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khagihara
khagihara, Doctor
Category: Medical
Satisfied Customers: 6587
Experience:  Trained in the multiple medical fields for many years.
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My 14 year old son was recently diagnosed with EE. Are there

Customer Question

My 14 year old son was recently diagnosed with EE. Are there other possible causes or theories other than food allergies? Food sensitivities maybe? Can those be tested for and identified? What about preservatives and additives in our food that could be avoided by eating more natural non-processed food diet? He throws up every time he eats, unable to keep anything down entirely. Including beverages – unless he just sips on them over an extended period of time. He is not even able to keep the omeprazol down that the GI doctor's PA gave him. Actually, he's not able to swallow it to begin with because the gelcap is too big. I have been giving him half a pill of high potency probiotic mixed in with Gatorade daily. His doctor also gave him Flovent HFA 220 mcg (inhaler) but he just puts two squirts in his mouth and swallows it twice a day to heal the damage to his esophagus. His doctor is still recommending the omeprazol as the treatment to keep him from throwing up. From what I understand, that is not the proper (or necessary/effective?) treatment recommendation. His colonoscopy also showed irritation in the colon, which the GI doctor has yet to address. Do you find this symptom is common in patients with EE as well? Any theory on what causes this or recommended treatment?
I was also requesting a food patch test since his skin test and RAST panel showed negative for any food allergies. Is there another test like possibly the FoodSafe test which shows food sensitivities as well as full-blown allergies? The Allergist's nurse said that the food patch test is probably not necessary since a true food allergy would have caused a more severe reaction requiring epinephrine etc.
My son is on homebound from school, is not seeing his friends and not wanting to get out of the house because his stomach is cramping so much or he is throwing up after eating or drinking or he is starving because he hasn't kept much down. It doesn't seem to matter what type of food he eats. The stomach cramping and hunger disturb his sleep as well. His bowel movements seem to be normal from what he tells me. Somehow he doesn't seem to be losing weight, but he is week everyday and miserable. I need some answers and relief suggestions. This is no life for a 14-year-old.
His symptoms actually started two years ago with what seemed to be major acid reflux, with belching, and regurgitation, but not as violently and often as it has been for the past few months. We took him out of school then, and he was homeschooled for the past two years. His symptoms did not completely disappear but lessened a lot until recently. He started back at a transitional school to hopefully be placed back with his peers in his regular public school starting at the first of the year. He was excited to have a chance to catch up agai finally, but was only there may be a week before realizing that being one of only six middle school and elementary students, the rest of whom were there for disciplinary reasons, was quite depressing, as well as not academically challenging at least so far. His symptoms came back like gangbusters maybe two weeks into the school season. His therapist and I were concerned that a lot of this could be psychosomatic since he has been through a lot emotionally over the last several years. He tested highly on a short, written depression evaluation she gave him. She and his pediatrician agreed to start him on 25 mg of Zoloft to treat his obvious anxiety issues, and optimally, his physical symptoms as well, but so far, nothing.
Is this severe amount of regurgitation/ vomiting and cramping typical of EE symptoms? What should we try next? Is it possible there are other factors or diagnoses? Please help.
Submitted: 1 year ago.
Category: Medical
Expert:  khagihara replied 1 year ago.

What is EE?

Customer: replied 1 year ago.
Sorry, I was writing because another patient's question to a different doctor who was online at the time came up and I thought I would be talking to him. Since EE (eosinophil esophagitis) has only been identified in the past few years, should I wait until an expert G.I. doc or other specialist is available to answer? No offense intended, I hope you understand.
Here is the main info on EE from that doctor's response:
You have unfortunately contracted a condition which is not well understood.
eosinophil esophagitis
The causes of EE are not well understood. Although food allergy is postulated as a cause, it is a hypothesis only and not proven - in most patients an offending food cannot be identified as in your case.So do not worry about not being able to identify the food allergen - this is quite common.However, I feel you are not being adequately treated. Although there is still a lot to be known about EE, it is known that PPI's have no role. Also as I said, food elimination is more often than not unsuccessful.Instead, following treatments are used and are much more effective:
Swallowed steroids like Fluticasone and Budesonide
AntihistaminicsRead more: http://www.justanswer.com/medical/5xq5i-high-eosinophil-count-esophogus-38-per-high.html#ixzz3oD2zXLFY
Expert:  khagihara replied 1 year ago.

There are some experimental treatments.

Expert:  khagihara replied 1 year ago.

Treatment with OC000459 (prostaglandin D2 receptor antagonist), but not placebo, was associated with a modest but significant reduction in esophageal eosinophil counts and an improvement in symptoms. Initial experience suggested that montelukast (a leukotriene inhibitor that has been used in eosinophilic gastroenteritis) may be helpful for symptom reduction in patients with eosinophilic esophagitis but subsequent experience has been mixed. Mepolizumab is a humanized monoclonal antibody against interleukin (IL)-5, which has a central role in eosinophil recruitment. Studies of mepolizumab have had variable results. n a report of two patients with multiple food allergies and eosinophilic esophagitis, treatment with the anti-IgE monoclonal antibody omalizumab was associated with an improvement in allergic symptoms but not in endoscopic or histologic features of eosinophilic esophagitis. A case report described a clinical and histologic response to azathioprine or 6-mercaptopurine in three adults with glucocorticoid-dependent eosinophilic esophagitis.