Reflux

Reflux is when food or drink comes back up from the stomach into the mouth. This can sometimes cause pain.

Difficulty swallowing

Some tamariki with eosinophilic oesophagitis can have difficulty swallowing, which can lead to:

• eating slowly 
• food getting stuck on the way down the oesophagus
• feeding difficulties 
• choking or gagging on food
• pain on swallowing

Other symptoms

Tamariki with eosinophilic oesophagitis may also:

• have stomach pain
• fail to gain weight 
• keep clearing their throat

Common symptoms in rangatahi

Reflux

Reflux is when food or drink comes back up from the stomach into the mouth. This can sometimes cause pain.

Difficulty swallowing

Rangatahi with eosinophilic oesophagitis can have trouble swallowing, which can lead to:

• food getting stuck on the way down the oesophagus
• chewing more
• needing to drink more water while eating solid foods
• chest pain when eating

 How is eosinophilic oesophagitis diagnosed?

A diagnosis of eosinophilic oesophagitis is based on:

• your child's symptoms
• how the oesophagus lining looks during a gastroscopy
• results from biopsies of the oesophagus taken during gastroscopy

Gastroscopy

If the doctor thinks your child has eosinophilic oesophagitis, your child will need a gastroscopy (also known as endoscopy). This involves putting a thin, flexible telescope (endoscope) through the mouth and down into the oesophagus. The endoscope has a tiny light and a camera at the end. This helps the doctor see the inside lining of the oesophagus to check for inflammation. Your child will have the procedure under general anaesthetic (they will be completely asleep). 

Biopsies

During the gastroscopy, the doctor can take tiny samples of tissue from the lining of the oesophagus. These tissue samples are called biopsies. Biopsies are looked at under a microscope at the laboratory. The results of these biopsies will help confirm whether or not your child has eosinophilic oesophagitis. Biopsies can also show how effective any treatment has been.

If my child has eosinophilic oesophagitis, who may be involved in their care?

Gastroenterologist

A gastroenterologist is a doctor who specialises in digestive tract conditions. If your child has a gastroscopy, a gastroenterologist will do this.  

Allergy specialist

Because eosinophilic oesophagitis can be related to allergies, your child may also see a doctor who specialises in allergies. 

Paediatrician

A paediatrician is a child health doctor. In some places, one of the hospital paediatricians may be the main person to look after your child. 

Dietitian

Specialist dietitians can help you with making changes to your child’s diet. 

How is eosinophilic oesophagitis treated?

Dietary changes 

Removing certain foods

Your child's doctor may advise you to remove certain foods from your child's diet. 

Foods that may cause problems with eosinophilic oesophagitis include:

• milk
• soy
• wheat
• eggs
• nuts
• seafood

A dietitian or allergy specialist can help you make changes to your child’s diet

Food reintroduction

After removing certain foods from your child's diet, you may be able to slowly reintroduce some of them, one by one. Your child's medical team will guide you on how and when to do this. Your child will need another gastroscopy to see if the changes have worked. 

Elemental diet

Some younger tamariki may benefit from an 'elemental diet'. This is a special milk formula that is made up of the simplest building blocks of protein (called amino acids). Amino acids are too small for the body to be allergic to, so are a good treatment for eosinophilic oesophagitis.  Elemental diets are commonly used for babies with eosinophilic oesophagitis. It is more difficult for older tamariki to manage an elemental diet as they have to stop all other food while taking it.

Medicine

Swallowed steroids

Corticosteroids are a type of anti-inflammatory steroid medicine that works well in eosinophilic oesophagitis. The corticosteroid fluticasone, is a common asthma treatment and comes in a puffer or inhaler. In eosinophilic oesophagitis you swallow the medicine instead of breathing it in. (With asthma, you breathe it in). Steroids also come in liquid form.

This video from Starship Child Health shows the right way to use a fluticasone inhaler to treat eosinophilic oesophagitis.

Proton pump inhibitors

A proton pump inhibitor is a medicine that comes as a tablet or liquid. It helps to reduce how much acid is made in your child's stomach. For some tamariki and rangatahi, it can also help to improve the inflammation in the oesophagus. 

Surgery

Dilatation

If the oesophagus becomes scarred or narrow from inflammation, your child can have a dilatation 'stretch' procedure (during a gastroscopy). It involves widening the narrowed parts of the oesophagus. This allows food to pass more easily to give short-term relief of symptoms. 

What happens after treatment is started? 

Your child will need to have another gastroscopy several months after they start treatment. During the gastroscopy, the doctor will take more biopsies to check that the treatment is working. Your child will continue to see their healthcare team for regular checkups. 

Is eosinophilic oesophagitis related to other conditions?

Around 75% of people with eosinophilic oesophagitis have other allergic medical conditions. This includes asthma, eczema and hay fever. It is important that your child also continues with their medicines for these other conditions.

See the KidsHealth page on allergy to learn more about allergies in young people

Getting support

Having a child diagnosed with eosinophilic oesophagitis can be overwhelming for your whānau. There is a lot to adjust to and learn. It will help to learn what you can from trusted sources such as your child's healthcare providers. You can also find support through support groups. ausEE Inc is a resource for whānau affected by eosinophilic disorders. It is a national charity in Australia, and they are happy to help Kiwi families.

See the KidsHealth section on allergies