University of South Florida

Dr. Racha Khalaf advances EoE monitoring at USF Health with new string test

The Esophageal String Test is a brand-new option, and USF Health is one of only three sites in the country offering it.

Racha Khalaf, MD, assistant professor and chief of Pediatric Gastroenterology at the USF Health Morsani College of Medicine, is using a less invasive method to monitor a condition known as Eosinophilic Esophagitis (EoE). The chronic disease is characterized by white blood cells called eosinophils infiltrating the esophagus and causing inflammation, which can lead to difficulty swallowing or food getting caught in the swallowing tube known as the esophagus.

“EoE patients have a migration of eosinophils to the esophagus, causing symptoms like vomiting and difficulty eating,” Dr. Khalaf said. “In children, it can even lead to difficulty with growth.”

Dr. Racha Khalaf.

Traditionally, after diagnosing the condition, physicians monitor EoE using a sedated procedure known as an endoscopy, in which the doctor snakes a tube containing a tiny camera down the patient’s throat to view the esophageal lining. The procedure requires anesthesia in children and can have risks including pain and discomfort. But Dr. Khalaf said she uses the Esophageal String Test, which provides her the information she needs to determine a treatment plan without the same level of discomfort and an improved risk profile.

The Esophageal String Test is a brand-new option, and USF Health is one of only three sites in the country offering it.

During the test, the patient swallows a small pill containing a flexible string. The end of the string is taped to the cheek and the string remains in place forĀ one hour and collects esophageal secretions that are then examined for the presence of inflammation caused by eosinophils.

Esophageal String Test with capsule.

For 9-year-old Shark Smith, who has been diagnosed with EoE, the Esophageal String Test is a welcome alternative to regular endoscopies. “It’s better because I don’t have to get put under with anesthesia,” he said. “And it doesn’t take that long. It only takes an hour.”

Shark’s mother, Jennifer Smith, shared his sentiment. She said, “He’s been scoped, I think, seven times since he was two years old.” The diagnosis of EoE came accidentally when Shark swallowed a penny, leading to his first endoscopy. “We never had any symptoms,” she said.

The Esophageal String Test proved beneficial when Shark’s treatment was not yielding the desired results. “It told us that we’re pretty much taking this medication for no reason now,” Jennifer Smith said. “So, we have to change our treatment plan.” They came to Dr. Khalaf, seeking other options apart from scoping every six to 12 months.

“It’s easier on him; it’s easier on the mom,” Jennifer Smith noted. Shark recommends patients bring something to keep themselves entertained during the procedure, such as a book or an electronic device. Both mother and son praise Dr. Khalaf and the string test. “Dr. Khalaf is amazing,” Shark said. “And if anybody has the chance to do this, I would definitely recommend it over scoping.”

“We’re just really happy,” Jennifer Smith said. “We’re happy with Dr. Khalaf. We’re happy with the test.”

Story, video and images by Allison Long, USF Health Office of Communications.

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