Clinical Manifestations of Eosinophilic Esophagitis in Children

Abstract

Eosinophilic esophagitis (EoE) typically develops as a manifestation of adverse reaction to food antigens, although there is a clear subset of patients whose esophagitis does not respond to any degree of dietary elimination, up to and including an elemental diet with an amino acid-based formula. Some of the overt manifestations of the esophagitis may be difficult to separate from those of the atopy (e.g., sore throat). To further complicate the evaluation of children who have EoE as a manifestation of food allergy, it is common for a child or caregiver to alter the diet or environment in response to consistent or perceived exposure-related symptoms. The goal of therapy for EoE is control over symptoms and resolution of esophagitis. The disparity between symptoms and the degree of esophagitis creates a dilemma for the treating physician. If significant injury to the esophageal wall occurs as a consequence of chronic inflammation, and if the inflammation is present without symptoms, the inflammation must be controlled even in the absence of symptoms. Lamina propria fibrosis, seen in children and adults who have EoE, has been seen to improve with therapy, such that prevention of permanent injury should be possible with well-maintained treatment