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Eosinophilic esophagitis: strictures, impactions, dysphagia.

Seema Khan1, Susan R Orenstein, Carlo Di Lorenzo

  • 1Division of Pediatric Gastroenterology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, Pennsylvania 15213-2583, USA.

Digestive Diseases and Sciences
|March 21, 2003
PubMed
Summary

Eosinophilic esophagitis in children can be linked to allergies or reflux. Management strategies differ based on eosinophil counts and food allergy presence, guiding treatment for obstructive esophageal symptoms.

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Area of Science:

  • Pediatric Gastroenterology
  • Allergy and Immunology
  • Gastroenterology

Background:

  • Eosinophilic esophagitis (EoE) is increasingly recognized, often associated with food allergies and gastroesophageal reflux disease (GERD).
  • The underlying pathophysiology and optimal management strategies for pediatric EoE remain unclear.
  • Obstructive esophageal symptoms in children can be a manifestation of EoE.

Purpose of the Study:

  • To describe clinical experience with eosinophilic esophagitis and obstructive symptoms in children.
  • To propose etiopathogenesis and management guidelines for pediatric EoE.
  • To differentiate EoE subtypes based on clinical presentation and response to therapy.

Main Methods:

  • Retrospective review of 12 children diagnosed with EoE and obstructive esophageal symptoms.

Related Experiment Videos

  • Diagnostic evaluation included esophagogastroduodenoscopy with biopsies, upper gastrointestinal series, and allergy testing (IgE, RAST, skin prick tests).
  • Histological analysis of esophageal biopsies for eosinophil density (>5 eos/hpf) and correlation with clinical outcomes and treatment response.

    • Main Results:

    • Four children with >20 eos/hpf and food allergies responded to elimination diets or steroids; one responded to fundoplication.
    • Seven children with 5-20 eos/hpf and no known food allergies responded to antireflux therapy.
    • Three children with 5-20 eos/hpf and positive food allergies responded to elimination diets and/or steroids.

    Conclusions:

    • Eosinophilic esophagitis in children can be categorized into GERD-associated (<20 eos/hpf, no food allergies) and allergic EoE (>20 eos/hpf, associated with food allergies).
    • Treatment strategies should be tailored based on these proposed subtypes.
    • Further research is needed to elucidate the precise etiopathogenesis and refine management guidelines for pediatric EoE.