What do eosinophils do when they invade tissue? Dellon: They have a lot of different functions. In the GI tract, eosinophils are normally found in the stomach, small bowel, and colon. When they come into the esophagus in high numbers, they do a number of things. They have a lot of toxic chemicals and factors that they contain. When those are released in the esophagus, it causes swelling, it causes irritation with the lining to become very delicate.
It can tear, and then that in turn causes scar tissue to be laid down. Sometimes the entire esophagus can become very narrow, almost like a straw. It can become very difficult to swallow. Falk: What drives the eosinophil to the esophagus, this unusual place for it to be? We think EoE is caused by allergies. In a lot of people, it seems to be food allergies. We know that, because if you take away a lot of different foods or give people an allergy-free diet, many of them get better right away.
We also know that it can be caused and driven by environmental allergies, like pollen or other things in the environment. We know a lot about the type of allergy reaction that is triggered. It sounds like the incidence of this disease, perhaps unrecognized in the past, but now quite prevalent, is being driven by something in the environment. What is it? Dellon: Absolutely. Something has clearly changed.
The incidence is increasing. What may cause it in the environment? Well a lot of things have changed in the environment over the last thirty years. These could all be contributing to environmental factors. There may be differences in pesticides or air pollution. Dellon: Yes. In kids, the food elimination diet was initially looked at. Now we know that adults respond to these kind of food elimination diets. Dellon: There are several kinds, actually.
It would be nice if you could go and have some allergy testing and figure out what foods you might be allergic to that cause EoE. The frustrating thing now, is that the allergy tests that we have, where you do skin prick tests with food allergies, are not very good at predicting what causes EoE. Dellon: It is a big list. Those are the top six food triggers in EoE. This is not a diet that most people can do on their own.
They have to work with a nutritionist. Almost like a Paleo diet in some respects. Dellon: Unprocessed foods, foods that would have been available when cavemen were around, that you can eat. So it does tend to be healthy. Of course, it is hard to do. People have to learn how to cook. There are a lot of resources out there to help with these kind of diets.
I would say here, at our center, about a quarter to a third of my adult patients elect to do this kind of a diet. Falk: So before you go on a diet that you may not want or is not easy to do, the diagnosis happens how?
By endoscopy? Dellon: Yes, the diagnosis is a combination of two things. The first is the clinical presentation. So like I mentioned: adults-mostly trouble swallowing. Kids actually have many more symptoms that we call non-specific in that the symptoms can reflect many diseases. Kids might have heartburn, or abdominal pain, or vomiting.
Babies might have failure to thrive- or growth problems, or feeding difficulties. There are some typical changes in the esophagus that we can see with swelling, or irritation, or scar tissue. Then we do the biopsies where we take little pieces of the esophagus, and send them to the lab to look at it, and they can see the eosinophils under the microscope.
This is called dysphagia. If EoE goes untreated, the esophagus may narrow because of scarring. This is called stricture. Infants with EoE don't want to breastfeed or take a bottle, and may frequently spit up and arch the back — a sign of pain. Older children eat reluctantly and slowly, don't grow as quickly as expected, develop seemingly irrational aversions to certain foods, and may have trouble sleeping.
They may complain of heartburn and dysphagia. Sometimes EoE is diagnosed after a child or teenager comes to the hospital with food in the esophagus that he or she is unable to cough up. This is called food impaction. EoE shares many symptoms with acid reflux, so a doctor will first prescribe an acid blocker medication or proton pump inhibitor PPI. These medicines do not help EoE, so if symptoms persist, the doctor will know reflux isn't the cause. It's estimated that up to 10 percent of children with reflux have EoE.
We don't know what causes EoE or why it often seems to run in a family. There are several theories, but none have been investigated enough to prove or negate them. If you think that your child may have eosinophilic esophagitis, contact your primary care physician.
He or she may then refer you either to a pediatric gastroenterologist or allergist for further evaluation. The only way to diagnose EoE is by a biopsy of the esophagus, performed by a gastroenterologist. The child is sedated and the physician inserts an endoscope into the mouth and through the esophagus, stomach and upper part of the small intestine, where a small sample of tissue is taken. Sometimes, the gastroenterologist can see signs of EoE in the esophagus, such as "rings" or "white plaques.
Therefore, it is critical to obtain an esophageal biopsy sample. Typical allergy tests, such as skin or blood tests that identify immediate allergic reactions, are not usually effective for diagnosis of eosinophilic esophagitis because the allergic reacting involved in EoE is often delayed several days after an allergen is introduced. Skin patch test is often more insightful, but is not routinely offered by most allergists.
As you do this, write down your symptoms. Symptoms of a failed food challenge may range from mild reflux, or pains, to severe cramps, vomiting, or difficulty swallowing — even food impaction. Any of these changes after reintroducing a food should be written down and considered a reaction. It is common for EOE food reactions to be delayed for hours or even days from exposure. Introduce ONE new food per week.
Over the next 3 days, continue to eat at least 1 serving of the food per day. If the food does not cause symptoms, it is considered safe. Wait to add the safe food back into your diet until the other food challenges are complete. Dairy Elimination. Dairy Example: There are three ways milk may be indicated on a label. See examples below:.
File Upload:. Coconut, hemp, oat, almond, or rice milk Dairy-free yogurts Dairy-free cheeses Coconut or cashew ice cream Hemp products Coconut milk products. Eggs yolks, whites, dried, powdered, and solids Egg substitites e. Coconut Secret Coconut Aminos soy sauce substitute.
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