An Allergy We Can’t See
Eosinophilic esophagitis (EOE) is a worrisome condition for young patients and parents alike — one that makes it difficult for a child to swallow food. Beyond the discomfort and stress, symptoms may also include reflux and poor growth, and future complications can result if untreated.
But fortunately, Tampa General Hospital – led by the expertise of Dr. Racha Khalaf, medical director of the Pediatric Gastroenterology Center of Excellence – is providing highly successful state-of-the-art care through a procedure called transnasal endoscopy (TNE). Powered by a robust academic partnership with USF Health, TNE is now offered to a full range of pediatric ages.
In October 2024, Tampa General achieved a groundbreaking milestone at the Muma Children’s Hospital at TGH of becoming the first children’s hospital in the Tampa Bay region to offer the novel treatment. Significantly, it requires no anesthesia, unlike the traditional approach, resulting in enhanced safety and comfort for patients who suffer from what is known as eosinophilic esophagitis (EOE), a chronic inflammation of the food pipe.
“We have one of the most comprehensive (EOE) programs in the country,” Dr. Khalaf says. “We incorporated unsedated transnasal endoscopy this past year and it’s primarily used for patients with EOE, which is akin to an allergy in the esophagus.”
The innovative, minimally invasive procedure allows a patient’s upper GI tract to be assessed visually and with biopsies conducted. A camera attached to a thin, flexible tube is passed through the patient’s nose and into the esophagus, stomach and even into the small intestine to view and sample the patient’s gastrointestinal (GI) tract.
“Being able to offer TNE means no risks from sedation and reduced time away from school,” Dr. Khalaf says. “Patients can typically just leave the procedure and go back to their usual activities that day.”
Children not only handle the procedure well but benefit from an overwhelmingly high success rate – greater than 90%. “We’re always surprised by how brave children are with this,” Dr. Khalaf said. “We use numbing medication to decrease the discomfort, and all they feel is mild pressure.”
A multidisciplinary group that includes skilled, empathetic pediatric nurses and child life specialists also plays a key part. The children are even offered virtual reality goggles and can watch programming of their choosing during the procedure. “We’re very fortunate that Tampa General has given us the right resources to help these patients,” says Dr. Khalaf.
Left undiagnosed or untreated, children suffering EOE can experience slow eating or even vomiting. They may avoid certain foods that help them grow and thrive. “It becomes their normal and it can go undetected for a long time,” says Dr. Khalaf. “In those cases, the inflammation can progress to fibrosis, where the esophagus narrows and now the food is stuck. That requires other procedures that we perform at Muma Children’s Hospital at TGH.”
But TNE is a game-changer that may prevent the need for that, and help children live normal lives. “Offering procedures like TNE is critical to improve care for our children,” says Nikki Hurley, interim vice president of Muma Children’s Hospital at TGH and TGH Women’s Institute. “Through the collaboration of Muma Children’s Hospital and USF Health, our GI Center of Excellence is leading and transforming the way we care for children in the Tampa Bay region and ultimately improving outcomes.”
READ MORE:
- The Gold Standard of Care: Women's Health Services at TGH
- Top-Tier Pediatric Trauma Care at Muma Children’s Hospital
*Presented by Tampa General Hospital | Originally published in the May 2025 issue of Tampa Bay Parenting Magazine.