The doctors suspected that the girl was suffering from an eating disorder.
Asher and Shilot (Photo: Courtesy of those photographed)
"For months, everything my daughter eats - she vomits. She became thinner and thinner. A normal-weight girl dropped to 34 kilos," says Asharat, a mother of two girls who suffer from Eosinophilic Esophagitis (EoE).
Type 2 esophagitis is considered a new disease, and therefore almost unknown, even among doctors and the public.
Sheilat, the eldest daughter, now 16 years old, was diagnosed about three years ago, after months that included repeated admissions to the hospital, in which the doctors sent her for a variety of tests, including psychiatric tests due to suspected eating disorders.
Asharat says that the trouble started when Shilot complained of stomach pains.
"We went to the doctor, and she prescribed an anti-tumor pill for her. We returned home, and then the vomiting started. Up until that time, the girl had no problems with eating. Sheilat died on junk food," she says.
After two weeks, the situation did not improve, and the mother took her daughter to the emergency room.
At the hospital, she says, they sent the girl to see a child psychiatrist because they suspected she had an eating disorder.
"And I had an inner knowledge that this is not true. That she has a real problem that the doctors are unable to solve. At the same hospitalization, they determined that she was suffering from stomach inflammation and released her home with a pill designed to relieve the inflammation by lowering the level of acidity in her stomach."
Since then, many months passed, followed by hospitalizations with weight loss and suffering until the diagnosis arrived: Sheilat suffers from EoE.
Mask of agony
Dr. Noam Zavit, director of the clinic for eosinophilic diseases of the digestive system at the Schneider Pediatric Center in Israel, explains that EoE, or eosinophilic inflammation of the esophagus, is a chronic inflammation characterized by an abnormal accumulation of immune system cells called eosinophils and lymphocytes in the esophagus, which release substances that promote inflammation. Over time The inflammation causes functional problems of the esophagus and even scarring. "In most cases the disease develops as a result of an allergic reaction to some food.
It's a disease that was identified as a separate disease only in 1995. Since then we've been learning more and more about the disease, its causes and the ways to treat it," says Dr. Zevit.
Most patients with EoE will suffer from other diseases such as asthma or atopic dermatitis (atopic inflammation of the skin).
The connection between all these diseases is type 2 inflammation. This is an inflammation that is not caused by the entry of bacteria, viruses or foreign substances into the body, but by processes that occur in the body itself.
Type 2 inflammation characterizes various conditions in which there is a chronic allergic reaction during which the control of the immune system goes wrong for a reason that is not entirely clear.
According to Dr. Zevit, "The typical symptoms of EoE vary according to age.
In babies, the common expression is food emissions that do not pass even at the age when they should pass, lack of weight gain and reluctance to eat.
In older children, the disease is often manifested by pain in the abdomen and unexplained vomiting, in teenagers and adults, the common symptoms are difficulties in swallowing and even food sticking in the esophagus, a feeling of suffocation when eating, and sometimes also heartburn that does not respond to treatment, chest pain or vomiting."
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Symptoms change with age.
A girl suffers from stomach pains (Photo: ShutterStock)
And so it was with Shilot.
"At home, the vomiting continued. I said to myself, 'Maybe we should give the pill time to work? But a month goes by, and there is no benefit. We went back to the emergency room. The girl was hospitalized. And once again they brought in a youth psychiatrist. And this time they also did more and more tests on her - head CT, A urine test, an abdominal x-ray. After 8 days of hospitalization, we were discharged again with a diagnosis of gastritis and medicine to lower the acidity in the stomach. And there is no improvement. She suffered terribly and I can see that her condition is getting worse and worse. Even so, she was thin, and she shrunk more and more," says the mother on Maskat the agony
How is EoE tested?
