000722 - Eosinophilic Esophagitis in children : a case study analysis and literature review

Keywords : eosinophilic esophagitis, treatment, allergy, dysphagia, children.

Introduction:

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammatory disease of the esophagus that is increasingly recognized in the pediatric population. It is characterized by esophageal dysfunction symptoms and eosinophilic infiltration of the esophageal mucosa, defined histologically by ≥15 eosinophils per high-power field. Due to symptom overlap with gastroesophageal reflux disease (GERD), particularly in children, EoE often remains underdiagnosed, resulting in delayed treatment and risk of long-term complications.

Case description:

We present the case of a 17-year-old patient with a strong atopic background, including allergic asthma, perennial allergic rhinitis, allergic rhinoconjunctivitis, and a history of atopic dermatitis. From the age of 8 years, the patient developed persistent throat clearing, nausea, epigastric pain, and heartburn, initially attributed to GERD and treated intermittently with proton pump inhibitors (PPIs) with only partial and transient response. Due to persistent symptoms, esophagogastroduodenoscopy with esophageal biopsies was performed at 11 years of age. Histological examination revealed marked eosinophilic infiltration of the esophageal epithelium (up to 25 eosinophils per high-power field), confirming the diagnosis of eosinophilic esophagitis. The patient was treated with a two-food elimination diet excluding milk and egg products, along with PPI therapy. Follow-up endoscopies demonstrated persistent but gradually decreasing eosinophilic inflammation, eventually progressing to low-activity esophagitis with minimal clinical symptoms.

Summary:

This case highlights the diagnostic challenges of pediatric EoE, particularly in patients with overlapping GERD-like symptoms and significant allergic comorbidities. The absence of prominent endoscopic findings emphasizes the importance of routine esophageal biopsies in symptomatic children.

Conclusion:

Early recognition of eosinophilic esophagitis in children with refractory GERD symptoms and atopic predisposition is essential. A multidisciplinary approach, including dietary management and targeted pharmacological therapy, can lead to disease control and improved quality of life.