Primary eosinophilic oesophagitis in children

Introduction : In recent years the increased incidence of diagnosed primary eosinophilic oesophagitis (EoE) has been observed in West Pomerania.

Aim: The analysis of clinical and endoscopic pictures of EoE in children.

Material and methods : The study covered 14 children (3 female, 11 men) at the average age of 9.2 years (aged 8 months – 17 years) whose oesophageal mucosa contained at least 15 eosinophils (18-80) per high-power field (400×). The group of younger children (aged 0-10 years, n = 8) was compared to the group of older children (aged 11-1 years, n = 6). Retrospective medical records of clinical manifestations and endoscopy examinations were analysed.

Results: The most common EoE symptoms were abdominal pain, food aversion and regurgitation (83-100%). Older children also displayed dysphagia, odynophagia and feeling of food impaction (50-66%). In 2/3 of younger patients no changes were observed in the endoscopic picture. The lesions were observed in all the older children. They included concentric rings (83%), longitudinal furrows (50%), granulated mucosa and oesophageal stenosis (17% each).

Conclusions : It is its clinical, endoscopic and histological picture that makes EoE different from gastroesophageal reflux disease. The clinical picture of EoE changes with age. In younger children the clinical picture is non-specific, while older children suffer from dysphagia, odynophagia and the sensation of food impaction. Since EoE often occurs in younger children with healthy mucosa, there is a high risk of overlooking the disease during a routine endoscopy of the upper part of the alimentary tract.