Information for parents
Eosinophilic Oesophagitis in Children
Eosinophilic oesophagitis (EoE) is a long-term, allergy-related inflammation of the oesophagus — the food pipe that carries food from the mouth to the stomach. A type of white blood cell called an eosinophil builds up in the lining, usually in response to foods, and the oesophagus becomes inflamed and irritable.
EoE is being recognised more often in children. It can look like reflux, fussy eating or feeding difficulties, which is why it is sometimes missed. With the right diagnosis, it can be managed well.
What are the symptoms of EoE?
Symptoms often depend on a child’s age:
Babies and young children
- Feeding difficulties, food refusal or very slow eating
- Vomiting or reflux symptoms that do not settle with usual treatment
- Poor weight gain
Older children and teenagers
- Food feeling stuck when swallowing (dysphagia)
- Chest or upper tummy pain, or heartburn
- Needing lots of drinks to wash food down, chewing for a long time, or avoiding meat and bread
- Food becoming lodged and needing urgent removal (food bolus obstruction)
What causes EoE?
EoE is an immune reaction, most often to foods. Common triggers include milk, wheat, egg and soy, although this varies between children. It is not caused by anything a parent did. Many children with EoE also have other allergic conditions, and it can run in families.
Unlike a typical food allergy, EoE usually does not cause an immediate reaction such as hives. The inflammation builds up over days to weeks, which is why standard allergy tests are not reliable for finding the triggers.
How is EoE diagnosed?
The only way to confirm EoE is a gastroscopy, where small biopsies are taken from the lining of the oesophagus and examined under a microscope for eosinophils. In children this is performed under anaesthetic care and is usually quick.
Before diagnosis, a paediatric gastroenterologist will consider other causes of similar symptoms, such as reflux. Follow-up gastroscopies are often used to check whether treatment is working, because symptoms alone do not always reflect how inflamed the oesophagus is.
How is EoE treated?
The goals are to settle the inflammation, relieve symptoms, support normal eating and growth, and prevent narrowing of the oesophagus over time. The main options are:
- Acid-suppressing medicines, which help many children with EoE
- Swallowed topical steroids, which coat the oesophagus to reduce inflammation
- Dietary treatment, where likely trigger foods are removed and then carefully reintroduced, ideally with support from a paediatric dietitian
- Newer targeted medicines for selected children whose EoE does not respond to other treatment
Living with EoE
EoE is usually a long-term condition, and symptoms may return if treatment stops. With a clear plan and regular review, most children eat well, grow normally and take part in everyday life. Encouraging good chewing, plenty of fluids with meals and a relaxed approach to mealtimes can help.
When should I be concerned?
Speak with your GP if your child has:
- Food repeatedly feeling stuck when swallowing
- Ongoing feeding difficulties, food refusal or poor weight gain
- Reflux or vomiting that does not improve with usual treatment
- Chest pain or pain with swallowing
Seek urgent care if food is stuck and your child cannot swallow their saliva, is drooling or is in distress.
When should my child see a paediatric gastroenterologist?
EoE is confirmed with a gastroscopy — see our guide to paediatric endoscopy.
Children with suspected EoE need a gastroscopy with biopsies, performed by a paediatric gastroenterologist. Eosinophilic oesophagitis is among the conditions Dr Malik manages, and paediatric endoscopy is performed at St Andrew’s War Memorial Hospital under expert paediatric anaesthetic care.
Straight answers
Questions parents often ask
Is EoE the same as reflux?
No. Reflux is stomach contents coming back up. EoE is an allergy-type inflammation of the oesophagus. The symptoms can overlap, and a gastroscopy with biopsies helps tell them apart.
Can allergy testing find my child’s trigger foods?
Skin prick and blood allergy tests are not reliable for identifying EoE triggers. Dietary trials followed by a repeat gastroscopy are the most dependable way to find them.
Will my child need to avoid lots of foods?
Not necessarily. Many children do well on medicines alone, and dietary approaches often start by removing just one or two foods. The plan is tailored to your child and family.
Will my child grow out of EoE?
EoE is usually a long-term condition, but it can be well controlled with ongoing treatment and review.
Related children’s gut-health resources
Reflux in Babies
When spilling and vomiting are normal, what GORD means and when to worry.
Gastroscopy and Colonoscopy in Children
What to expect before, during and after your child’s procedure.
Cow’s Milk Protein Allergy in Babies
Clearing up the confusion: symptoms, diagnosis, formulas and growing out of it.
If your child has persistent gastrointestinal symptoms or your GP has recommended specialist assessment, you can find information about appointments with Dr Rohan Malik here.