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Published on: May 10, 2024
Paediatric eosinophilic oesophagitis presenting to the otolaryngologist
1Department of Otolaryngology, St George's Hospital, London, UK. bertieharris@yahoo.com
Insights
Eosinophilic esophagitis (EoE) is increasingly diagnosed in children presenting with food impaction. Early collaboration between otolaryngologists and gastroenterologists is crucial for prompt diagnosis and management of this condition.
Area of Science:
- Otolaryngology
- Pediatric Gastroenterology
- Gastroenterology
Background:
- Eosinophilic esophagitis (EoE) prevalence is rising, yet few otolaryngology publications address it.
- Patients often present with dysphagia, vomiting, or food impaction, leading to gastroenterology referral.
- Delayed diagnosis of EoE can result in serious complications like esophageal stricture.
Observation:
- Two pediatric patients presented to otolaryngology with intermittent upper esophageal food impaction.
- Gastroenterology consultation was obtained for both cases.
- Esophageal biopsies confirmed eosinophilic esophagitis in both children.
Findings:
- Both pediatric patients received timely diagnosis and management.
- The otolaryngology team successfully managed the cases with gastroenterology support.
Implications:
- Clinicians should consider eosinophilic esophagitis in pediatric patients with food bolus impaction.
- Early pediatric gastroenterology team involvement is recommended for children with esophageal symptoms to prevent diagnostic delays.
Introduction:
The prevalence of eosinophilic oesophagitis is increasing. A Pubmed search for 'eosinophilic oesophagitis' and 'eosinophilic esophagitis' yielded 345 publications since 1976. Only seven were in otolaryngology journals.1-7 Patients typically present with dysphagia, vomiting, dyspepsia or food impaction and are therefore usually referred to a paediatric gastroenterologist; otolaryngologists are not usually involved in management. A missed diagnosis may result in oesophageal stricture.
Methods:
Two patients, aged two and four years, were referred to the paediatric otolaryngology department with intermittent upper oesophageal food impaction. A paediatric gastroenterologist was involved in the investigation. Histological examination of oesophageal biopsies demonstrated changes consistent with eosinophilic oesophagitis.
Results:
Both patients were expediently diagnosed, investigated and managed.
Conclusion:
A diagnosis of eosinophilic oesophagitis must be considered in patients presenting with food bolus impaction. Early involvement of a paediatric gastroenterology team in the diagnosis is recommended in children presenting with oesophageal symptoms, in order to avoid delayed diagnosis.
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