Eosinophilic Esophagitis Complicated by an Esophageal Stricture in a 15-Month-Old Child

Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder characterized by dysphagia, food impactions, and esophageal eosinophilia, which can lead to fibrosis and the formation of strictures. While fibrostenotic complications are relatively rare in children, studies have shown that up to 86% of adults with EoE experience dysphagia and esophageal narrowing, compared to only 6% in children. Furthermore, the incidence of stricture formation in children remains low, with reported rates of approximately 3.4%. The youngest child previously documented with this complication was 3 years old. Risk factors for fibrostenosis in EoE include older age, prolonged disease duration, and increased symptom frequency. This represents the youngest known presentation of such a case and suggests that fibrostenosis may be a distinct phenotype of the disease, rather than merely a progression from the inflammatory form. This case underscores the importance of early and thorough evaluation of EoE, given the potential for early stricture development.

Figure 1

(A) Normal epiglottis at index endoscopy. (B) Longitudinal furrows in the mid-esophagus. (C) Pinhole stricture at 20 cm from incisors with a soft plastic foreign body.

Figure 2

Histopathology of mid-esophagus at the index endoscopy demonstrating eosinophilic infiltrate, surface layering, and degranulation.

Figure 3

Histopathology of mid-esophagus 3 months after the index endoscopy after completing prednisone taper demonstrating improved eosinophilia.

Figure 4

(A) 3 months after index endoscopy, after completion of prednisone taper, on PPI therapy. Stricture at 20 cm from the incisors, 8 mm in diameter. (B) 4 months after index endoscopy. Stricture 8 mm in diameter, on PPI therapy. (C) 8 months after index endoscopy. Stricture measuring 15 mm in diameter on dietary elimination therapy.

Figure 5

15 months after index endoscopy, while on PPI therapy and OVB. Step-off noted at the site of prior stricture. White specks seen in the mucosa, reflective of Candida esophagitis.