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Treating Esophagitis

Logan MosherTwo-year-old Logan Mosher zooms the firetruck along the track, pushing its buttons to make its sirens wail. A minute passes, and then, he’s on to the tow truck. Next, he circles around the table to grab the helicopter, flying it above his head.

Too busy to look up and smile for the camera, he’s playing like any normal toddler. But just over a year ago, Logan was too sick for this kind of busy, active playtime — and his mom, Jody, had no idea what was wrong.   

“He wasn’t running around, and he probably would have preferred to just play on the floor,” said Jody, a pediatric nurse. “His skin had begun to look so pale.” 

When Logan first started to get sick, Jody and her husband, Brad, thought it was the stomach bug. He had all the classic, yucky symptoms, and the illness had been making the rounds at day care.  

But weeks went by, and while everyone else recovered, Logan didn’t. 

Months passed. At his 18-month checkup, he hadn’t gained any weight since his 1st birthday. 

“It was so difficult seeing him like that,” said Jody. “He had been such a big, happy baby, and he made a complete turn, within months.” 

After Logan made a visit to his pediatrician, Jody took him to see Jeanne Lomas, D.O., an allergist at the University of Rochester Medical Center. As soon as Lomas heard about Logan’s symptoms, she had a feeling she knew what was wrong. 

She suspected Logan had eosinophilic esophagitis (EoE), a chronic inflammatory disease of the esophagus that’s often associated with allergies. The condition can cause many of the symptoms Logan was experiencing, including poor growth, difficulty swallowing, choking, nausea, and vomiting. 

Despite having no family history of food allergies, tests revealed that Logan was allergic to a long list of foods: wheat, dairy, soy, eggs, and turkey. To confirm that Logan also had EoE, doctors performed an upper endoscopy — which allowed them to examine Logan’s esophagus using a tiny camera on the end of a long, flexible tube.  

“This condition has often been missed in the past, but we believe it’s much more common than previously thought,” said Lomas, noting that EoE was only first described in the 1990s. “Sometimes, it’s not identified until a child begins choking and shows up in our emergency room.”

Logan plays with toysTo better diagnose and care for children with EoE, Lomas, along with Esther Prince, M.D., a pediatric gastroenterologist, and Brianne Schmidt, a dietitian, set up a clinic focused solely on EoE in 2017. As part of the clinic, children who may have the disease or who have already been diagnosed are able to see all three specialists in one visit.  

“The clinic provides some added convenience for parents, but it also allows the three of us to sit in a room together and work collaboratively to come up with a treatment plan,” said Prince. “We each bring something different to the table.” 

The team now cares for more than 100 children from across the region, and the clinic will soon increase in frequency to twice a month. Depending on each child’s unique case, they have an array of treatment options to choose from, including medications that help control inflammation as well as a simple procedure that helps stretch narrowed portions of the esophagus. 

Many children also benefit from eliminating triggering foods from their diet. That’s where Schmidt steps in to help families identify substitutions and ensure children are still meeting their nutrition needs. 

“Eating affects so much — behavior, learning, development — and when there’s a problem, EoE is usually not the first thing you think of,” said Schmidt. “But once it’s identified, treatment can make a world of difference.” 

That sentiment rings true for Logan, who is a completely different kid than he was a year ago. Since his diagnosis, he’s been growing and gaining weight thanks to medication and a new diet. He has energy to play, and he’s making up for small delays in speech he was experiencing as a result of being sick. 

Now, he will undergo follow-up endoscopies to check on whether his treatment plan is helping, and in the coming months, he’ll be able to try reintroducing certain foods into his diet.

“It’s been a process, but he is doing so well,” said Jody.   

“You never stop worrying when you have a child with food allergies, but knowing that there was a reason behind his symptoms, and that it was treatable, gave us so much relief. Now, we have a path forward.”

12/27/2018

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