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 for 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.

What started as a simple fall led to a diagnosis the Weiler family wasn’t expecting – 8-year-old Patricia Weiler has Crohn’s Disease.

After the fall, Patricia’s mother, Annette, immediately took her to their dentist, who prescribed antibiotics but the swelling persisted. Patricia then saw her pediatrician who referred them to a maxillofacial surgeon who noticed abnormal tissue architecture. She performed a biopsy, which confirmed granulomatous inflammation consistent with Crohn’s disease.

She was then referred to Racha Khalaf, MD, assistant professor in the Department of Pediatrics in the USF Health Morsani College of Medicine and a pediatric gastroenterologist.  Dr. Khalaf and her team performed several tests, including a biopsy of Patricia’s wounds.  When the test revealed several key indicators, Dr. Khalaf confirmed that Patricia has Crohn’s Disease.

Racha Khalaf, MD, USF Health assistant professor and pediatric gastroenterologist.

Crohn’s disease is a chronic inflammatory bowel disease that causes inflammation in the gastrointestinal (GI) tract.  It’s a progressive condition, meaning it can get worse over time if untreated, and an autoimmune condition in which the body attacks the lining of the digestive tract often causing pain, diarrhea, weight loss and fever.   Treatment goals for Crohn’s include symptom mitigation, endoscopic improvement, and remission.

Patricia goes to the Tampa General Hospital Pediatric Day Hospital every six weeks to receive an intravenous treatment of Infliximab, commonly prescribed for a variety of autoimmune disorders.  Patricia said her favorite part of her visits are being able to play with TGH Valor Service Dogs, who are there to provide a comforting presence to children in the hospital setting, and helped young Patricia quell her fear of needles.

Dr. Khalaf and other physicians who have met Patricia commonly describe her a “wise beyond her years” in the wake of her diagnosis.  She understands this will be something that will be with her for the rest of her life and understands that she needs to make certain lifestyle changes including limiting her sun exposure, the amount of processed foods, and reducing the amount of dairy she consumes.  Patricia still participates in her favorite activities including soccer, ballet, and playing with her dog Mitch and sister Annabelle.

Patricia Weiler (right) and her sister Annabelle with their dog Mitch.

Patricia has been in remission for more than nine months and mother Annette is very thankful for all of the doctors who helped get her pointed in the right direction for care and getting her questions answered.  She is especially thankful to Dr. Khalaf and her team for finally bringing an end to the mystery of Patricia’s health.

“From the first moment I met the team, they were very assuring.  They said they would become ‘best friends’ throughout this process and that’s exactly how it has been,” Annette said.  “It was scary at first, but the reassurance is what really helped us through this.”

“It’s not a disability, it’s just something with my body that I have to keep an eye on,” Patricia said.  “I’m very thankful that we found a team that helps me and my family with my problems, and we did it before it got worse.”

Video and photos by Freddie Coleman