SELECTED ARTICLES FROM THE RECENT LITERATURE 2005

11/18/05

Esophagitis, eosinophilic in children

Summary
Background - There has been increasing recognition of eosinophilic esophagitis (EE) as an unusual chronic inflammatory disease of children and adolescents. EE is caused in some cases by food allergies and diagnosed by endoscopic biopsy.

Findings - De Angelis et al of the Bambino Gesu Pediatric Hospital in Rome, Italy described their experience with 12 children and adolescents with EE, documented by esophageal biopsy. All patients underwent upper G-I radiography, 24 hour esophageal pH probes, and evaluation for food allergies. When food allergies were detected, elimination diets were carried out. Oral steroids and then swallowed fluticasone were used in treatment.

After a 2 year follow-up, 7 patients (pts) were asymptomatic while on food elimination (cow's milk avoidance in 5 pts. elemental diet in 2 pts). Two pts without documented allergies had persistent mild dysphagia and eosinophilic accumulation in the esophagitis. One child required Nissen fundal plication with a good symptomatic response. Two pts were lost to follow-up.

Reference
Diig Liver Dis 2005;Sept 28, Epub

Editor's Comments
The understanding of the pathogenesis and clinical course of EE is evolving with additional clinical studies such as this. Some, but not all, of the food induced EE appears to be IgE mediated with significant improvement following selected food avoidance. A major concern in EE is that uncontrolled esophageal inflammation will result in esophageal strictures requiring periodic dilatation.

 

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