Gut Problems
Eosinophilic oesophagitis
Eosinophilic oesophagitis is a newer condition which has arisen in the last 15-20 years and is particularly prevalent in children with an allergy background in the family or allergy themselves, such as eczema, asthma or hay fever.It is inflammation of the oesophagus diagnosed at endoscopy and can present with discomfort or swallowing difficulties classically.Children will have symptoms which are typical of reflux and particular food stuffs may be implicated and can be tested by blood tests and skin prick tests and these include cow’s milk protein, wheat protein, egg, soya, nuts and seafood and sometimes other foods as well.
Initial treatment is with a proton pump inhibitor such as Omeprazole. If symptom relief is not provided within 1-2 months or if at repeat endoscopy the problem continues then we would generally move on to a non-absorbed swallowed viscous steroid called Budesonide mixed in 15mls sugary solution twice a day. Sometimes co-existent reflux can be treated with Omeprazole or equivalent anti-acids and occasionally dietary attempts to exclude the above foods will be helpful. Generally another endoscopy after 3 months of treatment would be needed and then follow up regularly.If untreated the inflammation can result in stricturing and scarring of the oesophagus which is not reversible easily.
The European Guidelines now published:
Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)
Amil-Dias J, Oliva S, Papadopoulou A, Thomson M et al. J Pediatr Gastroenterol Nutr 2024 Aug;79(2):394-437.