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Eosinophilic esophagitis (EoE)EEosinophilic esophagitis (EoE)Eosinophilic esophagitis (EoE)EnglishGastrointestinalChild (0-12 years);Teen (13-18 years)EsophagusEsophagusConditions and diseasesCaregivers Adult (19+)NA2021-03-10T05:00:00Z10.000000000000052.00000000000002035.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Information for children, adolescents and their families about eosinophilic esophagitis (EoE), a disorder that involves inflammation and swelling of the esophagus.</p><h2>What is eosinophilic esophagitis (EoE)?</h2> <figure><span class="asset-image-title">Esophagus</span><img src="https://assets.aboutkidshealth.ca/akhassets/Esophagus_MED_ILL_EN.jpg" alt="Upper body of a boy with esophagus and stomach identified" /></figure> <p>EoE is a chronic allergic/immune disorder that involves the esophagus, the tube that leads from the back of the throat into the stomach. It is called “eosinophilic” esophagitis because eosinophils, a type of white blood cells, are the cause of the inflammation and swelling in the esophagus. This inflammation and swelling can make it difficult for your child to swallow food and, sometimes, medications or supplements. Food, medications and supplements may also even get stuck in the esophagus.</p><p>EoE can affect people of any age, gender and ethnic background. It is more likely to occur in those who have allergies (such as asthma), food and seasonal allergies and eczema. EoE seems to affect males more often than females (3 to 1) and can run in families. It is thought to occur in about one in 10,000 children and across all ethnic groups.</p><h2>Key points</h2><ul><li>Eosinophilic esophagitis (EoE), is a chronic allergic/immune disorder that involves inflammation and swelling of the esophagus, the tube that leads from the back of the throat into the stomach.</li><li>EoE can occur at any age, from infants to adults. The type of symptoms can vary with age.</li><li>Your child will undergo an <a href="https://www.aboutkidshealth.ca/Article?contentid=2472&language=English">upper endoscopy</a> to help diagnose EoE.</li><li>Treatment for EoE can include medications and/or diet changes. Your child’s health-care team will help create a treatment plan.</li></ul><h2>Symptoms of EoE</h2><p>Symptoms of EoE may be different between people and ages.</p><h3>Common EoE symptoms by age</h3><table class="akh-table"><thead><tr><th>Age group</th><th>Signs and symptoms</th></tr></thead><tbody><tr><td>Infant and child</td><td><ul><li>refusing to eat</li><li><a href="https://www.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a></li><li>acid reflux</li><li>regurgitation (bringing swallowed food up again to the mouth)</li><li>poor appetite</li><li>pocketing food</li><li>prolonged chewing</li><li>poor growth and weight gain</li></ul></td></tr><tr><td>Adolescent/teen</td><td><ul><li>trouble swallowing</li><li><a href="https://www.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a></li><li>acid reflux</li><li>regurgitation (bringing swallowed food up again to the mouth)</li><li>stomach pain</li><li>nausea</li><li>chest pain</li><li>prolonged chewing</li><li>food impaction (food gets stuck)</li><li>poor growth</li></ul></td></tr><tr><td>Young adult/adult</td><td><ul><li>acid reflux</li><li>regurgitation (bringing swallowed food up again to the mouth)</li><li>stomach pain</li><li>chest pain</li><li>difficulty swallowing</li><li>food impaction (food gets stuck)</li></ul></td></tr></tbody></table><p>A person with EoE may not experience symptoms every time they eat, and they may only experience symptoms when eating certain foods.</p><p>Sometimes, food can become firmly stuck in the esophagus. This is called a food impaction. Food impactions can be stressful and are more likely to occur when eating dry foods, like crackers, or foods that require a lot of chewing, like chicken or hot dogs. If the food does not pass with swallowing, drinking liquids or by coughing it up, you should take your child to the emergency room where an <a href="https://www.aboutkidshealth.ca/Article?contentid=2472&language=English">endoscopy</a> may be needed to take the food out of the esophagus.</p><h2>What causes eosinophilic esophagitis?