Understanding the Role of Speech-Language Pathologists in Eosinophilic Esophagitis Treatment

Eosinophilic esophagitis (EoE) is a chronic condition that affects the esophagus, the tube that carries food from the mouth to the stomach. It is characterized by inflammation caused by an excess of eosinophils, a type of white blood cell. This inflammation can lead to symptoms like difficulty swallowing, food getting stuck in the throat, and chest pain.

EoE is becoming more recognized as a significant cause of swallowing problems in both children and adults. The inflammation caused by EoE can narrow the esophagus and make eating uncomfortable.

For some, managing EoE may require a team approach involving various healthcare professionals, including gastroenterologists, allergists, and other specialists, such as dietitians and speech-language pathologists (SLPs). SLPs help patients manage the practical challenges of eating and swallowing.

Holly Knotowicz, M.S., CCC-SLP is a certified speech language pathologist who specializes in feeding assessment and therapy. Holly herself has EoE and as a co-host of APFED’s podcast, she candidly shares her personal experiences with the condition. Here, she answers a few questions about how SLPs can help those who have EoE:

Q: How might one know if an SLP would benefit them or their child?

A: If you or your child are having any issues surrounding eating (eating preferred foods, learning about new foods, expanding variety of intake), swallowing (discomfort when swallowing, foods becoming stuck) and taking pills, an SLP will be able to assist and support you.

An SLP can help you understand which compensatory strategies can make swallowing more comfortable. This can be anywhere from learning how to modify your favorite food so you can enjoy it again to swallowing medications. For children specifically, they can help them learn about new foods, or different variations of their preferred foods in a new form (especially for children on elimination diets, chicken tenders to GF/DF chicken tenders, allergen safe bread, etc).

Q: What kinds of exercises or techniques do you use to help people with EoE who have trouble swallowing? Do these methods change depending on how old the person is?

A: For anyone with EoE, there are several compensatory strategies that can be very helpful to make eating and swallowing more comfortable. They are generally the same strategies for all ages. Below are some examples of things you can start doing on your own.

• Utilize dips/sauces to help lubricate your esophagus when swallowing
• Incorporate taking sips of a drink after every few bites ( otherwise known as a liquid wash) to help clear esophageal residue and helps foods go down easier
• Taking smaller bites and encouraging thorough chewing
• Cook foods in wet/moist preparation (crock pot, instant pot, soups/stews) versus grilling.

Q: How do you work with patients and other healthcare professionals to create eating plans or strategies that fit with managing EoE?

A: Ensuring everyone understands the diagnosis and how it affects the individual is the first step. I also participate in healthcare team discussions or school meetings to foster a better understanding of the diagnosis and to develop strategies to effectively implement a feeding and eating plan.

Feeding and eating plans often include:

• Tube feeding schedules for children requiring enteral feedings.
• High-calorie supplement goals, such as supervised consumption during school hours or in designated areas.
• Volume goals, with prompts to encourage meal completion.
• Mealtime and presentation adjustments, recognizing that children with EoE may need extra time to eat.
• Compensatory strategies tailored to individual needs.

These plans may require the development of a 504 plan to accommodate eating at school.

I also collaborate with other professionals involved in the patient’s care, such as occupational therapists, dietitians, allergists, gastroenterologists, endocrinologists, LCSWs, and psychologists to ensure their goals are appropriate for EoE and support the patient’s quality of life.

Q: What long-term strategies do you use to help patients with EoE cope with their swallowing difficulties over time?

A: Some longtime strategies that can be really helpful include ensuring you find a drink that helps you clear the food in your mouth and esophagus. Some patients report that carbonated water helps move food more easily than regular water. They also report that sugary drinks tend to make the foods stick more.

We help change perspectives on how food is prepared and eaten to make it easier to swallow. For example, if a person typically avoids dry or crumbly foods but really wants to eat them, they may be able to make modifications and add dips or sauces to help make swallowing those foods more comfortable.

Oftentimes pairing foods that tend to stick with a carrier food such as something crunchy like chips and crackers, or dips/sauces, can help create more salvia in your mouth and make it easier to chew and swallow. This is especially helpful for children and adults who have strong sensory preferences and dislike moist/wet foods on their own learn to like these textures when paired with a carrier food.

To learn more tips and strategies from Holly, check out this webinar she presented to share how to increase volume and variety during mealtimes:

Did You Know?

December 12, 2024 is World Swallowing Day!