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This is the first of three articles concerning gastrointestinal disorders in children. The second article will focus on celiac disease, and the third will explain disorders of gut-brain interaction (DGBI).
An eosinophil (pronounced ee·ow·si·nuh·fil) is a white blood cell that helps fight off certain types of infections—parasites, for example. But they’re often seen in high numbers in response to allergic conditions.
Eosinophils are usually low in number in the blood stream, but sometimes they can collect in tissues, especially in the GI tract, pointing to an underlying disorder.
In what follows, Dr. Aliza Solomon, a pediatric gastroenterologist and associate professor of clinical medicine at Weill Cornell Medicine, responds to parents’ FAQs and offers her expert advice to parents dealing with these potentially distressing and disruptive conditions.
Can over-the-top eosinophils attack any location in a child’s GI tract?
“Eosinophilic gastrointestinal disorders (EGIDs) usually begin in childhood. They’re often chronic and require long-term care, Dr. Solomon says. “They can occur anywhere along the GI tract: the esophagus, stomach, small intestine or large intestine.”
Which are the most common EGIDs in children?
The most common of all is eosinophilic esophagitis (EoE), a chronic immune inflammation, she explains, in which eosinophils collect in the esophagus, typically triggered by food allergens. That leads to dysfunction and related symptoms.
What is the relationship between EoE and allergic inflammation?
All of the EGIDs seem to be driven by an inflammatory process that’s commonly seen in allergic conditions, such as asthma, eczema, allergic rhinitis and food allergies. These are known as atopic disorders, meaning they’re inherited tendencies that lead to an exaggerated response. They don’t come out of nowhere, and they aren’t random.
“Large numbers of my EoE patients suffer from more than one of these other atopic disorders,” she says.
What are the usual symptoms of EoE?
In EoE, symptoms tend to vary by age.
“Infants and young children may experience feeding difficulties, food refusal, vomiting, poor weight gain and failure to thrive. In older children, abdominal pain, vomiting and reflux may be reported. And in older adolescents and young adults, additional complaints may include difficulty swallowing (dysphagia) or the feeling of food going down too slowly or getting stuck.
“A food impaction can occur,” she continues. That’s when a food bolus is unable to pass through the esophagus, because it’s temporarily stiff or narrowed.
A food impaction is a medical emergency that requires immediate treatment to remove the bolus or push it down into the stomach.
How is EoE diagnosed?
EoE, along with all of the EGIDs, are diagnosed with a tissue biopsy. “The number of eosinophils present in the tissue are counted, and the tissue’s appearance is also taken into account,” Dr. Solomon says.
For EoE, the tissue is generally acquired during an endoscopy under anesthesia. But in some instances, an unsedated transnasal endoscopy may be an option. During the latter procedure, a thin scope is passed through the nose into the GI tract, where tissue samples can be collected. The child is usually wearing virtual reality goggles—a means of distracting them during the procedure.
“There are other less invasive tools, such as the esophageal string test,” she adds, “during which the child swallows a capsule that contains a string that’s left in the esophagus for a length of time and then removed and processed. It can help determine whether the EoE is active or inactive.”
How is EoE treated?
A variety of treatment options are available for EoE, including:
As well, several clinical trials studying other medications are underway.
Have there been any recent advances in medications?
The latest medications approved by the FDA for use in children with EoE are Eohilia (budesonide) and Dupixent (dupilumab).
Eohilia was approved in 2024 for children ages 11 and older. It’s an oral suspension of the topical steroid budesonide.
Dupixent was approved in 2022 for children aged 12 and older, and in 2024 for those 1 year and older weighing at least 33.1 pounds. This medication is an injectable that’s used every 7 to 14 days, depending on the patient. It blocks two different pathways that drive the inflammation seen in EoE.
What is the role of food elimination diets?
“Food elimination diets vary in the extent of what’s eliminated,” says Dr. Solomon. “They can be quite restrictive, only providing a hypoallergenic formula supplement to avoid any causative proteins in the diet. But less restrictive diets have become more commonly used, targeting the most common food allergens.
“Unfortunately, there is no testing that can determine the individual patient’s trigger foods,” she continues, “since EoE is not a typical allergy generated by antibodies.”
When should a family see a pediatric gastroenterologist?
“A family should consult with a pediatric GI if they suspect their child has this disorder based on their complaints,” Dr. Solomon advises. “If an immediate family member has already been diagnosed with EoE or another EGID, and the child is expressing or displaying similar complaints, even if these are subtle, I would have a higher degree of suspicion that EoE is the culprit.”
Key takeaway points
Make an appointment with a pediatric gastroenterologist at Weill Cornell Medicine by calling (646) 962-3869 or visiting the department’s website here.
