Esophageal stenosis in a child with eosinophilic esophagitis: diagnosis and positive dynamics against the background of conservative therapy

Abstract

Introduction. Currently, eosinophilic esophagitis (EoE) is a big and urgent problem for modern pediatrics. Its pathogenesis is associated with the formation of stenoses and strictures of the esophagus during a long course of the disease without treatment, which leads to serious disorders in the nutrition of children. In widespread practice, X-ray contrast examination of the esophagus is used, however, it is also necessary to perform esophagogastroduodenoscopy (EGDS) with taking multiple biopsies with morphological examination to verify the diagnosis. Materials and methods. Boy Y. 12 years, was admitted in March 2021 with complaints of difficulty in swallowing solid food, as well as poor weight gain. From the anamnesis of the disease, it is known that the phenomena of dysphagia were noted from the preschool period. Symptoms have progressed over the past year. EGDS was performed. A biopsy was taken: 6 fragments of the esophagus, 2 fragments from each third. Results. Diagnosed with eosinophilic esophagitis, complicated by esophageal stenosis. Chronic gastritis, Helicobacter pylori-not associated, incomplete remission. Chronic duodenitis, incomplete remission. Protein-energy malnutrition, mild. Appropriate treatment was prescribed. An allergological examination of the child was carried out and recommendations for nutrition were given. Against the background of the therapy, the child’s condition with pronounced positive dynamics - the appetite improved, the phenomena of dysphagia were completely stopped. When the child was re-hospitalized a month later, there was an increase in body weight (900 g) and growth (3 cm). Conclusions. The high efficiency of complex conservative therapy has been shown. The prescribed conservative treatment made it possible to avoid dilatation and bougienage of the esophagus. In this case, all three components of EoE treatment were applied: elimination diet, proton pump inhibitors, and topical corticosteroids. In the future, it is necessary to observe the allergist, taking into account the data obtained on multiple sensitization with a decision on the question of further treatment.