Older children and adolescents with eosinophilic esophagitis (EoE) typically describe symptoms of frequent vomiting, abdominal pain, difficulty with swallowing (dysphagia), or pain with swallowing (odynophagia). Vomiting often but not always occur in association with eating and there may be some accompanying nausea. The problems associated with swallowing usually results in an intense feeling of discomfort as a swallowed food bolus slowly moves down the esophagus. Often patients will try to drink liquids to help bring the foods down which may help. Other times the liquid cannot pass and comes back up. Often these episodes end only after a child vomits up the food. These episodes may last for only a few seconds or can be more prolonged and severe, and occasionally result in food becoming stuck in the esophagus – that is a food impaction. If this occurs, then a gastroenterologist or surgeon may need to use an endoscope to remove the lodged food bolus. In those with severe and chronic symptoms, significant weight loss can also occur. Additional eosinophilic esophagitis symptoms include heartburn, cough, chest pain, or epigastric (upper abdominal) pain, which does not respond to anti-reflux therapy.
Some people with EoE may alter their eating habits to try to control or minimize their symptoms. People with eosinophilic esophagitis often adapt by chewing their food very carefully, taking smaller bites, drinking lots of liquid with meals, or eating foods with a softer consistency to minimize frequency or severity of their symptoms. Some have avoided eating in public to avoid the potential embarrassment of experiencing symptoms among friends or peers.
A common misconception among patients and families dealing with eosinophilic esophagitis is that a person is allergic to the food that is involved in these impaction episodes. However, the pain or difficulty swallowing a given food is more likely related to the specific texture of the food. It seems that foods that are more dense such as breads or meats are more often involved, even though a person may not necessarily have an allergy to these foods. These denser foods tend to be involved more often because of the underlying esophageal dysfunction that is set in place because of chronic food allergy exposure.
So with continued presence of food allergens in the diet, this can result in significant inflammation within the esophagus which then can predispose a person with EoE to these episodes of difficulty and pain with swallowing. If food triggers are removed from the diet, the esophagus often can heal and regain its normal function.