Children's Hospital Colorado

Eosinophilic Esophagitis (EoE) in Kids

What is eosinophilic esophagitis?

Eosinophilic esophagitis, also known as EoE, is the chronic (long term) swelling of the esophagus caused by food allergies. Eosinophils (pronounced "e-o-sin-o-fils") are a kind of white blood cell activated by an allergic reaction.

When a child has EoE, eosinophils build up in the lining of their esophagus, which can cause inflammation (swelling) and many uncomfortable symptoms including abdominal pain, reflux-like symptoms and swallowing or feeding problems. Doctors must confirm an EoE diagnosis with a biopsy (a small tissue sample) showing an increased number of eosinophils in the esophagus.

EoE is one of several eosinophilic gastrointestinal disorders (EGIDs) that can affect other parts of the gastrointestinal tract:

  • Eosinophilic esophagitis affects the esophagus and is the most common EGID.
  • Eosinophilic gastritis affects the stomach.
  • Eosinophilic gastroenteritis affects the intestines or multiple areas of the gastrointestinal (GI) tract.
  • Eosinophilic colitis affects the large intestine.

Learn about specialized care for kids with eosinophilic gastrointestinal diseases at Children's Hospital Colorado. Or, watch the video below to see how Kyla's family found hope after an EoE diagnosis.

What causes eosinophilic esophagitis in children?

EoE is caused by chronic exposure to certain foods. Every EoE patient is different and may react to different types of food. Just like a person can develop a seasonal allergy when exposed to pollen, dust or mold, a child can develop an allergy (and EoE) after eating certain foods, such as dairy, eggs or wheat.

Is EoE genetic?

Research shows that EoE can run in families, which means there is likely a genetic cause of EoE.

Who gets eosinophilic esophagitis?

EoE can occur in both children and adults. It affects boys more often than girls (about three to one), though doctors do not yet understand why. EoE is more common in kids and teens who have other allergic diseases, such as hay fever, eczema, asthma and food allergies.

EoE can run in families. For instance, it is not unusual for a patient's parent or other relative to have a history of food getting stuck in the esophagus, swallowing problems or esophageal dilations.

What are the signs and symptoms of EoE in children?

Kids with EoE may have a wide variety gastrointestinal symptoms, including:

Very young children (infants and toddlers) may vomit or have other feeding problems. Young children may complain of abdominal pain, vomit or not want to eat. Older children may have problems swallowing or get food stuck in their throat or esophagus.

Because the symptoms of EoE are similar to those of other gastrointestinal conditions, doctors must rule out other conditions before making an EoE diagnosis.

What tests are used to diagnose eosinophilic esophagitis in children?

Doctors diagnose EoE in kids using a procedure called an upper endoscopy with biopsy. This allows doctors to examine tissue from your child's esophagus under a microscope to confirm the presence of eosinophils.

Though a pediatrician or gastroenterologist may suspect EoE, they must rule out other potential causes of inflammation such as acid-reflux (heartburn) first. Your child's doctor may recommend trying an acid suppression medication before performing an endoscopy or biopsy.

Endoscopy with biopsy for kids

When a child undergoes an upper endoscopy, a gastroenterologist inserts an endoscope (a small lighted, flexible instrument) through their mouth into the esophagus, stomach and the initial part of the small intestine. The instrument has a tiny camera inside that allows the doctor to see images of the digestive system on a video screen. The doctor will take photos as well as small tissue samples (called biopsies) along the way.

Nasal endoscopy with biopsy for kids

At Children's Colorado, we invented a procedure called the transnasal endoscopy, which allows our doctors to perform the same procedures as a normal upper endoscopy, but without the need for sedation or anesthesia.

Learn more and watch videos about what to expect during an endoscopy.

How is eosinophilic esophagitis treated?

There is not yet a cure for EoE or other EGIDs. After your child is diagnosed with EoE, their healthcare team will create an EoE treatment plan to help manage the symptoms and prevent further damage.

We treat EoE in three ways: medication, diet and esophageal dilation. (These are sometimes called the "three Ds:" drugs, diet and dilation.) At Children's Colorado, we work with your family to find the best EoE treatment plan for your child.

Medication for EoE

One treatment option for many kids with EoE is taking steroids, a type of medication to help control inflammation in the esophagus. Your child's doctor may prescribe topical steroids, which are swallowed from an inhaler or as a liquid. Your child's doctor may also prescribe an acid suppressor to help decrease reflux symptoms and control inflammation.

EoE diet

EoE is a lifelong condition that may require changes to your child's lifestyle, especially their diet. In this case, an allergist will help test for and identify foods that could be causing an allergic response.

Many children with EoE will go on a single food-elimination diet where they must avoid specific foods for several weeks. If your child feels better, you can work with your doctors and dietitian to add foods back to their diet one-by-one. Your child may need repeated endoscopies so doctors can learn whether they are tolerating these foods.

EoE elimination diets

Children with EoE are often allergic to more than one food, in which case their doctor may prescribe a stricter elimination diet, such as a four- or six-food elimination diet. In this case, your child will avoid a combination of the foods most likely to cause allergies, including milk, soy, eggs, wheat, peanuts/tree nuts and seafood. The medical team will guide your family on which EoE diet is best for your child.

With any elimination diet, it is important to involve a dietitian in your child’s care to ensure they are receiving enough nutrition. Learn more about elimination diets for kids.

Dilation for EoE

In severe cases of EoE, the tissue of the esophagus may narrow (called "a stricture"). When there's a stricture in the esophagus, food may not be able to pass from the mouth to the stomach, which can cause food to get stuck (food impaction). We treat esophageal strictures with dilation (stretching) of the esophagus. At Children's Colorado, our providers have extensive experience performing this procedure on kids and teens with EoE.

Get answers to frequently asked questions and learn even more about our approach to EoE treatment.

Why choose Children's Colorado for your child's EoE or EGID care?

Children's Colorado nationally-ranked Digestive Health Institute is a leader in clinical care and research in eosinophilic gastrointestinal disorders in kids. Here, our Gastrointestinal Eosinophilic Diseases Program has been providing outstanding, individualized care for children with EoE and other EGIDs for more than a decade.

Unlike many other EoE programs, we focus on providing multidisciplinary care for every patient. This means that our team of EoE experts, gastroenterologists, allergists, psychologists and dietitians works together to treat all aspects of your child's health – from food allergies to EoE symptoms to mental health and beyond. All of these pediatric specialists see patients in one appointment and in one convenient location through Children's Colorado's Multidisciplinary Clinic.

As an academic research institution, our Program has access to the latest technology and knowledge to diagnose, monitor and treat kids and teens living with EoE. In fact, we are leaders in improving care for patients with EoE through innovations like the minimally-invasive Esophageal String Test and the transnasal endoscopy technique.

At Children's Colorado, we see children and teens with EoE from around the United States and the world. Our nurse coordinators are available to help book appointments to make traveling for care as easy as possible.

Additional EoE resources

To learn more about EoE in kids, we recommend the following resources:

See our Program's list of EoE resources for book recommendations, support groups and more.

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