</h2><p>Normally, there are no eosinophils in the esophagus. EoE happens when many eosinophils gather in the lining of the esophagus and release granules that cause inflammation. Eosinophils are a type of white blood cells that are made in the bone marrow. They are an important part of the immune system because they help to fight off certain types of infections. When there are too many eosinophils in one part of the body, they can cause inflammation. These cells also play a role in the mechanisms that cause <a href="https://www.aboutkidshealth.ca/Article?contentid=804&language=English">allergies</a> and <a href="https://www.aboutkidshealth.ca/Article?contentid=1470&language=English">asthma</a>.</p> <figure class="asset-c-80"><span class="asset-image-title">Eosinophil</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Eosinophil_MED_ILL_EN.jpg" alt="A cell with nucleus and granules identified" /> <figcaption class="asset-image-caption">An eosinophil is a type of white blood cell. It has a nucleus with two lobes and is filled with small granules. These granules contain proteins that are released into the lining of the esophagus, causing inflammation. Eosinophils are the same cells that are released when you eat something you are allergic to or if you get a parasite.</figcaption></figure> <p>The cause of EoE is not yet known, but several triggers likely play a role; and each person’s triggers can be different. Food allergies, sensitivities to food or environmental allergies may trigger eosinophils to gather in the lining of the esophagus. The most common foods that have been found to cause an EoE reaction are cow’s milk, wheat, soy, egg, peanut and tree nuts, and fish and seafood. Most people with EoE usually only react to one or two of these foods. People with environmental allergies, like a pollen or grass allergy, often experience EoE symptoms more often during “allergy season” (usually Spring and Fall).</p><p>People with EoE often have other allergic conditions such as <a href="https://www.aboutkidshealth.ca/Article?contentid=1470&language=English">asthma</a>, <a href="https://www.aboutkidshealth.ca/Article?contentid=773&language=English">eczema</a>, seasonal runny nose and sinus problems.</p><h2>Complications of EoE</h2><p>Over time, the inflammation triggered by eosinophils can cause fibers deep in the esophagus to become tough, making the esophagus stiffer and less stretchy. This is called fibrosis. Fibrosis may make it difficult for your child to swallow foods and/or cause food impactions (food to get stuck in the esophagus). If untreated, long-term fibrosis can lead to strictures (permanent narrowing of the esophagus).</p><h2>Diagnosis of EoE</h2><p>A visit to a paediatric gastroenterologist will help with both the diagnosis of EoE and the creation of a treatment plan for your child if EoE is confirmed.</p><p>If your child’s symptoms are suggestive of EoE, several tests may be ordered. Often, imaging tests called <a href="https://www.aboutkidshealth.ca/Article?contentid=1279&language=English">esophagus-stomach-duodenum (ESD) and esophagus-stomach-small-bowel (ESSB) tests</a> will be ordered to look for any narrowing of the esophagus. These tests use X-rays and a contrast medium to look at parts of the digestive system.</p><p>An <a href="https://www.aboutkidshealth.ca/Article?contentid=2472&language=English">upper endoscopy</a> will also be organized. During the endoscopy, the gastroenterologist will be able to see what the esophagus looks like from the inside and take samples of the lining of the esophagus, called biopsies. These biopsies are sent to a pathologist who will look under a microscope and count the number of eosinophils in the tissue samples. An upper endoscopy is performed to diagnose EoE, but also to follow and assess your child’s response to their treatment plan.</p><p>Your child may also be sent to see an allergist. If your child is diagnosed with an allergy, the allergist will determine if your child requires <a href="https://www.aboutkidshealth.ca/article?contentid=130&language=English">epinephrine (an EpiPen)</a> and provide guidance on how to use it.</p><h2>Treatment for EoE</h2><p>The main goal of treatment for EoE is to clear out the eosinophils in the esophagus. Over time, removing eosinophils from the esophagus lining helps decrease swelling and can even eliminate fibrosis.</p><p>You and your child will work with your child’s health-care team to decide which treatment approach is best. Your child’s team may include paediatric gastroenterologists, dietitians and nurses with knowledge of EoE. An allergist may also be involved in your child’s care.</p><p>There are several treatment choices for EoE. One type of treatment is not necessarily better than another. The two main types of treatment include medication and diet therapy. Some people with EoE respond well to one type of therapy, and some require both. Some people with EoE may also need to have a <a href="https://www.aboutkidshealth.ca/Article?contentid=3901&language=English">dilatation of the esophagus</a>, which is a procedure that helps open up any narrowing.