Eosinophilic Esophagitis in Children

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Eosinophilic esophagitis (EoE) is a chronic condition of the esophagus, the tube that connects the mouth to the stomach. EoE can affect a child’s ability to eat and thrive. Despite this, children can remain healthy and active if they are diagnosed early and receive ongoing care from a team of experts.

Duke pediatric gastroenterologists and pediatric allergists are specialists in diagnosing and treating EOE. Pediatricians refer children to us who are suspected of having the condition based on their symptoms. We also provide second opinions if your child has been seen elsewhere. We can confirm the diagnosis and start young children through teens on individualized treatment programs. We help you and your child learn to live with this chronic condition.

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About Eosinophilic Esophagitis

Eosinophilic esophagitis occurs when a type of white blood cell called an eosinophil accumulates in the esophagus and causes inflammation. While the exact cause of eosinophilic esophagitis is unknown, in some cases it may be caused by the immune system's response to certain foods. Eosinophils may also show up in the esophagus as a result of:

Gastroesophageal reflux disease (GERD)
Other types of esophagitis
Inflammatory bowel disease (IBD)
Infection

Children with EoE may experience trouble swallowing, vomiting, and other symptoms that can cause weight loss and failure to thrive. If eosinophilic esophagitis is left untreated, it can cause the esophagus to narrow, which can make swallowing even more difficult and lead to choking on food.

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Tests

Upper Endoscopy

A small tube with a camera at its tip is inserted through the mouth. This allows your gastroenterologist to view the esophagus, stomach, and duodenum, which make up the upper part of the GI tract. At the same time, a small sample of tissue may be removed from the esophagus to look for the presence of eosinophils, which confirms a diagnosis of EoE.

Transnasal Endoscopy (TNE)

This relatively new procedure allows your child’s gastroenterologist to evaluate the esophagus, stomach, and duodenum, perform biopsies, and obtain good-quality images, without sedation. Rather than pass an endoscope through the mouth to reach the upper gastrointestinal tract, a camera, about the size of a thick noodle, is passed through the nose, then down to the GI tract. Children can eat up until four hours before the procedure and return to their activities the same day.

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Treatment Options

Diet and medication are the primary treatments. They may be tried alone or in combination. Your child’s treatment is tailored to meet their and your family’s specific needs.

Elimination Diets

May eliminate specific food(s) that are suspected to cause immune-mediated inflammation in your child or are identified through an allergy test. The foods that are thought to be connected with EOE most often are dairy, wheat, egg, soy, nuts, and seafood, but other foods can be involved. The most common trigger is dairy. The goal of elimination diets is to identify your child’s specific trigger(s). A dietitian can provide individualized diet recommendations for your child.

Elemental Diet

Eliminates all foods that contain protein and provides nutrition in a liquid formula. This can result in a complete remission of symptoms in some people.

Topical Steroid Medications

Reduce inflammation in the tissue of the esophagus. Topical steroid medications can be prescribed as a swallowed powder through an inhaler to coat the esophagus.

Biologic Medications

Biologic medications target specific parts of the immune system and are often effective with little or low side effects. The newly FDA-approved medication, dupilumab, is an injection given at home that can help manage symptoms of EoE.

Consistently Ranked Among the Nation's Best Children's Hospitals

Duke Children's Hospital & Health Center is proud to be nationally ranked in 9 pediatric specialties.

Why Choose Duke

Every Child with EoE Is Different
As experts in diagnosing and treating eosinophilic esophagitis and other eosinophilic-related gastrointestinal disorders, we get to know your child and provide ongoing care that fits your family’s needs.

A Team of Dedicated Specialists
Our pediatric gastroenterologists, allergists, and dietitians are available to answer your questions and ensure you understand the challenging aspects of your child’s care.

Personalized Care
We consider the medical aspects of your child’s condition and your family’s lifestyle and preferences when we make treatment recommendations. As your child matures, we help you adjust their treatments to keep him or her healthy and active.

A Sense of Community
We understand that EoE can make your child feel isolated. You and your child can meet other families who can share their experiences with this condition. Sharing the challenges of EoE, along with stories about what works for others can help you feel more confident about your child’s health.

This page was medically reviewed on 04/15/2024 by

John L. Lyles, MD | Pediatric Gastroenterologist