Some children with extreme picky eating have a medical condition called eosinophilic esophagitis, or EoE. Learn about the signs and symptoms of this condition.
I’ve had several clients over the years who come to me for extreme picky eating. Through my assessment, I find signs that suggest a medical condition called eosinophilic esophagitis (EoE).
This condition can be the cause of ARFID (Avoidant Restrictive Food Intake Disorder) and extreme pickiness.
In this article, you’ll learn:
- The definition of eosinophilic esophagitis
- The symptoms of EoE
- Who’s at risk for developing this condition
- How the condition is diagnosed
- Treatment, including diet changes, and medications
What is Eosinophilic Esophagitis (EoE)?
Eosinophilic esophagitis is part food allergy and part swallowing disorder. It’s a chronic condition of the immune system, identified by the medical community in recent decades. Diagnosis rates have been increasing over the last 10 years, similar to the increasing rates of allergy and asthma diagnoses.
Eosinophils are white blood cells normally found in your digestive tract, but with EoE disease, they gather in build up in the esophagus (throat). High eosinophils cause swelling.
Chronic swelling can lead to scarring and narrowing of the esophagus over time, leading to the formation of scar tissue in the lining of the esophagus called strictures.
What causes eosinophils to build up in the esophagus? The body is responding to a food allergen, or other allergens like pollen, or it’s caused by long-term gastric acid reflux.
About 50% of people with EoE also have seasonal allergies or asthma. The damage caused by eosinophils in the esophagus makes it difficult to swallow, or may lead to a feeling that food is stuck in the throat.
What are the EoE Symptoms?
Symptoms of eosinophilic esophagitis in children and adults differ. Depending on the age of the child, symptoms may be hard to pinpoint. Let’s look at the differences:
Signs of EoE in Adults
Adults may have a variety of symptoms, including:
- Difficulty swallowing, also known as dysphagia
- Food impaction (food getting lodged in throat)
- Chest pain similar to heartburn, which does not resolve with antacids
- Upper abdominal pain
- Symptoms that don’t resolve with gastroesophageal reflux disease (GERD) medication
- Regurgitation (backflow of undigested food)
Children’s Symptoms of Eosinophilic Esophagitis
The following symptoms may be a sign of EoE in your child (remember, older children and teens may show the signs seen in adults, as well):
- Problems with feeding
- Tummy pain
- Trouble swallowing
- A sense of food being lodged in throat
- Poor weight gain and growth (e.g., failure to thrive, malnutrition, and nutrient deficiencies)
- Non-responsive to medications for GERD (reflux)
Who is at Risk for Esophagitis?
There are several factors which make developing this condition more likely, but the evidence linking how, when, and if eosinophilic esophagitis will occur is still emerging.
The following risk factors have been identified:
Eosinophilic esophagitis is more common in boys than girls.
EoE seems to be genetically related; if a family member has EoE, the risk is higher for someone else in the family to develop EoE.
Allergies and Asthma:
Those individuals with food allergies, environmental allergies, and asthma are at a higher risk for developing EoE.
Living in a cold or dry climate increases your risk for EoE.
Seasons of the Year:
Individuals are more likely diagnosed between spring and fall when environmental allergens are higher and people are outdoors more often.
How is Eosinophilic Esophagitis Diagnosed?
If your child is suspected to have EoE, several tests may be performed, including an upper endoscopy and/or biopsy of the esophagus.
An upper endoscopy uses a long narrow tube with a camera on the end. This is inserted through the mouth and down the esophagus, allowing the doctor to view the esophagus and look for swelling (a sign of increased eosinophils), or any other signs associated with EoE.
A biopsy involves taking a sample of the esophagus tissue from several locations (usually two to four).
Additional tests, such as blood tests, medications, a food patch test, and diet modifications may be used to confirm the diagnosis.
EoE Treatment: How We Help Children
EoE is a chronic, relapsing disease requiring ongoing treatment.
Here are the most common treatment approaches:
Diet Changes and Modifications
The protein in these foods must be removed from the diet on a long-term basis in order for the symptoms to resolve.
The irony of EoE is that your child’s body may be reacting to a food they eat everyday – like wheat found in bread, pasta and cereal. You may not realize these foods are a problem. That’s because the allergic response is internal (in the throat) and low-grade, unlike a traditional food allergy.
If you learn that a food or more than one food is causing symptoms, those foods must be removed from the diet.
Elemental diets are sometimes used to get rid of all food sources of protein while covering your child’s nutritional requirements, especially if multiple foods need to be removed from the diet.
Some cases of EoE require significant dietary changes. In other cases, special formulas that are allergen-free and made with amino acids (the broken down form of protein) are used to ensure enough nutrition is provided while taking out the whole protein allergen from food.
You can imagine how challenging it would be to feed a child who is allergic to multiple allergens like egg, wheat and dairy which are widespread in our food supply!
Medications for EoE
Several medications may be used in the treatment of EoE. Typically, an acid blocker is tried first, but some people don’t show improvement.
A topical steroid applied to the interior of the throat may be used. This can help relieve swelling in some individuals without the side effects associated with steroids.
If these medications don’t work, steroids, such as prednisone, may be prescribed.
Steroids may decrease eosinophils and allow the throat to heal. Some individuals may be on steroids for an ongoing basis.
Dilation for Eosinophilic Esophagitis
Some people will experience narrowing of the esophagus, known as strictures. In this case, a procedure called dilation may be recommended. This procedure widens the esophagus and makes swallowing easier. However, there are risks of tearing of the esophagus, so discuss this option carefully with your doctor.
Want to Learn More?
Read: The ARFID Guide for suspicion of ARFID in children.
Be sure to check out The Ultimate Guide to Feeding the Picky Eater!
Listen: The Best of Extreme Picky Eating
Got a child with ADHD? Check out my resources.