</p><h2>Medication</h2><p>Two groups of medications are commonly used to treat EoE: topical steroids and proton pump inhibitors (PPIs).</p><h3>Topical steroids</h3><p>Your child may be prescribed a mild topical steroid medication such as budesonide or fluticasone. Topical steroids work at the surface of the esophagus lining to reduce inflammation. The purpose of this medication is to reduce the number of eosinophils in the esophagus and help your child with any symptoms of EoE, like difficulty swallowing. The steroids used are the same as those used in the inhalers used to treat asthma; but instead of inhaling the medication, it is swallowed.</p><p>Budesonide is a liquid that is mixed with a thickener and ingested so it coats and sticks to the esophagus on the way down. Budesonide is also available as a dissolving tablet. Fluticasone is a spray that your child sprays into their mouth. After waiting for a few seconds, it is swallowed with your child’s saliva. If your child takes the medication as directed, their symptoms should improve within days or weeks.</p><h3>Proton pump inhibitors (PPIs)</h3><p>Other frequently prescribed medication for EoE are PPIs such as <a href="https://www.aboutkidshealth.ca/article?contentid=204&language=English">omeprazole</a>, <a href="https://www.aboutkidshealth.ca/article?contentid=169&language=English">lansoprazole</a> or rabeprazole. The purpose of this medication is also to reduce the inflammation and number of eosinophils in the esophagus. PPIs reduce the production of stomach acid and can also help with symptoms of acid reflux.</p><h2>Diet therapy</h2><p>Dietary changes can also be used to treat EoE. This is called diet therapy. Some foods can trigger eosinophil production and inflammation. By removing these foods from the diet, symptoms of EoE and inflammation can be reduced.</p><p>Diet changes are guided by your child’s health-care team. The foods that are most commonly removed in order to treat EoE are cow’s milk and wheat (both often removed at the same time). However, your child’s health-care team will provide diet therapy advice that is specific to your child.</p><p>Sometimes, your child’s health-care team will suggest removing many foods from your child's diet all at once. This is called an EoE elimination diet. As part of managing your child’s EoE with diet therapy, the health-care team will make sure that your child gets enough energy (calories) and nutrients to grow and develop.</p><p>There are a few different ways to approach EoE elimination diets:</p><ol><li>Remove foods identified by an allergist.</li><li>Remove foods identified by an allergist and/or other foods known to worsen symptoms in EoE. This can include two, four, six or more foods. The most common foods known to trigger inflammation in EoE are cow’s milk, wheat, soy, eggs, peanuts and tree nuts, and fish and seafood.</li><li>Remove all foods from your child’s diet. This type of elimination diet is the strictest and is sometimes called elemental therapy. Your child is prescribed special liquid nutrition for four to eight weeks. During the time your child is on strict elimination therapy, they are not allowed to eat any other foods. After four to eight weeks, foods are slowly reintroduced into their diet while monitoring for symptoms of EoE. You should not attempt to try elimination therapy without the advice and supervision of your child’s health-care team.</li></ol><p>Your child’s health-care team may recommend a combination of medication and diet therapy. How well your child responds to therapies will be assessed by the reduction of symptoms and/or eosinophils seen in an esophagus biopsy.</p>
L’œsophagite éosinophiliqueLL’œsophagite éosinophiliqueEosinophilic esophagitis (EoE)FrenchGastrointestinalChild (0-12 years);Teen (13-18 years)EsophagusEsophagusConditions and diseasesAdult (19+) CaregiversNA2012-01-03T05:00:00ZHealth (A-Z) - ConditionsHealth A-Z<p>Information destinée aux parents et portant sur l’œsophagite éosinophilique, trouble douloureux qui rend la déglutition difficile.</p><h2>Qu’est-ce que l’œsophagite éosinophilique?</h2> <figure> <span class="asset-image-title">L’œsophage</span><img src="https://assets.aboutkidshealth.ca/akhassets/Esophagus_MED_ILL_FR.jpg" alt="La partie supérieure du corps d’un garçon avec l’œsophage et l’estomac identifiés" /> </figure> <p>L’œsophage est le tube qui fait passer la nourriture de la bouche à l’estomac. L’œsophagite éosinophilique est l’inflammation de l’œsophage.