New Center for Eosinophilic Disorders

Welcoming a new baby into the world can be a stressful endeavor and sometimes lead to new challenges. For David and Rosie Dawson, one of those challenges was unexpected – their son, Bradshaw, had difficulty feeding.

Rosie's pregnancy and birth were normal, but when Bradshaw was a few weeks old, he began frequently spitting up. This raised alarm bells for the Dawsons. They went to see their pediatrician who thought that Bradshaw might be experiencing a severe case of acid reflux, causing his esophagus to be inflamed, and was prescribed an antacid.

But the medication failed to relieve Bradshaw's symptoms.

Over the next year, the Dawsons went through extensive testing to try to identify the cause of Bradshaw's symptoms: Rosie removed dairy from her diet to limit his exposure to potential allergens. Bradshaw saw an allergist to determine if any potential environmental allergens were causing his symptoms and was referred to a gastroenterologist who performed an endoscopy, a procedure that allows doctors to visualize the esophagus, which showed continued inflammation.

Ultimately, Bradshaw was placed on a severely restrictive diet that prevented him from eating any proteins. This was difficult for him because he enjoyed nothing better than a good omelet, and he could no longer eat eggs.

However, none of these interventions reduced the inflammation in Bradshaw's esophagus.

"It was a traumatic year," said David Dawson. "He was doing well, but he wasn't thriving."

A "New" Esophageal Disorder

Last year, MUSC Children's Health started a clinic, MUSC Children's Center for Eosinophilic Disorders, dedicated to eosinophilic gastrointestinal diseases – a group of chronic intestinal diseases that are characterized by gastrointestinal symptoms caused by a subset of overactive immune cells called eosinophils. Benjamin Kuhn, D.O., leads the center and treats patients from across the region, including South Carolina, North Carolina, Georgia, and Tennessee.

Kuhn is division chief of Pediatric Gastroenterology with a specialty in allergic gastrointestinal conditions. His expertise is in treating eosinophilic esophagitis (EoE), which is an autoimmune disorder that causes inflammation of the esophagus.

"This condition is present in 1 out of 2,000 people, whether they know it or not," explained Kuhn. "It's not that uncommon, and we are identifying new cases at a faster rate because we've become aware of the condition over time."

EoE can present at any age and symptoms often vary depending on the age of onset. In younger children, their symptoms may present as difficulty eating or symptoms of reflux that aren't getting better with standard treatments. In older children and adults, they are more likely to have issues with swallowing – to the point where food is getting stuck while they're eating. It can be difficult to diagnose and is often delayed because doctors treat the patients' reflux symptoms.

There aren't many effective treatment options for EoE. Allergy testing is useful for identifying anaphylactic allergens but often fails to identify EoE allergens. Additionally, most medications are only 40% to 60% effective. Oftentimes, patients are placed on a restrictive diet; however, these diets vary in their effectiveness, and furthermore, they can be hard for families, especially at a time when parents are encouraging children to explore a wide range of foods.

There is never a one-size-fits-all solution. Currently, there is no way to predict which treatment option will work for a patient. There is often a lot of trial and error in finding the right one, which can sometimes take up to a year to identify.

New Treatment, New Outlook

The Dawsons were eventually referred to Kuhn, who met with the family. Together they decided on the most practical approach to treat Bradshaw.

"It was very validating to have him say, 'Here's a treatment option. Here are the pros and here are the cons,'" recalled David. "He walked through all the different considerations. It was an amazing feeling when we walked out knowing we had a plan."

"After I had met them and reviewed Bradshaw's case, I offered to change over to a medication treatment and then liberalize his diet back to eating and drinking whatever he wanted," said Kuhn. "And it worked; the follow-up endoscopy and biopsies were normal."

Within four months of first seeing Kuhn and being prescribed a new medication, Bradshaw was symptom-free.

"It was life-changing for him – he doesn't have to worry about throwing up," said David. "He's a happier kid now. He's able to focus and relax."

"What's so wonderful is that if there is an issue, if there is a flare-up, or something happens, we know exactly where to go and who to talk to," added Rosie. "We'll be able to manage it because of his knowledge."

The Dawsons weren't the only ones who were pleased with Bradshaw's complete reversal.

"It was heart-warming to be in the room when sharing his normal results on his new treatment," said Kuhn. "His outlook will be as normal as any other child could be."

With a new treatment regimen in hand, Bradshaw can now go back to eating and drinking whatever he wants. Once again, Bradshaw can enjoy his omelets with cheese and red and green peppers.