Tu2004 EOSINOPHILIC ESOPHAGITIS IN CHILDREN WITH ESOPHAGEAL ATRESIA: IS THERE AN ASSOCIATION?

Abstract

Dysphagia is a common symptom after surgical repair of esophageal atresia (EA), usually related to stricture, dysmotility and peptic esophagitis. Recent studies suggest that esinophilic esophagitis (EoE) play a role in the reoccurrence of strictures in patients with EA. The aim of this study was to evaluate the association of EA and EoE in patients undergoing esofagogastroduodenoscopy (EGD) in a pediatric hospital in Rio de Janeiro, Brazil. A prospective longitudinal study was carried out in patients with EA who were submitted to EGD in a period of 6 months in a Pediatric Hospital in Brazil. The data collected were age, sex, type of EA, associated diseases, type of surgery performed, peripheral eosinophilia, clinical indication, endoscopy features and endoscopy biopsies. All patients presenting symptoms underwent EGD and biopsies of the proximal and distal esophagus. When stenosis was diagnosed, anastomotic dilatation was carried out. Seventeen patients were included in this study, and 10 were male (59%). Sixteen children (94%) had EA with distal fistula and one (6%) EA with proximal fistula. Thirteen patients (77%) were submitted to surgical repair with ligation of the fistula and 4 (23%) were submitted to gastric transposition. The most commonly associated disease was pneumopathy in 8 children (47%) and 3 (18%) had food allergies. 6 (35%) of patients were using proton pump inhibitor. The most common indication of endoscopy was dysphagia (65% patients) and 13 patients (76%) had symptoms in the first year after surgery. Eleven patients (65%) had stenosis of anastomotic and were submitted to esophageal dilatation. One patient (6%) had recanalization of the tracheoesophageal fistula. Only one patient (6%) had histological findings consistent with EoE. This patient was a 5 year-old girl with recurrent respiratory infection and gagging, without peripheral eosinophilia, and without esophageal anastomotic stricture. In our study, we found an association of EA and EoE in only one patient. It may be justified by the fact that most of our patients present dysphagia early in the postoperative period. In these cases, this symptom is more frequently related to an anastomotic stricture. Eosinophilic esophagitis is more often found in patients with EA repair and dysphagia later on in life. Although further studies are needed to follow up these patients, we recommend early routine endoscopy in all symptomatic infants after EA repair. We also recommend esophageal biopsies to exclude EOE in EA patients with symptoms that are refractory to IBP or recurrent stricture. Endoscopy with esophageal biopsies is reported to be associated with few complications, there has been an increasing prevalence of EoE in recent years, and patients who are treated for EoE early in the course of the disease, stricture formation may be prevented.