</p><p>L’œsophagite éosinophilique touche des patients de tout âge, des deux sexes et de toute origine ethnique. Il semble toutefois que les hommes en souffrent plus souvent que les femmes. Elle est congénitale dans certaines familles. Elle touche une personne sur 10 000.<br></p><h2>À retenir</h2><ul><li>L’œsophagite à éosinophiles est une maladie qui provoque le rétrécissement de l’œsophage, le tube situé entre la bouche et l’estomac qui sert à l’alimentation.</li><li>Les symptômes de l’œsophagite à éosinophiles comprennent, entre autres, des douleurs, un faible gain pondéral et de la difficulté à avaler ou à faire descendre les aliments dans l’œsophage.</li><li>Le diagnostic de la maladie peut exiger l’essai de plusieurs médicaments, une analyse sanguine et une endoscopie accompagnée de biopsies pour poser le diagnostic de l’œsophagite à éosinophiles.</li><li>La maladie peut être traitée avec des médicaments et des modifications apportées au régime alimentaire.</li></ul><h2>Symptômes de l’œsophagite éosinophilique</h2><p>Les symptômes diffèrent d’une personne à l’autre et varient selon l’âge.</p><p>Chez les enfants, les symptômes les plus fréquemment observés sont les suivants :</p><ul><li>reflux gastro-œsophagien (nourriture et acide de l’estomac remontant dans l’œsophage) qui ne répond pas aux traitements usuels</li><li>douleurs dans la poitrine et à l’abdomen (ventre)</li><li>manque d’appétit</li><li>enfant qui tarde à prendre du poids</li><li>retard de croissance</li><li>insomnie</li><li>dysphagie (difficulté à avaler)</li><li>aliments pris dans l’œsophage</li><li>nausée et vomissements</li></ul><h2>Quelles sont les causes de l’œsophagite éosinophilique?</h2><p>L’œsophagite éosinophilique se déclare lorsqu’un grand nombre de globules blancs, appelés éosinophiles, s’accumulent dans l’œsophage.</p><p>Un éosinophile est un type de globule blanc fabriqué par la moelle osseuse. Ils constituent un élément important du système immunitaire, car ils contribuent à combattre certains types d’infections. Ils peuvent cependant provoquer une inflammation lorsqu’ils sont trop nombreux dans une partie du corps. Ils jouent aussi un rôle dans le mécanisme des allergies et de l’asthme.</p><p>Nous ne savons pas trop ce qui déclenche l’œsophagite éosinophilique, peut-être des allergies alimentaires ou des facteurs environnementaux. Les personnes atteintes de cette inflammation souffrent souvent d’autres maladies allergiques : <a href="/Article?contentid=1470&language=French">asthme</a>, <a href="/Article?contentid=773&language=French">eczéma</a>, écoulements nasaux saisonniers et problèmes de sinus.<br></p><h2>Diagnostic de l’œsophagite éosinophilique</h2><p>Au premier rendez-vous de votre enfant chez son gastroentérologue, il se peut que le spécialiste lui prescrive un médicament contre le reflux gastro-œsophagien qu’il devra prendre de six à huit semaines.</p><p>Si ce médicament ne soulage pas ses symptômes, le gastroentérologue pourrait diagnostiquer une œsophagite éosinophilique et recommandera alors d’autres tests. Il prescrira une analyse sanguine, dont un hémogramme et une numération différentielle. Il est possible que l’hémogramme indique une abondance d’éosinophiles ou d’anticorps appelés immunoglobulines E. Bien que ces résultats laissent croire que le patient souffre peut-être d’œsophagite éosinophilique, ils ne sont pas suffisants pour la diagnostiquer. Par ailleurs, il peut être atteint de cette infection sans que les tests indiquent quoi que ce soit d’anormal.<br></p> <figure class="asset-c-80"><span class="asset-image-title">Éosinophile</span><img src="https://assets.aboutkidshealth.ca/akhassets/Eosinophil_MED_ILL_FR.jpg" alt="Un globule avec le noyau et les granulations identifiés" /><figcaption class="asset-image-caption">Un éosinophile est un type de globule blanc. Il a un noyau à deux lobes et est rempli de petits granulations.</figcaption> </figure> <p>La prochaine étape du diagnostic est une <a href="/Article?contentid=2472&language=French">endoscopie digestive haute</a> accompagnée de biopsies :</p><ul><li>On procède souvent à une endoscopie. L’endoscopie est une intervention où l’on insère par la bouche du patient un endoscope, qui consiste en un tube souple équipé à son extrémité d’une lampe et d’une minuscule caméra et qui sert à examiner l’œsophage, l’estomac et la première partie de l’intestin grêle.</li><li>La biopsie est l’action de prélever un petit morceau de tissu, puis de l’examiner au microscope.