Eosinophilic esophagitis or reflux? Signs your child has EoE

Could your child’s picky eating or spitting up be something more? Dr. Jay Lieberman, a pediatric allergist/immunologist, discusses eosinophilic esophagitis, an allergic inflammation of the esophagus.

If you can’t pronounce that long “E” word, I don’t blame you. Let’s just call it “EoE.”

EoE is essentially a form of food allergy but atypical. With EoE, a child can eat a food every day and not know it is slowly causing a build-up of inflammation in their food pipe. Once a child has inflammation in his or her food pipe, he or she can start to develop any number of symptoms. 

In infants, EoE can just look like colic. Children are fussy eaters or spit up a lot. We typically do not get worried about EoE in these children, however, until they fail to grow or to thrive. After all, the majority of infants with these symptoms WILL NOT have EoE.

 In toddlers and children, we often see EoE presenting with symptoms of chronic abdominal pain. Some kids will also complain of chronic nausea and/or vomiting. Many parents will report that the child just throws up a lot, often at home and at school. These symptoms can also be due to other causes, so we definitely recommend seeing a pediatrician first for these symptoms and ruling out more common causes before seeking a diagnosis of EoE.

As children get older, they may start to complain more about trouble swallowing or food getting caught in their throat. These are symptoms that may be more suggestive of EoE, rather than typical reflux. If a child has issues of food getting caught or “hung up” in their throat, of if they have ever had to go to the emergency department due to this, it is more than reasonable to consider that they may have EoE.

Small signs that can tip you off to EoE or other problems in the esophagus are:

• excessive chewing
• eating very slowly
• cutting up food into tiny pieces
• avoiding food that has gotten "hung up" before, such as steak

Many patients will have a grandparent, aunt, uncle, cousin, parent, etc. who has to have their food pipe stretched every few years.

In the end, EoE can only be diagnosed with a biopsy, which is taken during a procedure in which the patient is asleep (an endoscopy). Thus, we like to rule out other causes of these symptoms before we submit our patients to this. Once the diagnosis is established, there are various treatment options to both improve the inflammation and the symptoms in these patients.