Whenever digestive problems involve the throat, esophagus or upper chest, you might experience heartburn, difficulty in swallowing or that “food stuck in the throat” sensation.

You might associate such symptoms with children who have food allergies, but when these symptoms are seen in adults, there can be a number of causes. Doctors are finding that with adults, too, they can be food-related.

This brings into play a condition called eosinophilic esophagitis, or EoE, because it is increasingly behind cases of throat and chest discomfort in adults.

In simplest terms, EoE occurs when the esophagus becomes inflamed from an increased number of eosinophils, a type of white blood cell. These cells are provoked into production by allergens, drugs, parasites and other means.

If you zero in on food allergies as a possible cause of EoE, then there’s good news from the American Gastroenterological Association.

A recent article in Gastroenterology, the AGA’s official journal, reviewed the success of a six-food elimination diet in adult patients with EoE. In fact, identifying food triggers could become a therapeutic alternative to corticosteroids, the article said.

Dr. Nirmala Gonsalves of Northwestern University, lead author of the study on the six-food elimination diet, said it could help identify food triggers when the patient has no history of food allergy or intolerance.

“By first eliminating, then systematically reintroducing foods in our adult patients, we were able to identify the specific food triggers that caused their symptoms, such as heartburn, chest pain and difficulty swallowing, or the sensation of food being stuck in their throat,” said Gonsalves.

She added that by undergoing the elimination diet, adult EoE patients would be in a position to receive better information for tailoring their individual diet and managing their symptoms for the long-term.

The elimination diet studied at Northwestern involved six common culprits — milk, soy, egg, wheat, peanuts/tree nuts and shellfish/fish.

When the regimen was complete, participants showed an improvement in symptoms and a reduction in esophageal tissue damage associated with EoE. Also, 78 percent of participants saw eosinophil cell counts in their esophagus go down by half.

Cases of EoE generally appear to be on the rise. The Mayo Clinic reports that it was among the first U.S. medical centers to publish research on incidence, and cited a more than tenfold increase in EoE cases in the last 30 years.

The Mayo’s patient information page on EoE notes that treatment involves one or more of these three strategies:

– Dietary therapy, when the inflammation of the esophagus appears to be food-related. Doctors might perform a skin-prick test or prescribe an elimination diet.

– Medications, usually steroids to decrease white blood cells in the esophagus, lessen inflammation and give the esophagus a chance to heal. The steroids that are prescribed are typically not the kind that produce unwanted side effects.

– Experimental therapies, including asthma medications and acid-blocking medications. Mayo is among the research centers now looking at such experimental treatments.

– Deborah Ross (source: EmpowHER)

When it’s time to eat, 14-year-old Cristobal Serrano grabs a plastic pitcher and fills it from a jug of sterile water. He opens a can filled with white powder and gets a metal whisk. He mixes the ingredients to a chalky, milky liquid and then pours it into a little plastic bag.

The bag hooks to a pump and a thin plastic tube on a metal post with wheels. The white liquid moves through the tube into a port in his abdomen.

“It’s like a permanent straw,” he says. “It’s my leash.”

Cris is tethered to that line for 20 hours a day. But, he says, it used to be worse. He used to drink it, back when he still could eat certain foods. But having to drink it all day is one of the reasons he got the feeding tube.

It doesn’t taste like much, but after a swallow it creeps up the throat and lingers, heavy and thick.

Cris has Eosinophilic Esophagitis, a disease that causes an allergic reaction in the esophagus affecting his ability to eat most food. The allergic reaction causes vomiting and pain, and sometimes food gets stuck and has to be removed surgically.

As a further complication, Cris also has Gastroparesis, a condition that means part of his stomach is paralyzed.

All this means Cris will never get to eat a pizza, although he can eat potatoes, white rice and some varieties of candy. Cris will never get to belly flop from a 30-foot-high diving board into a swimming pool. He’ll never get to eat a hamburger from a drive-thru — all things he says he’d like to do.

Cris lives with his mom, dad and sister in a home between Hawthorne and Interlachen. He likes AC/DC and Black Sabbath. He wears a fedora and skipped the third grade. He’s planning on going to Interlachen High School this year.

Last year, he missed 75 days of school because of his health problems.

He carries the pole with his pump on it like a spear around the house. One time he busted out a light bulb.

“It’s a pain in the neck for him,” said his mother, Jodi Serrano.

“More like a pain in the stomach,” he answered.

* * *

There is no known cause for Eosinophilic Esophagitis, except that some people are genetically predisposed to it, and there is no known cure, said Dr. Glenn T. Furuta, director of the

Gastrointestinal Eosinophilic Diseases Program at Children’s Hospital Colorado and National Jewish Health.

