Eosinophilic Esophagitis in Children: Clinical Findings and Diagnostic Approach

• Published in: Current pediatric reviews Vol. 16; no. 3; p. 206
• Main Authors: De Matteis, Arianna, Pagliaro, Giuseppe, Corleto, Vito Domenico, Pacchiarotti, Claudia, Di Giulio, Emilio, Villa, Maria Pia, Parisi, Pasquale, Vassallo, Francesca, Ziparo, Chiara, Di Nardo, Giovanni
• Format: Journal Article
• Language: English
• Published: United Arab Emirates 01-01-2020
• Subjects: Child; Diagnosis, Differential; Eosinophilic Esophagitis - diagnosis; Eosinophilic Esophagitis - epidemiology; Eosinophilic Esophagitis - pathology; Eosinophilic Esophagitis - physiopathology; Esophagoscopy; Esophagus - diagnostic imaging; Esophagus - pathology; Europe - epidemiology; Gastroesophageal Reflux - diagnosis; Gastroesophageal Reflux - drug therapy; Gastroesophageal Reflux - physiopathology; Humans; Proton Pump Inhibitors - therapeutic use; United States - epidemiology; United States; Europe; gastrointestinal; dysphagia; proton pump inhibitors; EoE; subepithelial fibrosis; gastroesophageal reflux disease
• ISSN: 1875-6336
• DOI: 10.2174/1573396315666191004110549

Eosinophilic esophagitis (EoE) is an emerging chronic immune and antigen-mediated clinicopathologic disease. During the last 2 decades, the incidence of this condition in children has increased significantly, thanks to practitioners for creating the awareness and higher use of diagnostic endoscopy. We have analysed paediatric literature on EoE focusing on the epidemiology, pathophysiology, clinical findings and diagnostic approach. EoE is pathogenically related to a Th2 inflammation characterized by a mixed IgE and non-IgEmediated reaction to food and/or environmental agents. This leads to esophageal dysfunction and remodeling accompanied by subepithelial fibrosis. EoE can be presented with several range of gastrointestinal symptoms, including regurgitation, vomiting, feeding difficulties or feeding refusal in infants and toddlers, as well as heartburn, dysphagia and food bolus impaction in older children and adults. The diagnostic suspicion is based on the presence of chronic symptoms of esophgeal dysfunction and esophageal eosinophilia characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field). In this review, we will provide an update on clinical presentation and diagnostic approach to EoE in children. We emphasized on the relevant aspects of the new clinical condition termed "PPI responsive esophageal eosinophilia", as entities distinct from EoE and the role of PPI trial in the diagnostic workup, therefore we proposed a new diagnostic algorithm.