Eosinophilic Esophagitis in Children

EoE is thought to be an immune reaction to certain foods (and possibly things in the air) in children who are prone to allergy. Milk, wheat, egg and soy are among the more common food triggers, but this differs from child to child. It is not caused by anything parents did, and it is not infectious. Untreated, the long-term inflammation can lead to scarring and narrowing.

EoE is now recognised much more often than in the past, in both children and adults. It is more frequent in boys and in children who have other allergic conditions such as eczema, asthma, hay fever or food allergy.

Wheat (bread, flatbreads), dairy (laban, cheese) and eggs are central in family meals, so ask your dietitian for practical, culturally suitable alternatives and for help reading labels on local products.

The diagnosis is confirmed with an upper endoscopy, a camera test done under anaesthetic or sedation in children, with small tissue samples (biopsies) taken from the food pipe. The pathologist counts the eosinophils. Doctors may first rule out other causes such as reflux. Allergy testing can give information, but skin or blood tests do not reliably identify the foods that trigger EoE.

Eating habits can make life easier while treatment works.

• Encourage small bites, thorough chewing and sitting upright at meals; do not rush.

• Watch for foods that often stick, such as dry meat, bread and rice, and report any sticking episodes.

• Keep a food and symptom diary to share with the team.

• Keep follow-up visits, since repeat endoscopy is often needed to check that the inflammation is controlled.

Food changes are an effective treatment for many children, but must be supervised.

• The team may suggest removing one or more common trigger foods (for example milk) for a few weeks, then reintroducing foods one at a time with repeat endoscopy to find the trigger.

• A special amino-acid formula is sometimes used in young children or severe cases.

• Work with a dietitian to protect growth, calcium and vitamin intake while foods are avoided.

• Do not remove foods on your own without medical advice, because this can harm nutrition and make the next tests harder to interpret.

Medicine can control inflammation when diet alone is not enough or not practical.

• Topical steroids are swallowed (not inhaled) as a liquid or paste to coat the food pipe. The doctor will explain how to give them correctly.

• Acid-suppressing medicines help some children and are often tried early.

• Newer biologic medicines may be considered in selected cases.

• Medicine usually needs to continue to keep control. The doctor decides the choice, dose and duration.

Endoscopy is used to diagnose, monitor, and sometimes treat.

• Repeat endoscopy with biopsies checks whether treatment is working.

• If the food pipe has narrowed, it can be gently stretched (dilated) during endoscopy.

• A stuck piece of food that does not pass needs emergency removal by endoscopy.

Treatment options now include dietary therapy, swallowed topical steroids, acid-suppressing medicines for some children, and in selected cases newer biologic medicines. The best option is chosen with your child's specialist.

EoE is usually long-term. Treatment can control symptoms and inflammation and help prevent narrowing, but symptoms often return if treatment is stopped. With regular follow-up, most children eat and grow well.

• How sure are you that this is EoE and not reflux?

• Should we try diet changes, medicine, or both?

• How often will my child need repeat endoscopy?

• What should I do if food gets stuck?

• How can we protect growth and nutrition?

This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the Approved for publication by SGA; individual clinician review is ongoing. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.