In fact, Furuta said the disease wasn’t officially diagnosable until 2007, although doctors had presumed Cris had Eosinophilic Esophagitis ever since he was about 4.

His mom said they’ve been dealing with issues since Cris was a baby. He has nausea almost every day. When he has flares, he’ll get limb pain and lose his voice.

He has been to the hospital more times than he can remember, and sometimes his esophagus will swell up so bad it has to be reopened with a surgical procedure.

Furuta said it’s estimated the disease affects somewhere between one in 10,000 people and 10 in 10,000 people.

“Something as simple as a stomach bug or constipation will send him to the hospital,” Jodi Serrano said.

The hole in his stomach where the tube goes tries to close itself, so Cris has sticks of silver nitrate that he uses to remove excess skin that grows around it.

As for the future, Furuta is optimistic. Despite the lack of a cure and no preventative measures, the doctor said he’s on the front lines of research that is under way to find a cure.

“There’s an increasing amount of effort,” he said, adding that because the disease covers so many areas of health, different doctors are getting involved in the research. He said he knows the disease is troublesome for young children and wants to work toward a cure.

“We want to make sure that children can grow and develop in the best way possible,” he said, “but also balance the risk and benefits of treatment.”

* * *

When Cris goes to school, he wears the pump in a backpack. He doesn’t go to the cafeteria with the other kids.

“I’m banned from the cafeteria,” he joked.

But he’s upbeat about it.

Cris uses the pump like a hall pass, he said. He’ll make his machine beep for fun sometimes – to get out of class.

The two things that cause the most trouble for him when the tube is in are the difficulty in sleeping and riding his bike. The line hangs low, and once it got caught in his bicycle’s spokes.

Because of Cris’ lack of food options, his mom has found creative ways to cook potatoes.

“You have to figure out a way to get something out of only one ingredient,” she said.

By the kitchen in his house, stacks of boxes with his formula almost hit the ceiling. There are baskets filled with all types of medicine.

There also is a cotton candy machine.

Cris sometimes crushes Dum Dums candy with a large rock and, using the cotton candy machine, creates one of the few edible concoctions he can tolerate. There’s no stick, but the candy comes out like stretched-out cotton balls.

He can eat Smarties, too, because “they have nothing in them.”

His mother just wishes the family could sit down to a normal dinner.

“I want them to come out with some pill or some medicine that’s going to let him sit down and eat,” she said. Sometimes she goes through a drive-thru, and he gets upset with her.

“I get hungry,” she said.

– Jon Silman (source: The Gainesville Sun)

EDMOND, Oklahoma – Oklahomans are stepping up to help a little girl who is allergic is almost everything.
Riley Kahn, 3, suffers from a rare disorder where her body can’t digest solid food. So on Saturday, friends and family gathered for the first ever “Riley’s Run”.

“I ran!” Riley said.

“Did you run for all the kids with allergies? And tummy problems?” Riley’s mom, Jill Kahn asked.

“Uh-huh,” replied Riley.

As runners crossed the finish line at Oakdale School Saturday, Riley was there with mom and dad cheering them on. The 3-year-old has an extremely rare Eosinophilic Gastrointestinal Disorder.

“Words cannot express what this means for us,” Riley’s dad, Mike Kahn said.

“It’s so humbling and amazing,” Jill said.

You’d never know their happy bouncing 3 year old is sick. Another mom started “Riley’s Run” after seeing what the Kahn’s have been through.

“I would see Riley struggling and see Jill and Mike struggling,” Sexton said. “I love them like family and would do anything for people who are like family to me.”

Dad says Riley is basically allergic to everything. Her little body rejects food.

Sexton, American Partnership for Ensinophilic Disorders (APFED), OKCPD, neighbors, friends and family got together Saturday at Oakdale School for a 5K, 1K run.

“At this point Riley doesn’t have any solid foods that she can eat. She eats through a tummy tube and it’s in her backpack,” Mike said.

“Is this your backpack?” Jill asks Riley.

“Yeah,” Riley said with a grin,

“She likes her backpack,” Jill said.

The race was also a way to teach other kids about Riley’s disorder and explain why she can’t do everything her little friends do. But Riley sure did run the race like a champ. Before Jill and Mike or even doctors knew Riley’s diagnosis, she suffered through.

“That’s what this race is meant to do, is get the awareness out there and the diagnosis can happen quicker and these kids can start being happy like riley and can run through a one mile run no problem,” dad said.

Oklahoma City Police Officer Chad Peery hopes to run with Riley someday.

2/9/2012 Related Story: Trial Delayed For Suspects In Chad Peery Case

“Her [disorder] is going to be the rest of her life. Mine, if I can keep my progress going, I have the potential or at least the mindset that I’m going to get up and get out of this chair,” Peery said.

