S1216 Speech-Language Pathologists Promote Management of Children With Eosinophilic Esophagitis

Abstract

INTRODUCTION: Speech-language pathologists (SLPs) assess feeding and swallowing problems, and provide education and skill-based interventions which can improve clinical outcomes. Children with eosinophilic esophagitis (EoE) frequently present with feeding and swallowing problems. However, the spectrum of these problems has not been well studied. Herein, we sought to characterize the feeding and swallowing disorders and the related interdisciplinary care in children with EoE. We hypothesized that prompt recognition and management of feeding and swallowing problems in children with EoE can promote their clinical care. METHODS: We reviewed medical records of 170 children with EoE for feeding and swallowing concerns prior to their visit to our interdisciplinary EGID clinic. Of these, 46 (27%) children were identified and evaluated by SLPs during their clinic visit for dysphagia (oral, pharyngeal, coughing/choking, and aspiration), selectivity (texture aversion, difficulty with texture advancement, limited variety of food groups), and meal time behaviors (refusal, extensive duration, need for distractions, pocketing food, and caregivers stress). Next, the SLPs provided specific dietary guidance, skill acquisition and behavioral management strategies, additional testing, or an intensive outpatient feeding evaluation. Descriptive statistics were used to analyze data. RESULTS: The age of our cohort was 10 (1.8–18) years [median (interquartile range (IQR)]. In all 22 (51%) [n (%)] had dysphagia, 22 (51%) reported selectivity, and 18 (41%) indicated negative meal time behaviors. Dysphagia was more prevalent in older children [13 (7–16) years], whereas selectivity [9 (5–12) years] and meal time behavior [9 (6–12) years] were common in relatively younger children with EoE. Twenty-two (48%) children were offered dietary guidance on alternating liquids/solids and puree/liquid wash, 22 (48%) were educated on sensory exploration/food chaining, and 18 (39%) were instructed on behavior management strategies. Three (7%) were advised video fluoroscopic swallow study. In all, 22 (48%) were referred for an intensive outpatient evaluation. CONCLUSION: In our single center study, we found that almost a third of children with EoE experience feeding and swallowing problems, and about half of them require intensive feeding evaluation. A large multi-center approach to integrate SLPs in the care of EoE patients is warranted to promote clinical outcomes.