Eosinophilic esophagitis (EE) and eosinophilic related gastroenterophaties are emerging diseases in children; the prevalence of the disease is thought to be around 4.26 per 10,000 children, around 80% of them are boys.
In children, these diseases are often related with Gastroesophageal Reflux Disease (about 8-10% of cases) or with a food allergy. In fact, food allergy, abnormal immunologic response, and autoimmune mechanisms are suggested as possible etiological factors for Eosinophilic Esophagitis in childhood (Ozdemir O et al . 2008).
A definitive diagnosis can be made by counting eosinophils numbers in esophageal tissue biopsy specimens.
Once a diagnosis of Eosinophilic esophagitis is made, patients should seek the consultation of the allergist in an effort to identify possible food sensitivities.
This is particularly important because the etiologic agent(s) that drive the eosinophilia are likely to be different for each patient. If the allergic evaluation identifies a specific food, this food should be strictly avoided as a first-line treatment.
If a food is not identified, an elemental hypoallergenic formula as Neocate should be used to induce a remission (Ngo P et al, 2005).
In fact, exclusive feeding with amino acid-based formula has been shown to be the most effective way of treating eosinophilic esophagitis: patients are extremely sensitive to food antigens and not all hypoallergenic formulas are appropriate for successful treatment.
Studies have shown that a successful treatment of chronic gastrointestinal symptoms associated with eosinofilic esophagisit is feeding infants with an amino acid formula, as Neocate: ten children, diagnosed with gastroesophageal reflux and eosinophilic infiltration of the esophagus, with longstanding symptoms despite standard anti-reflux therapies, showed resolution (n=8) or improvement (n=2) of gastrointestinal symptoms after receiving the amino acid-based formula Neocate for a minimum of 6 weeks. Other reactive epithelial changes of the esophageal mucosa also improved significantly. (Kelly et al. 1995).
Growth parameters and micronutrient levels need to be carefully monitored while on elimination diets for prolonged periods. In older children and adults with eosinophilic gastrointestinal disorders, the response to dietary restriction is variable (Heine, 2004).