You may have noticed that we’ve been slowly moving down the digestive tract during this series. That’s very intentional on my part. Why? Because I like to think of the GI tract as a person’s “plumbing”, because from mouth to tush it is all one long connected tube! Think about it. Our GI tract is this marvelous run of “human plumbing” that starts at our mouth continues down the throat to the esophagus, into the tummy, and then out of our tummy through our small and large intestine and then out the other end! In between there are some valves, much like you have in your household plumbing, that help keep things moving in the right direction: either into the city sewers or, for us rural folks, into our septic systems.
With that in mind, our next step in our descent through the GI tract, is into the stomach. In the previous installation of this series, I talked about reflux and how that can impact the adenoids, tonsils, and throat. But why does reflux occur? Good question!! I am not a gastroenterologist so I am not qualified to really go into why reflux occurs in some people and not in others, but I can tell you what we often see in our selective eaters and how it impacts their ability to expand their diets. To begin with, let’s talk about allergies and intolerances. Most of us think of allergies as causing stuffy noses, itching, perhaps scaly skin and rashes, or when they are very severe, problems with being able to breathe (anaphylaxis). But did you know that some allergies cause stomach and esophageal problems rather than typical “allergy” symptoms? If you stop and think about it, lots of adults will tell you they are allergic to or don’t tolerate milk and/or gluten, and they usually have very specific GI symptoms that they recite regarding why they need to avoid these foods. Well, kids can have these challenges, too, and often they are overlooked until the stomach and esophagus have become so irritated, we call this esophagitis, that the child is now refusing most foods. In severe cases, the child’s allergy results in a condition called EoE, or eosinophilic esophagitis. If you look this up online, many websites will tell you that it is a rare condition, and yes, when looking at the entire population of humans on the planet, it IS rare. However, it has a much higher level of occurrence in our kids that struggle with food refusals, and is often at the root of why the child is having difficulty.
So, what IS EoE? According to the John Hopkins website, “eosinophilic esophagitis is an allergic condition that happens in the esophagus. The esophagus becomes inflamed and does not contract properly.” Essentially this means that foods have a hard time traveling comfortably from the throat to the stomach; sometimes foods feel like they are “caught” or “stuck” on the way down, and/or the movement of foods and liquids from the throat to the stomach is uncomfortable and even painful.
Please keep in mind that many people who have discomfort in their esophagus when they swallow do not have EoE, as a matter of fact, most people don’t have it! Instead, they have “esophagitis” which is a fancy way of saying that their esophagus is sore and inflamed. But, and here’s the clincher, just like when we looked at adenoids and tonsils, the important take away from this is, again, the “why”. That is, “why” is this occurring? Why is the esophagus inflamed?
Next up: The rest of the GI tract or “Wait, what does a Speech Pathologist know about poop?!"