Dysphagia in childhood: Think of eosinophilic esophagitis

Patient A, a 13 year old boy, was seen referred because of a perforation of the esophagus dut to upper gastrointestinal endoscopy for food impaction. Histological findings were consistent with eosinophilic esophagitis; the boy was treated with elemental diet and corticosteroids. In patient B, a two-year old boy with symptoms of coughing and vomiting, the diagnostic work-up for gastroesophageal reflux revealed eosinophilic esophagitis. After local treatment with fluticason his symptoms disappeared entirely. In the case of patient C, a three-year old girl with longstanding feeding problems and failure to thrive, eosinophilic granulocytes were abundant in tne esophageal mucosa. Treatment with corticosteroids led to improval of symptoms. Eosinophilic esophagitis is an emerging entity that is strongly associated with (food) allergic disorders. Symptoms in adults mainly include food impaction and dysphagia; most children present with gastroesophageal reflux, feeding intolerance and feeding refusal. Treatment of eosinophilic esophagitis in children consists of a strict elimination diet or corticosteroids. Frequently relapses occur.