Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus. It commonly affects children and is often associated with atopic conditions such as asthma, eczema, allergic rhinitis, and food allergies.
The key is recognizing how EoE presents at different ages and confirming the diagnosis correctly.
How EoE presents (varies by age)
Infants and toddlers
- Feeding difficulty or refusal
- Vomiting or regurgitation
- Poor weight gain
- Irritability with feeds
School-age children
- Abdominal pain
- Nausea, reflux-like symptoms that persist
- Slow eating or picky eating
- Avoidance of certain textures (especially meats, breads)
Adolescents
- Dysphagia (food sticking)
- Food impaction (emergency presentations)
- Prolonged mealtimes, cutting food into tiny pieces
- Excessive drinking with meals
A common clue: symptoms out of proportion to reflux treatment and/or a strong atopic background.
Why diagnosis is often delayed
Children adapt:
- They chew excessively
- They avoid certain foods
- They drink frequently during meals
- They eat slowly and silently struggle
Asking about these behaviors is important.
How EoE is diagnosed
Diagnosis is confirmed by:
- Upper endoscopy with esophageal biopsies
- Looking for characteristic inflammation on biopsy
Symptoms alone are not enough. Endoscopy is essential for diagnosis and to assess severity and healing.
Common endoscopic features (not always present)
- Rings (trachealization)
- Linear furrows
- White exudates or plaques
- Edema (pale mucosa)
- Narrowing or strictures (more in long-standing disease)
Biopsies matter even when the esophagus looks normal.
Treatment options (modern approach)
Treatment is individualized based on age, severity, and family preference. Main options include:
1) Dietary therapy
- Targeted elimination diet or empiric elimination strategies
- Requires careful nutrition planning
- Best done with dietitian support
2) Swallowed topical corticosteroids
- Delivered to coat the esophagus
- Often effective and well tolerated
- Requires technique and adherence
3) Acid suppression therapy
- Helps some children and may be part of the overall plan
- The role is individualized
4) Endoscopic dilation (selected cases)
- For strictures/narrowing when symptoms are significant
- Usually combined with medical/diet therapy, not used alone
Follow-up and monitoring
EoE is chronic. Symptoms may improve before the esophagus fully heals, so:
- Follow-up assessment often includes repeat endoscopy based on the treatment plan
- Ongoing attention to nutrition, growth, and symptom patterns is important
Complications if untreated
- Esophageal remodeling and narrowing over time
- Higher risk of food impaction
- Reduced quality of life around eating
Early recognition and consistent treatment reduce long-term risk.
Parent-friendly summary
EoE is inflammation in the swallowing tube. Kids may have feeding trouble, stomach pain, reflux-like symptoms, or food getting stuck. Diagnosis is confirmed by endoscopy and biopsies. Treatment can include diet changes, swallowed anti-inflammatory medicine, and other options.
Next post
If you’d like, I can write a post on:
- “Reflux vs EoE: how to tell the difference” or
- “Food impaction in teens: what families should do”