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

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.

Contribution:
Makarova S.G., Lokhmatov M.M., Vyazankina S.S., Budkina T.N., Fisenko A.P., Alkhasov A.B., Potapov A.S. — concept and design studies;
Vyazankina S.S., Budkina T.N., Kulikov K.A., Ilansskaya M.V., Movsisyan G.B., Anushenko A.O., Oldakovsky V.I., Tupylenko A.V., Korolev G.A., Galimova A.A. — collection and processing of material;
Vyazankina S.S., Budkina T.N. — statistical processing of the material, writing the text;
Makarova S.G., Lokhmatov M.M., Ereshko O.A., Gordeeva I.G. — editing the text.
All co-authors have final approval of the article and are responsible for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: June 04, 2024
Accepted: June 11, 2024
Published: July 12, 2024

1. Dellon E.S., Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology. 2018; 154(2): 319–32. https://doi.org/10.1053/j.gastro.2017.06.06

2. Dhar A., Haboubi H.N., Attwood S.E., Auth M.K.H., Dunn J.M., Sweis R., et al. British Society of Gastroenterology (BSG) and British Society of Paediatric gastroenterology, hepatology and nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults. Gut. 2022; 71(8): 1459–87. https://doi.org/10.1136/gutjnl-2022-327326

3. Votto M., Castagnoli R., De Filippo M., Brambilla I., Cuppari C., Marseglia G.L., et al. Behavioral issues and quality of life in children with eosinophilic esophagitis. Minerva Pediatr. 2020; 72(5): 424–32. https://doi.org/10.23736/S0026-4946.20.05913-7

4. Uchida A.M., Burk C.M., Rothenberg M.E., Furuta G.T., Spergel J.M. Recent advances in the treatment of eosinophilic esophagitis. J. Allergy Clin. Immunol. Pract. 2023; 11(9): 2654–63. https://doi.org/10.1016/j.jaip.2023.06.035

5. Gordeeva I.G., Makarova S.G., Chernikov V.V., Surkov A.N. Use of the questionnaire for screening of the latent forms of cow’s milk protein allergy in children with inflammatory bowel diseases. Pediatriya. Zhurnal imeni G.N. Speranskogo. 2021; 100(1): 179–89. https://doi.org/10.24110/0031-403X-2021-100-1-179-189 https://elibrary.ru/ckeezw (in Russian)

6. Vandenplas Y., Dupont C., Eigenmann P., Host A., Kuitunen M., Ribes-Koninck C., et al. A workshop report on the development of the cow’s milk-related symptom score awareness tool for young children. Acta Paediatr. 2015; 104(4): 334–9. https://doi.org/10.1111/apa.12902

7. Hirano I., Moy N., Heckman M.G., Thomas C.S., Gonsalves N., Achem S.R. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013; 62(4): 489–95. https://doi.org/10.1136/gutjnl-2011-301817

8. Alexander R.G., Ravi K., Collins M.H., Lavey C.J., Snyder D.L., Lennon R.J., et al. Eosinophilic esophagitis histologic scoring system: correlation with histologic, endoscopic, and symptomatic disease and clinical use. Dig. Dis. Sci. 2023; 68(9): 3573–83. https://doi.org/10.1007/s10620-023-08029-6

9. Dellon E.S., Khoury P., Muir A.B., Liacouras C.A., Safroneeva E., Atkins D., et al. A clinical severity index for eosinophilic esophagitis: development, consensus, and future directions. Gastroenterology. 2022; 163(1): 59–76. https://doi.org/10.1053/j.gastro.2022.03.025

10. Warners M.J., Oude Nijhuis R.A.B., de Wijkerslooth L.R.H., Smout A.J.P.M., Bredenoord A.J. The natural course of eosinophilic esophagitis and long-term consequences of undiagnosed disease in a large cohort. Am. J. Gastroenterol. 2018; 113(6): 836–44. https://doi.org/10.1038/s41395-018-0052-5

11. Hirano I., Furuta G.T. Approaches and challenges to management of pediatric and adult patients with eosinophilic esophagitis. Gastroenterology. 2020; 158(4): 840–51. https://doi.org/10.1053/j.gastro.2019.09.052

12. Choudhury S., Kozielski R., Hua J., Wilding G.E., Baker S. Do histological features of eosinophilic esophagitis in children correlate with peripheral eosinophils? J. Pediatr. Gastroenterol. Nutr. 2020; 70(5): 604–7. https://doi.org/10.1097/MPG.0000000000002646

13. Moawad F.J., Molina-Infante J., Lucendo A.J., Cantrell S.E., Tmanova L., Douglas K.M. Systematic review with meta-analysis: endoscopic dilation is highly effective and safe in children and adults with eosinophilic oesophagitis. Aliment. Pharmacol. Ther. 2017; 46(2): 96–105. https://doi.org/10.1111/apt.14123

14. Laserna-Mendieta E.J., Navarro P., Casabona-Francés S., Savarino E.V., Pérez-Martínez I., Guagnozzi D., et al. Differences between childhood- and adulthood-onset eosinophilic esophagitis: An analysis from the EoE connect registry. Dig. Liver Dis. 2023; 55(3): 350–9. https://doi.org/10.1016/j.dld.2022.09.020