Remodeling the Esophagus

I had a bit of an ah-ha moment recently. It was about the importance of all the effort and commitment our family dedicates to ensuring our teenage son avoids his eosinophilic esophagitis (EoE) food triggers, as well as his anaphylactic allergens – it’s not just about today, but about our son’s future too. I was listening to Dr. Amanda Muir, Assistant Professor of Pediatrics at Children’s Hospital of Philadelphia talk about what ‘remodeling’ means in terms of the esophagus, and I learned so much.

My initial thought was that remodeling the esophagus was something good. Remodeling sounds positive, right? Well, read more…

Dr Muir explained that remodeling results when eosinophils (‘fancy’ white blood cells) congregate in the esophagus and digestive tract, causing damage to both the tissue on the surface and tissue beneath the surface. While the main focus of research currently is on the surface of the esophagus (the epithelial compartment), Dr Muir is interested in what is going on underneath the surface (the lamina propria), where the most EoE remodeling occurs. She notes:

…It’s over time when eosinophils ‘excite’ the cells beneath the surface, the cells then begin to try to heal damage that is occurring, releasing collagen to try to attempt to repair the tissue. (Think of collagen as the ‘glue’ that holds the body together.) When this happens over and over and over again, releasing more and more collagen, the esophagus becomes stiffer and stiffer.

More research is ongoing to understand esophageal remodeling, which is found more in adults than in children. However, some pediatric patients as young as six years old can begin to develop this stiffening damage. Once this remodeling occurs, the current solution is periodic dilations to stretch the esophagus -- it is believed once this stiffening presents, it is not reversible.

So, learning all of this from Dr Muir made me realize the utmost importance of avoiding my son’s known EoE triggers. I’ll admit it has crossed my mind since my son has been taking Dupixent (dupilumab) biologic, which has addressed his EoE symptoms, do we need to be as careful in avoiding his trigger foods? 

My takeaway – YES, to prevent esophageal remodeling, I’m now more aware of how strict avoidance can prevent further damage and problems for my son into adulthood.

Thank you to Apfed (The American Partnership for Eosinophilic Disorders) and their excellent podcast Real Talk for sharing such important topics relative to the challenges our family lives with daily. Click here to listen.

And click here for more about how our family lives with EoE, or here for more about the resources I trust.