A clinical case of eosinophilic esophagitis in a child

Eosinophilic esophagitis is a rare chronic inflammatory disease of the esophagus, which is entered into the list of orphan and rare diseases of the Ministry of Health of the Russian Federation in 2024. In recent years, the disease has become increasingly important in clinical practice, especially in pediatrics, as its prevalence is rapidly growing throughout the world. It is reported that eosinophilic esophagitis is associated with allergic diseases such as food allergy, atopic dermatitis, bronchial asthma and allergic rhinitis, and represents a significant clinical and diagnostic challenge due to the similarity of symptoms with gastroesophageal reflux disease. Such non-specific symptoms as regurgitation, nausea and vomiting, abdominal pain while eating are observed in young children, and complaints of dysphagia are registered in older children. It is quite difficult to diagnose eosinophilic esophagitis due to the lack of specific symptoms and markers, as well as the need for invasive diagnosis confirmation using endoscopy and biopsy examinations. This results in frequent cases of understaging or late diagnosis, which, in turn, can worsen the prognosis and patient’s quality of life. The article presents clinical cases of eosinophilic esophagitis in young children, assessment of symptoms, diagnostic search, and principles of therapy choice.

1. Alsohaibani FI, Peedikayil MC, Alzahrani MA, Azzam NA, Almadi MA, Dellon ES, Al-Hussaini AA. Eosinophilic esophagitis: Current concepts in diagnosis and management. Saudi J Gastroenterol. 2024;30(4):210–227. https://doi.org/10.4103/sjg.sjg_50_24.

2. Scutaru TT, Kupcsulik P, Sahin P, Szücs Á. From eosinophilic esophagitis to esophagus perforation: clinical management strategies. Arch Clin Cases. 2021;6(2):37–47. https://doi.org/10.22551/2019.23.0602.10152.

3. Dellon ES, Khoury P, Muir AB, Liacouras CA, Safroneeva E, Atkins D et al. A Clinical Severity Index for Eosinophilic Esophagitis: Development, Consensus, and Future Directions. J Allergy Clin Immunol. 2022;150(1):33–47. https://doi.org/10.1016/j.jaci.2022.03.015.

4. Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022–1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009.

5. Molina-Infante J, Gonzalez-Cordero PL, Ferreira-Nossa HC, Mata-Romero P, Lucendo AJ, Arias A. Rising incidence and prevalence of adult eosinophilic esophagitis in midwestern Spain (2007–2016). United European Gastroenterol J. 2018;6(1):29–37. https://doi.org/10.1177/2050640617705913.

6. Kinoshita Y, Ishimura N, Oshima N, Ishihara S. Systematic review: Eosinophilic esophagitis in Asian countries. World J Gastroenterol. 2015;21(27):8433–8440. https://doi.org/10.3748/wjg.v21.i27.8433.

7. Hahn JW, Lee K, Shin JI, Cho SH, Turner S, Shin JU et al. Global Incidence and Prevalence of Eosinophilic Esophagitis, 1976–2022: A Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol. 2023;21(13):3270–3284.e77. https://doi.org/10.1016/j.cgh.2023.06.005.

8. Ivashkin VT, Maev IV, Trukhmanov AS, Lapina TL, Andreev DN, Baranskaya EK et al. Clinical Guidelines of the Russian Gastroenterological Association on the Diagnostics and Treatment of Eosinophilic Esophagitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(6):84–98. (In Russ.) https://doi.org/10.22416/1382-4376-2018-28-6-84-98.

9. Connor F, Salvatore S, D’Auria E, Baldassarre ME, Acunzo M, Di Bella G et al. Cows’ Milk Allergy-Associated Constipation: When to Look for It? A Narrative Review. Nutrients. 2022;14(6):1317. https://doi.org/10.3390/nu14061317.

10. Ивашкин ВТ, Баранская ЕК, Трухманов АС, Кайбышева ВО. Эозинофильный эзофагит. М.: ООО «АИСПИ РАН»-М; 2013. Режим доступа: https://gastroscan.ru/literature/pdf/ivashkin-vt-eosin_esofagit.pdf.

11. Straumann A, Katzka DA. Diagnosis and Treatment of Eosinophilic Esophagitis. Gastroenterology. 2018;154(2):346–359. https://doi.org/10.1053/j.gastro.2017.05.066.

