Abstract
Recent studies have reported a higher prevalence of eosinophilic esophagitis in children with esophageal atresia. Under recognition of eosinophilic esophagitis in these patients may lead to excessive use of antireflux therapy and an escalation of interventions, including fundoplication, as symptoms may be attributed to gastroesophageal reflux disease. In addition, long-term untreated eosinophilic esophagitis may lead to recurrent strictures due to transmural esophageal inflammation, necessitating repeated dilatations. Eosinophilic esophagitis should be considered when children with esophageal atresia show persistent symptoms on standard antireflux treatment, increasing dysphagia, and recurrent strictures. Treatment has been found to not only significantly reduce intraepithelial eosinophil count, but also to improve symptoms, and to lower the occurrence of strictures and the need for dilatations. Future prospective studies are warranted in this area.
Highlights
Eosophageal atresia (EA) is one of the common congenital gastrointestinal anomalies with an incidence of around 1 in 2500 live births
As presenting symptoms of eosinophilic esophagitis (EoE) are similar to those of gastroesophageal reflux disease (GERD), misdiagnosis or delayed diagnosis often occurs in EA patients, in whom anastomotic strictures, GERD and dysphagia are common
Due to this considerable symptom overlap the consensus guidelines on the management of gastrointestinal and nutritional complications in EA patients by ESPGHAN/NASPGHAN societies, recommended that EoE be excluded with endoscopy and multiple biopsies both proximal and distal to the anastomotic site, in EA patients of all ages with dysphagia, reflux symptoms, coughing, choking or recurrent strictures that are refractory to pump inhibitor (PPI), before proceeding to fundoplication [61]
Summary
Reviewed by: MatjaŽ Homan, University Medical Centre Ljubljana, Slovenia Carsten Posovszky, Ulm University Medical Center, Germany. Recent studies have reported a higher prevalence of eosinophilic esophagitis in children with esophageal atresia. Under recognition of eosinophilic esophagitis in these patients may lead to excessive use of antireflux therapy and an escalation of interventions, including fundoplication, as symptoms may be attributed to gastroesophageal reflux disease. Long-term untreated eosinophilic esophagitis may lead to recurrent strictures due to transmural esophageal inflammation, necessitating repeated dilatations. Eosinophilic esophagitis should be considered when children with esophageal atresia show persistent symptoms on standard antireflux treatment, increasing dysphagia, and recurrent strictures. Treatment has been found to significantly reduce intraepithelial eosinophil count, and to improve symptoms, and to lower the occurrence of strictures and the need for dilatations. Future prospective studies are warranted in this area
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