Q: I can barely get my 2.5-year-old to eat solid foods. He’s not even drawn to foods that kids love – like bologna or chicken nuggets. He’s underweight, complains of tummy aches, and when he does eat, it’s with great effort. He often gags or even throws up after eating a small amount. I don’t think this is just toddler resistance.
Our doctor is reading up on the EoE (eosinophilic esophagitis) form of allergy. Is that something to consider, or should we be doing other allergy testing?
Dr. Sharma: Eosinophilic esophagitis, or EoE, is a condition where the esophagus, or food pipe, becomes inflamed by white blood cells, called eosinophils. This inflammation is caused by allergies, particularly food allergies, but sometimes also environmental allergies.
In teens and adults, the symptoms of EoE are typically localized to the esophagus, and may include difficulty swallowing, food becoming stuck, chest pain, or heartburn. However, in younger children such as your son, symptoms of EoE can be more generalized, including difficulty feeding (especially refusing to eat solids), poor weight gain, vomiting, and abdominal pain.
In order to make the diagnosis of EoE, an evaluation by a gastroenterologist is needed, both to consider other potential causes of these sorts of symptoms, and to perform an upper endoscopy, which is required to confirm the diagnosis.
In this endoscopy, samples of tissue from the esophagus are biopsied, and then examined under a microscope for eosinophils. (Before the endoscopy, it is recommended to be treated for at least eight weeks with an acid-blocking medication called proton pump inhibitor.)
If elevated numbers of eosinophils are found in the esophagus and the diagnosis of EoE is confirmed, then at that point an allergist would perform allergy testing.
Unfortunately, allergy testing in EoE is not always accurate and may not help to identify which food(s) are causing the inflammation. Treatment options in EoE include elimination diets, in which suspect foods are removed, and medication called topical steroids.
Since your child has many symptoms that could be consistent with EoE, you can discuss with his doctor whether a referral to a pediatric gastroenterologist is a reasonable next step.
Dr. Sharma is an allergist, clinical researcher and assistant professor of pediatrics. He is Clinical Chief of the Division of Allergy and Immunology at Children’s National Health System in Washington, D.C. and Director of the Food Allergy Program. Questions submitted below will be considered for answer in the magazine.