</li><li>Ces interventions aideront à poser le diagnostic. Si le patient a un grand nombre d’éosinophiles dans son œsophage, il est probablement atteint d’œsophagite éosinophilique.</li></ul><h2>Traitement de l’œsophagite éosinophilique</h2><p>Il existe plusieurs façons de traiter l’œsophagite éosinophilique, selon l’âge et l’état de santé général de votre enfant. Après le diagnostic, vous et votre famille vous réunirez avec l’équipe de soins de santé et opterez pour le meilleur traitement. C’est une décision que la famille et l’équipe de soins de santé doivent prendre en commun. Nous discuterons ici des options de traitement les plus fréquentes.</p><h3>Médicaments</h3><p>Il se peut qu’on prescrive à votre enfant l’un des deux stéroïdes légers suivants, en vue de réduire le nombre d’éosinophiles dans son œsophage et de l’aider à mieux avaler :</p><ul><li><a href="/Article?contentid=87&language=French">budésonide</a></li><li><a href="/Article?contentid=143&language=French">fluticasone</a></li></ul><p>Le choix de l’un plutôt que l’autre dépend de l’âge de votre enfant.</p><p>S’il suit les recommandations de son médecin lorsqu’il prend ses médicaments, ses symptômes devraient s’améliorer au bout de quelques jours ou de quelques semaines.</p><h3>Changement de régime alimentaire</h3><p>Certains enfants atteints d’œsophagite éosinophilique découvrent que leurs symptômes empirent parfois lorsqu’ils consomment certains aliments. Ils pourraient peut-être les améliorer en modifiant un peu leur régime. C’est ce qu’on appelle un traitement diététique. C'est votre équipe de soins de santé qui vous guidera en ce sens. Il se peut qu’on recommande votre enfant à un allergologue, qui aidera à déterminer si certains aliments causent les symptômes de l’œsophagite éosinophilique. Il arrive que, même si votre enfant prend les médicaments prescrits et suit un régime simple, il continue de manifester des symptômes difficiles à gérer. Si c’est le cas, l’équipe de soins de santé peut vous suggérer d’éliminer complètement certains aliments du régime de votre enfant. C’est ce qu’on appelle un régime d’élimination.</p><p>Il existe trois types de régimes d’élimination :</p><ol><li>Éliminer les aliments interdits par l’allergologue.</li><li>Éliminer d’autres aliments, notamment une partie ou la totalité des groupes alimentaires importants dont on sait qu’ils empirent les symptômes chez plusieurs patients souffrant d’œsophagite éosinophilique : le lait, le soya, les arachides, les noix, les œufs, le blé et les fruits de mer.</li><li>Le dernier type est le plus strict. Il peut toutefois aider à découvrir quels aliments empirent les symptômes. De quatre à six semaines, on prescrira à votre enfant un régime spécial à base d’un liquide nutritif particulier. Pendant cette période, il ne pourra consommer aucun autre aliment. Au bout de ce délai, on introduira graduellement d’autres aliments, et vous et l’équipe de soins de santé vérifierez si ses symptômes réapparaissent.</li></ol><p>Aucun de ces régimes n’est facile. L’équipe de soins de santé évaluera votre enfant et discutera des options avec votre famille.</p>

 

 

 

 

Eosinophilic esophagitis (EoE)824.000000000000Eosinophilic esophagitis (EoE)Eosinophilic esophagitis (EoE)EEnglishGastrointestinalChild (0-12 years);Teen (13-18 years)EsophagusEsophagusConditions and diseasesCaregivers Adult (19+)NA2021-03-10T05:00:00Z10.000000000000052.00000000000002035.00000000000Health (A-Z) - ConditionsHealth A-Z<p>Information for children, adolescents and their families about eosinophilic esophagitis (EoE), a disorder that involves inflammation and swelling of the esophagus.</p><h2>What is eosinophilic esophagitis (EoE)?</h2> <figure><span class="asset-image-title">Esophagus</span><img src="https://assets.aboutkidshealth.ca/akhassets/Esophagus_MED_ILL_EN.jpg" alt="Upper body of a boy with esophagus and stomach identified" /></figure> <p>EoE is a chronic allergic/immune disorder that involves the esophagus, the tube that leads from the back of the throat into the stomach. It is called “eosinophilic” esophagitis because eosinophils, a type of white blood cells, are the cause of the inflammation and swelling in the esophagus. This inflammation and swelling can make it difficult for your child to swallow food and, sometimes, medications or supplements. Food, medications and supplements may also even get stuck in the esophagus.