12. Hill DA, Grundmeier RW, Ramos M, Spergel JM. Eosinophilic Esophagitis Is a Late Manifestation of the Allergic March. J Allergy Clin Immunol Pract. 2018;6(5):1528–1533. https://doi.org/10.1016/j.jaip.2018.05.010.

13. Chan J, Flynn DM, Gordon M, Parmar R, Moolenschot K, Jackman L et al. Swallowed topical steroid therapy for eosinophilic oesophagitis in children: practical, evidence-based guidance by the BSPGHAN Eosinophilic Oesophagitis Working Group. BMJ Paediatr Open. 2024;8(1):e002467. https://doi.org/10.1136/bmjpo-2023-002467.

14. Franciosi JP, Gordon M, Sinopoulou V, Dellon ES, Gupta SK, Reed CC et al. Medical treatment of eosinophilic esophagitis. Cochrane Database Syst Rev. 2023;7(7):CD004065. https://doi.org/10.1002/14651858.CD004065.pub4.

15. Dellon ES, Woosley JT, Arrington A, McGee SJ, Covington J, Moist SE et al. Efficacy of Budesonide vs Fluticasone for Initial Treatment of Eosinophilic Esophagitis in a Randomized Controlled Trial. Gastroenterology. 2019;157(1):65–73.e5. https://doi.org/10.1053/j.gastro.2019.03.014.

16. Dutta P, Shah-Riar P, Bushra SS, Haque SN, Rafa ZI, Hawa F et al. Recent Trends in the Management of Eosinophilic Esophagitis: A Systematic Review. Cureus. 2023;15(8):e43221. https://doi.org/10.7759/cureus.43221.

17. Philpott H, Nandurkar S, Thien F, Gibson PR, Royce SG. Eosinophilic esophagitis: a clinicopathological review. Pharmacol Ther. 2015;146:12–22. https://doi.org/10.1016/j.pharmthera.2014.09.001.

18. Montoro-Huguet MA. Dietary and Nutritional Support in Gastrointestinal Diseases of the Upper Gastrointestinal Tract (I): Esophagus. Nutrients. 2022;14(22):4819. https://doi.org/10.3390/nu14224819.

19. Molina-Infante J, Gonzalez-Cordero PL, Arias A, Lucendo AJ. Update on dietary therapy for eosinophilic esophagitis in children and adults. Expert Rev Gastroenterol Hepatol. 2017;11(2):115–123. https://doi.org/10.1080/17474124.2017.1271324.

20. Molina-Infante J, Lucendo AJ. Update on topical steroid therapy for eosinophilic esophagitis. Gastroenterol Hepatol. 2015;38(6):388–397. https://doi.org/10.1016/j.gastrohep.2014.12.006.

21. Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol. 2005;3(12):1198–1206. https://doi.org/10.1016/s1542-3565(05)00885-2.

22. Franciosi JP, Hommel KA, DeBrosse CW, Greenberg AB, Greenler AJ, Abonia JP et al. Quality of life in paediatric eosinophilic oesophagitis: what is important to patients? Child Care Health Dev. 2012;38(4):477–483. https://doi.org/10.1111/j.1365-2214.2011.01265.x.

23. Arias A, Lucendo AJ. Dietary therapies for eosinophilic esophagitis. Expert Rev Clin Immunol. 2014;10(1):133–142. https://doi.org/10.1586/1744666X.2014.856263.

24. Delaney AL, Arvedson JC. Development of swallowing and feeding: prenatal through first year of life. Dev Disabil Res Rev. 2008;14(2):105–117. https://doi.org/10.1002/ddrr.16.

25. Mukkada VA, Furuta GT. Management of refractory eosinophilic esophagitis. Dig Dis. 2014;32(1-2):134–138. https://doi.org/10.1159/000357296.

26. Kagalwalla AF, Shah A, Li BU, Sentongo TA, Ritz S, Manuel-Rubio M et al. Identification of specific foods responsible for inflammation in children with eosinophilic esophagitis successfully treated with empiric elimination diet. J Pediatr Gastroenterol Nutr. 2011;53(2):145–149. https://doi.org/10.1097/MPG.0b013e31821cf503.