Phenotype of eosinophilic esophagitis with outcome in stenosis in children: a series of clinical cases

Abstract

Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by esophageal dysfunction due to prolonged eosinophilic infiltration of tissues. In recent years, there has been a tendency to increase the prevalence of EoE, which may lead to an increase in the detection of esophageal strictures in children. Aim: to determine the clinical features of the phenotype of eosinophilic esophagitis with an outcome in stenosis in children. Materials and methods. Seventy children diagnosed with EoE were examined, 9 (12.86%) of them had esophageal stenosis. The average age of the disease manifestation was 6.17 years. The analysis of a series of EoE cases with esophageal stenosis was carried out to describe the phenotype of the disease. At the same time, clinical characteristics of patients with EoE, data from laboratory and instrumental examination methods, including esophagogastroduodenoscopy with biopsy, were used. Results. In the examined patients, the delay in the diagnosis of EoE averaged 3 years after the appearance of the first symptoms. Early manifestations of EOE in children are discomfort when swallowing and the need to grind food. The most common concomitant gastroenterological disease was gastroesophageal reflux (GER). All patients had food allergies, of which 55 (77.8%) were allergic to cow’s milk proteins (ACMP). Esophageal stenosis was more often local, in the lower or middle third. Inflammatory changes in the mucous membrane (MM) of the esophagus were detected in all patients; ring-type disorders were noted in 47 (66.7%) patients. The median of the maximum number of eosinophils in MM is 30 per 0.3 mm2. Subepithelial fibrosis was observed in 16 (22.2%) children. In 62 (88.9%) patients, esophageal stenosis was stopped against the background of conservative treatment. Conclusion. Increasing awareness of EoE in children is necessary to reduce the time for diagnosis, timely treatment and reduce the risk of complications in the form of esophageal stenosis.