</p><p>EoE can affect people of any age, gender and ethnic background. It is more likely to occur in those who have allergies (such as asthma), food and seasonal allergies and eczema. EoE seems to affect males more often than females (3 to 1) and can run in families. It is thought to occur in about one in 10,000 children and across all ethnic groups.</p><h2>Key points</h2><ul><li>Eosinophilic esophagitis (EoE), is a chronic allergic/immune disorder that involves inflammation and swelling of the esophagus, the tube that leads from the back of the throat into the stomach.</li><li>EoE can occur at any age, from infants to adults. The type of symptoms can vary with age.</li><li>Your child will undergo an <a href="https://www.aboutkidshealth.ca/Article?contentid=2472&language=English">upper endoscopy</a> to help diagnose EoE.</li><li>Treatment for EoE can include medications and/or diet changes. Your child’s health-care team will help create a treatment plan.</li></ul><h2>Symptoms of EoE</h2><p>Symptoms of EoE may be different between people and ages.</p><h3>Common EoE symptoms by age</h3><table class="akh-table"><thead><tr><th>Age group</th><th>Signs and symptoms</th></tr></thead><tbody><tr><td>Infant and child</td><td><ul><li>refusing to eat</li><li><a href="https://www.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a></li><li>acid reflux</li><li>regurgitation (bringing swallowed food up again to the mouth)</li><li>poor appetite</li><li>pocketing food</li><li>prolonged chewing</li><li>poor growth and weight gain</li></ul></td></tr><tr><td>Adolescent/teen</td><td><ul><li>trouble swallowing</li><li><a href="https://www.aboutkidshealth.ca/Article?contentid=746&language=English">vomiting</a></li><li>acid reflux</li><li>regurgitation (bringing swallowed food up again to the mouth)</li><li>stomach pain</li><li>nausea</li><li>chest pain</li><li>prolonged chewing</li><li>food impaction (food gets stuck)</li><li>poor growth</li></ul></td></tr><tr><td>Young adult/adult</td><td><ul><li>acid reflux</li><li>regurgitation (bringing swallowed food up again to the mouth)</li><li>stomach pain</li><li>chest pain</li><li>difficulty swallowing</li><li>food impaction (food gets stuck)</li></ul></td></tr></tbody></table><p>A person with EoE may not experience symptoms every time they eat, and they may only experience symptoms when eating certain foods.</p><p>Sometimes, food can become firmly stuck in the esophagus. This is called a food impaction. Food impactions can be stressful and are more likely to occur when eating dry foods, like crackers, or foods that require a lot of chewing, like chicken or hot dogs. If the food does not pass with swallowing, drinking liquids or by coughing it up, you should take your child to the emergency room where an <a href="https://www.aboutkidshealth.ca/Article?contentid=2472&language=English">endoscopy</a> may be needed to take the food out of the esophagus.</p><h2>What causes eosinophilic esophagitis?</h2><p>Normally, there are no eosinophils in the esophagus. EoE happens when many eosinophils gather in the lining of the esophagus and release granules that cause inflammation. Eosinophils are a type of white blood cells that are made in the bone marrow. They are an important part of the immune system because they help to fight off certain types of infections. When there are too many eosinophils in one part of the body, they can cause inflammation. These cells also play a role in the mechanisms that cause <a href="https://www.aboutkidshealth.ca/Article?contentid=804&language=English">allergies</a> and <a href="https://www.aboutkidshealth.ca/Article?contentid=1470&language=English">asthma</a>.</p> <figure class="asset-c-80"><span class="asset-image-title">Eosinophil</span> <img src="https://assets.aboutkidshealth.ca/akhassets/Eosinophil_MED_ILL_EN.jpg" alt="A cell with nucleus and granules identified" /> <figcaption class="asset-image-caption">An eosinophil is a type of white blood cell. It has a nucleus with two lobes and is filled with small granules. These granules contain proteins that are released into the lining of the esophagus, causing inflammation. Eosinophils are the same cells that are released when you eat something you are allergic to or if you get a parasite.</figcaption></figure> <p>The cause of EoE is not yet known, but several triggers likely play a role; and each person’s triggers can be different. Food allergies, sensitivities to food or environmental allergies may trigger eosinophils to gather in the lining of the esophagus. The most common foods that have been found to cause an EoE reaction are cow’s milk, wheat, soy, egg, peanut and tree nuts, and fish and seafood. Most people with EoE usually only react to one or two of these foods. People with environmental allergies, like a pollen or grass allergy, often experience EoE symptoms more often during “allergy season” (usually Spring and Fall).