Dysphagia in Children, Do Not Blame Eosinophils Too Quickly

Area of Science:

• Pediatric Gastroenterology
• Esophageal Disorders
• Clinical Diagnosis

Background:

• Dysphagia is a common pediatric symptom, often congenital or ENT-related.
• Eosinophilic esophagitis (EoE) is the primary cause of non-congenital esophageal dysphagia.
• Standard EoE treatment involves dietary changes and/or medication.

Observation:

• A 10-year-old patient presented with dysphagia.
• Initial diagnosis was eosinophilic esophagitis (EoE).
• The patient did not respond to standard EoE treatment, and histology normalized.

Findings:

• Persistent dysphagia despite normalized histology and treatment suggested an alternative diagnosis.
• The patient was ultimately diagnosed with type III achalasia.
• Misdiagnosis of EoE delayed the correct diagnosis of achalasia.

Implications:

• This case highlights the importance of reconsidering the diagnosis when EoE treatment fails.
• Type III achalasia should be considered in pediatric dysphagia cases unresponsive to EoE therapy.
• Accurate diagnosis is crucial for effective management of pediatric esophageal motility disorders.