Spreading the word, bringing cool cop friends, bomb squad and helicopter included, Peery is a father of four and says so many people in the community have helped him. He said being there for Riley’s Run was a must.

“My hope, I will get to overcome my battle. Riley on the other hand is going to have to deal with this,” Peery said.

“On the down times, you start losing hope because one day is great and one day is bad when it’s a gastro issue, so this definitely brings us tons of hope,” said Jill.

Doctors don’t know what causes the disorder and there’s not a cure. The Kahn family has to travel to Denver, Colorado to see a specialist, because Oklahoma doesn’t have a gastro-intestinal expert to treat Riley’s disorder.

– Jamie Oberg (source: News9)

A six-food elimination diet can successfully treat adults with eosinophilic esophagitis, according to a study published in the June issue of Gastroenterology.
FRIDAY, June 8 (HealthDay News) — A six-food elimination diet can successfully treat adults with eosinophilic esophagitis (EoE), according to a study published in the June issue of Gastroenterology.

Nirmala Gonsalves, M.D., of the Northwestern University Feinberg School of Medicine in Chicago, and colleagues conducted a study involving 50 adults with EoE who were treated with a six-food elimination diet (SFED) for six weeks. The foods eliminated were: milk, soy, egg, wheat, peanuts/tree nuts, and shellfish/fish. Participants underwent esophagogastroduodenoscopy (EGD), biopsies, and skin-prick tests before treatment. Histologic response was defined as having ≤5 eosinophils per high-power field (eos/hpf), and responders underwent systematic reintroduction of food, after which, EGD and biopsies were repeated.

The researchers found that 96, 74, and 94 percent of participants experienced dysphagia, food impaction, and heartburn, respectively. In the proximal and distal esophagus, there was a significant reduction in the peak eosinophil count after SFED (from 34 to 8 and from 44 to 13 eos/hpf, respectively). Sixty-four percent of participants met the criteria for a histologic response and 70 percent had peak counts ≤10 eos/hpf after SFED; symptom scores improved for 94 percent of participants. Problem foods identified on reintroduction were wheat (60 percent of cases) and milk (50 percent of cases). Only 13 percent of foods associated with EoE were identified on skin-prick testing.

“An elimination diet significantly improves symptoms and reduces endoscopic and histopathologic features of EoE in adults,” the authors write. “Food reintroduction re-initiated features of EoE in patients, indicating a role for food allergens in its pathogenesis.”

– HealthDay (source: DoctorsLounge)

A 7-year-old Yorktown girl has inspired politicians to fight for passing a legislature that will amend the insurance law and require certain health insurance policies to include coverage for the cost of enteral formulas for the treatment of a potentially fatal condition.

‘Hannah’s Law’ was recently passed with the help of Senator Greg Ball (R, C – Patterson).

The little girl, Hannah Devane, suffers from eosinophilic esophagitis which is a potentially fatal condition that makes it impossible for her to eat most foods.

Children with eosinophilic esophagitis and similar disorders can only obtain nourishment from special, enteral formulas, which in some cases may be ingested orally, but in other circumstances must be administered via a feeding tube.

In Hannah’s case, the life sustaining formula can be taken orally and comes with a cost of approximately $1,200 per month, or $14,400 annually.

Her medical insurance provider already provides coverage for the cost of enteral formulas, but only under conditions that require tube feeding, and extremely evasive, life-altering procedure.

Currently the insurance companies are making parents decide between incurring the significant out-of-pocket costs for the enteral formula needed, or forcing their children use a feeding tube, Ball said.

“Hannah is the cutest and toughest little girl I know and is an outstanding, giving member of our community,” he said. “Hannah has volunteered at events like my ‘Veterans Thanksgiving Dinner’ and is an impressive little girl. Passing this bill in the Senate brings New York State one step closer to ensuring that thousands of families are never again victimized by the system, like the Devane family.”

‘Hannah’s Law’ will amend the insurance law and require certain health insurance policies to include coverage for the cost of enteral formulas for the treatment ofeosinophilic esophagitis and related eosinophilic disorders.

Hannah’s mother, Jessica Devane, said she was happy people saw how important the issue was and passed the bill.

“We are grateful and beyond words for this legislation to finally start moving,” Devane said. “This bill will give parents the peace of mind of knowing they can take care of their children without a financial burden.”

‘Hannah’s Law’ is currently being sponsored by Assemblywoman Amy Paulin and is in Assembly Insurance Committee.

“This legislation is critical because it will mean that children with eosinophilic esophogitis will no longer have to use an invasive feeding tube simply because that is the only method their insurance company covers,” Paulin said. “It will allow children whose families cannot afford the out-of-pocket cost of oral formula to finally have access to it.”

– Plamena Pesheva (source: Patch)