To diagnose EoE, one must contact a specialist in gastroenterology. Among other things, a gastroscopy examination will also be performed, which examines the appearance of the inside of the esophagus and looks for the signs of inflammation typical of the disease, and collecting samples for biopsies, which are examined under a microscope to assess whether there is a high presence of eosinophil cells in the esophagus, which define the the disease
"For Shilot, this test was only done near the end of her third hospitalization, which lasted a whole month, and after the girl was referred twice to the eating disorders department. After the diagnosis," Asharat says, her daughter began to be treated with steroids, which reduce inflammation in the esophagus.
"The doctor also recommended an avoidance diet whose purpose is to try to find out if there is an allergy to a certain food by avoiding eating it. She would eat vegetables, meat in a pan and that's about it. She made sure to eat slowly and in small bites. Chew the food very well."
A disease that was identified as a separate disease only in 1995. Esophagitis (Photo: ShutterStock)
Often, there is a significant delay in the diagnosis of EoE, partly due to a lack of awareness of its existence, among patients and doctors alike.
"Because this is a young and rare disease, many complain of difficulty swallowing and the doctor gives them medication for reflux or explains that they are not chewing enough. If these medications do not solve the problem, many patients hear that 'this is the situation and you have to live with it,'" explains Dr. Zevit A
second problem that causes misdiagnosis, adds the gastroenterology expert, is that the disease develops slowly. "Patients do not recognize that their condition is actually abnormal.
Not everyone knows that something has gone wrong and not everyone feels that the food 'creaks' while it goes down into the stomach, and as long as nothing extreme happens they don't know that they need to get treatment."
One treatment approach to EoE today is to avoid foods that can cause an allergy.
"Many patients have a combination of several allergens, and sometimes there are other factors as well," explains Dr. Zevit. One problem with this approach is that the usual allergy tests are not helpful in identifying the causes of the disease, so you have to start an elimination diet, controlled and supervised by a doctor. In which you stop eating the suspect foods and gradually reintroduce foods until the disease breaks out and thus the cause of it is identified. Today it is also possible to start with less severe diets. The treatment is tailored to the patient's condition."
The nurse was also diagnosed
According to the expert, in most cases, if the patients fail to reach a balance by finding the cause of the allergy.
"The first line of treatment is old drugs that inhibit acid secretion, and also create an anti-inflammatory effect in the esophagus," he says.
In half of the patients, this treatment is not helpful.
"The second option is steroids that are given by swallowing for local treatment of the esophagus. A kind of "anti-inflammatory cream for the esophagus.
This is a very effective treatment that, according to studies, has between 70 and 90 percent success."
However, in about five percent of patients, steroids are not helpful either. "This year, for the first time, the American FDA approved the use of a biological drug that treats type 2 inflammation to deal with the inflammation of the esophagus, given with one injection per week.
This is a new drug for EoE but approved for other diseases such as severe asthma and atopic dermatitis," says Dr. Zevit.
Did the dietary restrictions and the daily steroid treatment help the shedding?
"In the beginning, her condition really improved, but the inflammation did not go away, and after a few months, the vomiting resumed. This time, on the recommendation of the family doctor, we suddenly learned that there is an association called the Lehdo'a Association (for patients with eosinophilic esophagitis), which aims to increase awareness of the disease and prevent patients from years of undiagnosed suffering.
The association was founded by Sigal Feingold and her daughter Tal, who was also diagnosed as suffering from "EoE", says Asharat.
Sigal Feingold referred the mother and daughters to Dr. Zevit, who changed her treatment.
Today Shilot is receiving research treatment with injections, and she is back to eating the foods she likes.
"The doctor explained that he sees no reason to continue with the diet if a year has passed and there is no improvement. Sheilat's condition is improving and she has returned to a normal weight," Osherat says.
A year later, when Shireen, Shilet's younger sister, began to complain that she had difficulty swallowing, the mother already knew what to expect.
Yarin, now 15 years old, was immediately diagnosed with EoE, in a less severe condition than her older sister.
"She receives the steroids, and the treatment helps her. She manages to eat normally."
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