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Allergy, GI offer eosinophilic esophagitis clinic

For an increasing number of children, a condition known as eosinophilic esophagitis (EoE) is greatly impacting their quality of life. Along with feeding difficulties and gastrointestinal problems such as stomach pain and vomiting, there’s a strong association with allergic conditions, including multiple food allergies, environmental allergies, asthma and atopic dermatitis.

To help manage this complex illness, Akron Children’s now offers the area’s only comprehensive, multidisciplinary clinic for the ongoing treatment of EoE. The clinic brings together specialists from allergy/immunology and gastroenterology, as well as a social worker and dietitian.

Symptoms
Symptoms of EoE vary, depending on the age of the patient.

“In infancy until age 3 to 5 years, patients typically have feeding difficulties, vomiting and poor weight gain,” said Dr. Sirvart Kassabian. “Between ages 5 to 12, they often have frequent abdominal pain, heartburn and may avoid certain types of food, whereas teens typically have dysphagia or a history of food impaction.”

Dr. Sirvart Kassabian

Dr. Kassabian performs an upper endoscopy

Diagnosis
When EoE is suspected, an upper endoscopy with esophageal biopsy is performed. In some instances, treatment with a proton pump inhibitor can help first rule out more common conditions associated with esophageal eosinophilia, such as gastroesophageal reflux or a newer condition known as proton pump inhibitor responsive esophageal eosinophilia (PPI-REE).

“Because EoE can mimic other conditions and is a chronic problem, it is crucial to make an accurate diagnosis,” said Dr. Kassabian.

If a biopsy shows a peak eosinophil count greater than 15 per high-powered field and symptoms of esophageal dysfunction are present, EoE is likely. Abnormalities in the structure of the esophagus may also be detected by radiography or endoscopy, such as stacked circular rings or linear furrows. However, because these features can vary, a biopsy is essential in confirming EoE.

Treatment
“In most cases, one or more food allergies cause the inflammation in the esophagus, although a small number of patients may have EoE due to non-food allergies,” said Dr. Rajeev Kishore.

It can also be made worse by seasonal or environmental allergies.

Because food allergies are the most likely culprit, dietary therapy or food elimination is the primary treatment. Oral steroids may also be used. One treatment option is elemental feeding of an amino acid-based formula.

Dr. Rajeev KIshore

Dr. Rajeev KIshore examines a patient.

Other treatment options that Dr. Kishore generally prefers are either a 6-food elimination diet that removes the most common food allergens (milk, eggs, wheat, nuts, seafood and soy) or a more targeted elimination diet based on the results of allergy blood tests or skin tests.

“Although both elimination diets are 70 to 80 percent effective, I prefer the targeted elimination diet,” said Dr. Kishore. “It can be difficult, as well as unnecessary, to eliminate the 6 most common food allergens.”

Allergy testing can also identify less common allergies, as well as anaphylactic responses.

“Regardless of the approach, eliminated foods are gradually reintroduced after symptoms and eosinophilia resolve,” said Dr. Kishore.

Ongoing care
Follow-up care for EoE is essential. On the average, patients are seen in the clinic every 2 to 4 months to re-evaluate their treatment plan and make adjustments. Patients also undergo regular upper endoscopies to monitor their response to treatment.

The clinic’s dietitian helps patients make adjustments to their diets to avoid allergens, while striving for optimal nutrition. The social worker can help patients adjust to living with EoE, especially in school and other social situations.

The EoE Clinic is located in the Center for Allergy & Immunology at 130 W. Exchange St. on the Akron campus.

For more information or to refer a patient, call 330-543-0140 or 330-543-4488.

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