</p><p>People with EoE often have other allergic conditions such as <a href="https://www.aboutkidshealth.ca/Article?contentid=1470&language=English">asthma</a>, <a href="https://www.aboutkidshealth.ca/Article?contentid=773&language=English">eczema</a>, seasonal runny nose and sinus problems.</p><h2>Complications of EoE</h2><p>Over time, the inflammation triggered by eosinophils can cause fibers deep in the esophagus to become tough, making the esophagus stiffer and less stretchy. This is called fibrosis. Fibrosis may make it difficult for your child to swallow foods and/or cause food impactions (food to get stuck in the esophagus). If untreated, long-term fibrosis can lead to strictures (permanent narrowing of the esophagus).</p><h2>Diagnosis of EoE</h2><p>A visit to a paediatric gastroenterologist will help with both the diagnosis of EoE and the creation of a treatment plan for your child if EoE is confirmed.</p><p>If your child’s symptoms are suggestive of EoE, several tests may be ordered. Often, imaging tests called <a href="https://www.aboutkidshealth.ca/Article?contentid=1279&language=English">esophagus-stomach-duodenum (ESD) and esophagus-stomach-small-bowel (ESSB) tests</a> will be ordered to look for any narrowing of the esophagus. These tests use X-rays and a contrast medium to look at parts of the digestive system.</p><p>An <a href="https://www.aboutkidshealth.ca/Article?contentid=2472&language=English">upper endoscopy</a> will also be organized. During the endoscopy, the gastroenterologist will be able to see what the esophagus looks like from the inside and take samples of the lining of the esophagus, called biopsies. These biopsies are sent to a pathologist who will look under a microscope and count the number of eosinophils in the tissue samples. An upper endoscopy is performed to diagnose EoE, but also to follow and assess your child’s response to their treatment plan.</p><p>Your child may also be sent to see an allergist. If your child is diagnosed with an allergy, the allergist will determine if your child requires <a href="https://www.aboutkidshealth.ca/article?contentid=130&language=English">epinephrine (an EpiPen)</a> and provide guidance on how to use it.</p><h2>Treatment for EoE</h2><p>The main goal of treatment for EoE is to clear out the eosinophils in the esophagus. Over time, removing eosinophils from the esophagus lining helps decrease swelling and can even eliminate fibrosis.</p><p>You and your child will work with your child’s health-care team to decide which treatment approach is best. Your child’s team may include paediatric gastroenterologists, dietitians and nurses with knowledge of EoE. An allergist may also be involved in your child’s care.</p><p>There are several treatment choices for EoE. One type of treatment is not necessarily better than another. The two main types of treatment include medication and diet therapy. Some people with EoE respond well to one type of therapy, and some require both. Some people with EoE may also need to have a <a href="https://www.aboutkidshealth.ca/Article?contentid=3901&language=English">dilatation of the esophagus</a>, which is a procedure that helps open up any narrowing.</p><h2>Medication</h2><p>Two groups of medications are commonly used to treat EoE: topical steroids and proton pump inhibitors (PPIs).</p><h3>Topical steroids</h3><p>Your child may be prescribed a mild topical steroid medication such as budesonide or fluticasone. Topical steroids work at the surface of the esophagus lining to reduce inflammation. The purpose of this medication is to reduce the number of eosinophils in the esophagus and help your child with any symptoms of EoE, like difficulty swallowing. The steroids used are the same as those used in the inhalers used to treat asthma; but instead of inhaling the medication, it is swallowed.</p><p>Budesonide is a liquid that is mixed with a thickener and ingested so it coats and sticks to the esophagus on the way down. Budesonide is also available as a dissolving tablet. Fluticasone is a spray that your child sprays into their mouth. After waiting for a few seconds, it is swallowed with your child’s saliva. If your child takes the medication as directed, their symptoms should improve within days or weeks.