Pediatric Eosinophilic Esophagitis

An upper endoscopy is necessary to make the diagnosis. This is a procedure done under anesthesia and passing a thin flexible tube with camera down from the mouth into the esophagus, stomach and initial part of the small intestine. During the procedure the physician might see abnormalities in the esophagus like deep lines called furrows, rings or collection of white spots ( usually allergic cells) or the esophagus can even look normal. The tissue samples from the esophagus are examined under the microscope for allergic cells called eosinophils. The child might get an X-ray called an Upper GI or Barium esophagram to make sure there is no narrowing of the esophagus and rule out other conditions that can affect the esophagus.

The treatment usually involves dietary changes. This might mean eliminating foods that a child is allergic to. Allergy testing can help in identifying foods that are problematic. The child might need to avoid one or several foods. The six most allergenic foods are cow’s milk, soy, eggs, nuts, fish and wheat. Sometimes completely broken down formulas called amino-acid based formulas can be given to a child if they are allergic to multiple foods or have poor growth. Medications are considered if dietary therapy fails or is not feasible. These include proton pump inhibitors and oral and topical corticosteroids.