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Pediatric Gastroenterology: Eosinophilic esophagitis, often confused with reflux, treated in new UCLA G.I. disorders clinic

12/01/2007

UCLA has established a Pediatric Eosinophilic G.I. Disorders Clinic – only the third program of its kind in the United States and the first in the Los Angeles region. Often misdiagnosed as gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EE) is now recognized as a distinct disease with unique etiology, symptoms, treatment and consequences.

EE more commonly affects males and causes many of the same symptoms as GERD, including heartburn, chest pain and abdominal pain while eating. The primary symptom that distinguishes EE from reflux is difficulty swallowing and food impaction (food becoming lodged in the esophagus). Definitive diagnosis of EE involves an upper endoscopy with biopsy to check for infiltration of cells called eosinophils. The cells, which are present only in the lower portion of esophagus with GERD but throughout the esophagus with EE, can narrow the esophagus and make swallowing increasingly difficult.

About 75 percent of EE cases are associated with food or environmental allergies. Evidence of other allergic conditions also may be present, including asthma, allergic rhinitis and eczema. In addition, the disease runs in families. More research is needed to fully understand the association between EE and allergies, and possible genetic components.

Diagnosing and treating food and environmental allergies often sends the disease into full remission. Patients who have had difficulty swallowing certain foods eventually can resume a normal diet and regain lost weight. Steroid treatment can reduce EE-related esophageal inflammation and help control symptoms in patients who have no apparent allergies. If reflux symptoms are present, acid blockers may provide relief.

Without treatment, EE patients gradually lose their ability to swallow – first foods and then, in extreme untreated cases, purees and then liquids. Choking also is a hazard as eosinophils progressively narrow the esophagus.

Clinic services

The Pediatric Eosinophilic G.I. Disorders Clinic at UCLA combines the expertise of a gastroenterologist, allergist and dietician to provide a full range of diagnostic and treatment services. The team initially evaluates the patient’s gastrointestinal, allergy and diet history to identify potential associations and exposures. If the history indicates possible EE, patients undergo an upper endoscopy to check for eosinophils. Further diagnostic studies include skin-prick and patch testing for food and environmental allergies. The treatment consists of counseling on how to avoid any allergens identified by the testing, and possible use of topical steroids and an acid blocker, as appropriate.

Team members

Mini Mehra, M.D.
Director, Pediatric Eosinophilic G.I. Disorders Clinic
Assistant Professor of Pediatrics, Division of Gastroenterology and Nutrition

Maria Garcia-Lloret, M.D.
Director, Food Allergy Clinic
Assistant Professor of Pediatrics, Division of Allergy and Immunology

Diana Saikali, M.S., R.D.
Pediatric Nutritionist


Patient referral

Physicians may refer patients to the Pediatric Eosinophilic G.I. Disorders Clinic at UCLA by phone at (310) 825-0867, by fax at 310-206-0203 or by e-mail at mmehra@mednet.ucla.edu. The clinic is located in the Peter Morton Building at 200 UCLA Medical Plaza on the UCLA campus.





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