</p><h3>Proton pump inhibitors (PPIs)</h3><p>Other frequently prescribed medication for EoE are PPIs such as <a href="https://www.aboutkidshealth.ca/article?contentid=204&language=English">omeprazole</a>, <a href="https://www.aboutkidshealth.ca/article?contentid=169&language=English">lansoprazole</a> or rabeprazole. The purpose of this medication is also to reduce the inflammation and number of eosinophils in the esophagus. PPIs reduce the production of stomach acid and can also help with symptoms of acid reflux.</p><h2>Diet therapy</h2><p>Dietary changes can also be used to treat EoE. This is called diet therapy. Some foods can trigger eosinophil production and inflammation. By removing these foods from the diet, symptoms of EoE and inflammation can be reduced.</p><p>Diet changes are guided by your child’s health-care team. The foods that are most commonly removed in order to treat EoE are cow’s milk and wheat (both often removed at the same time). However, your child’s health-care team will provide diet therapy advice that is specific to your child.</p><p>Sometimes, your child’s health-care team will suggest removing many foods from your child's diet all at once. This is called an EoE elimination diet. As part of managing your child’s EoE with diet therapy, the health-care team will make sure that your child gets enough energy (calories) and nutrients to grow and develop.</p><p>There are a few different ways to approach EoE elimination diets:</p><ol><li>Remove foods identified by an allergist.</li><li>Remove foods identified by an allergist and/or other foods known to worsen symptoms in EoE. This can include two, four, six or more foods. The most common foods known to trigger inflammation in EoE are cow’s milk, wheat, soy, eggs, peanuts and tree nuts, and fish and seafood.</li><li>Remove all foods from your child’s diet. This type of elimination diet is the strictest and is sometimes called elemental therapy. Your child is prescribed special liquid nutrition for four to eight weeks. During the time your child is on strict elimination therapy, they are not allowed to eat any other foods. After four to eight weeks, foods are slowly reintroduced into their diet while monitoring for symptoms of EoE. You should not attempt to try elimination therapy without the advice and supervision of your child’s health-care team.</li></ol><p>Your child’s health-care team may recommend a combination of medication and diet therapy. How well your child responds to therapies will be assessed by the reduction of symptoms and/or eosinophils seen in an esophagus biopsy.</p><h2>Living with eosinophilic esophagitis</h2><p>Beyond the goal of reducing inflammation and EoE symptoms, it is important to help support your child’s growth, development and quality of life (like their participation in everyday activities). Coping with a chronic condition like EoE may involve taking medications every day or following dietary restrictions—even when your child feels well—and sticking to these routines can be hard for anyone, especially children or teens. It can also be stressful for parents and caregivers. If you or your child are having trouble dealing with the treatment of EoE, remember:</p><ul><li>Keep the lines of communication open between you, your child and their health-care team.</li><li>Be sure to let your child know that it is normal to feel sad or anxious.</li><li>Assure your child that taking their medications every day and/or following diet therapy will help them to lead a healthy life.</li><li>Let your child know it is important to talk about their feelings with a parent or a doctor.</li></ul><p>It is important that adolescents with EoE have an active role in understanding their condition and managing their clinic visits and therapy plans. As your child gets ready to move into adult care (after the age of 18) their team will assess their EoE status and follow-up care.</p><h2>Follow-up care</h2><p>In general, your child will be followed regularly by a paediatric gastroenterologist and, in some cases, by a team that may include a dietitian, nurse and allergist.</p><p>EoE is a chronic condition that requires ongoing observation and management. It is not currently known how long EoE has to be present before strictures (narrowing of the esophagus) form. There is little data that suggests EoE causes cancer of the esophagus, and EoE does not appear to affect life expectancy. What is known about the natural history and course of EoE continues to evolve, so close monitoring and long-term follow-up of your child is advised.</p>https://assets.aboutkidshealth.ca/akhassets/Esophagus_MED_ILL_EN.jpgEosinophilic esophagitis (EoE)False

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