Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a chronic allergic (immune-mediated) disease that leads to esophageal dysfunction and feeding disorders in children. Foods, and possibly environmental triggers, cause an inflammatory response in the esophagus, leading to esophageal inflammation, eosinophilic infiltration, and esophageal dysmotility, which may progress to dysphagia, food impaction, and esophageal stricture. Endoscopy with biopsy and histologic evaluation is currently the only method to diagnose EoE. Once diagnosed with EoE, children undergo follow-up endoscopy after therapy initiation and adjustments to ensure remission. Furthermore, children with food impactions or strictures may require endoscopic intervention such as foreign body removal and/or esophageal dilation.

Keywords: Dilation; Dysphagia; Eosinophilic esophagitis; Food allergy; Food impaction.

Fig. 1

Endoscopic findings of EoE. (A) Normal esophageal mucosa. (B) Esophageal furrowing. (C) Esophageal white mucosal plaques. (D) Esophageal mucosal fragility in a patient with EoE after biopsy. (E) Esophageal mucosal fragility with so-called crepe paper esophagus. (F) Esophageal trachealization. (Courtesy of [C, E, F] The International Gastrointestinal Eosinophilic Researchers (TIGERS) and Children’s Digestive Health and Nutrition Foundation (CDHNF) slide set; and [E] Chris A. Liacouras, MD, Philadelphia, PA.)

Fig. 2

Esophagram findings of EoE. (A) Diffuse esophageal narrowing. (B) Esophageal stricture with 2 pronounced areas of narrowing. (C) Esophageal rings indicated by white arrows. (Courtesy of [A, C] TIGERS and CDHNF slide set.)

Fig. 3

Histology of the esophagus. (A) Normal esophagus (B) EoE esophagus with basal cell hyperplasia and eosinophilic infiltrate. (C) EoE esophagus with superficial layering of eosinophils (black arrow) and an eosinophilic abscess. Histologic evaluation of the esophagus by hematoxylin and eosin stain. (Courtesy of [C] TIGERS and CDHNF slide set.)

Fig. 4

EndoFLIP catheter. (A) EndoFLIP catheter deflated, and (B) inflated.