001498 - Clinical heterogeneity of Eosinophilic Esophagitis in children
Case report
Clinical case:
10 years old, male.
History of wheezing since the first year of life, with multiple hospitalizations. Currently, uncontrolled asthma despite high-dose inhaled corticosteroids + LABA.
Episode of vomiting and abdominal pain after ingestion of fish and seafood, with no cutaneous symptoms.
Targeted history: frequent choking episodes, difficulty swallowing solid foods, prolonged time to finish meals.
Laboratory tests: peripheral eosinophilia: 10.6%; specific IgE negative for foods and inhalant allergens.
Upper GI endoscopy: 20, 60, 60 eosinophils/HPF (proximal, middle, and distal thirds of the esophagus, respectively).
After 3 months of budesonide oral viscous (1000 mcg/day), improvement in GI and respiratory symptoms, inhaled steroid discontinuation, as well as macroscopic and histologic features remission.
Discussion
Eosinophilic esophagitis (EoE) in children presents with a wide heterogeneity of clinical manifestations, often identified only through targeted questioning.
Infants: GERD with no improvement after the introduction of complementary feeding; feeding refusal; irritability.
Preschool/school-aged children: difficult-to-control asthma, food selectivity or poor appetite, prolonged time to complete meals, abdominal pain, vomiting, dysphagia, choking/food impaction episodes, preference for soft or pureed foods.
Frequent laboratory findings:
- In the presence of food allergies, a clinical–laboratory dissociation may be observed, with marked symptom exacerbation despite low levels of specific IgE.
- Difficult-to-control asthma in the absence of specific IgE sensitization to aeroallergens.
Considerations:
EoE is often underdiagnosed in childhood, although its increase in this age group.
The absence of objective symptoms or the overlap with conditions associated with dysphagia may lead to delayed appropriate investigation.
Refractory respiratory symptoms may be secondary to gastroesophageal reflux or involvement of associated Th2-mediated conditions, particularly in cases without sensitization to inhalant allergens.
