Esophageal perforation in eosinophilic esophagitis: five cases in children

Background and study aims  Eosinophilic esophagitis (EoE) is a chronic immune disease with increasing incidence. It is clinically defined by symptoms of esophageal dysfunction and histologically by eosinophilic polynuclear cell infiltration of the esophageal mucosa. Symptoms are not specific and include gastroesophageal reflux disease (GERD), dysphagia, vomiting or dietary blockages. Chronic inflammation of the mucosa may lead to narrowing of the esophageal lumen responsible for impactions. Extraction procedures can be complicated by dissection and perforation. Rare spontaneous ruptures of the esophagus known as Boerhaave syndrome are also possible. We report five cases of esophageal perforation in children with EoE, three with spontaneous rupture and two after an endoscopic procedure. The evolution was favorable under medical treatment.

[Complementary feedings and socioeconomic factors]

INTRODUCTION

In order to limit the risk of food allergies, it is recommended to begin complementary feedings for infants between the ages of 4 and 6 months old. The objective of this study is to describe how complementary feedings are carried out until the age of 1 year old and to analyze criteria, especially socio-economic, that influence compliance with recommendations.

METHODS

This observational and descriptive quantitative study lasted from November 21st, 2016 to February 21st, 2017 and took place in 10 doctor's offices around the city of Saint-Etienne. Anonymous surveys were distributed to the mothers of children aged between 12 and 47 months old inclusive, born at term, and with a weight above 2.5 kg.

RESULTS

More than 2/3rds of the 163 children included started complementary feedings between 4 and 6 months old. Gluten (P = 0.02) and meat (P = 0.016) were introduced later and infant formulas (P = 0.005) were stopped sooner when the mother's education level was low. The average number of fruit and vegetables was smaller when the mother had a low socio-economic level or if she was multiparous. At the age of one, fewer than 20% of the children had consumed fat content rich in omega-3. At the same age, 70% had consumed egg and 12.3% nuts, which are some of the major allergens.

CONCLUSION

These outcomes show the need for general practitioners to inform parents, especially those with a low socio-economic level, about early food introduction, including allergens.

[Eosinophilic esophagitis. Clinical presentation, allergology and treatment: a series of 22 children]

BACKGROUND AND AIMS

Eosinophilic esophagitis (EE) is a disorder characterized by severe eosinophilic infiltration of the esophagus, with dysphagia and gastroesophageal reflux disease (GERD) symptoms unresponsive to acid blockade therapy but responsive to the removal of dietary antigens. We report information relating to children diagnosed with EE in Nice, France, over a 6-year period.

PATIENTS AND METHODS

We conducted a retrospective study between January 1, 2004, and July 31, 2009, evaluating all children diagnosed with EE. Clinical and demographic data, endoscopic and histological findings, allergology data, and results of treatment were collected and evaluated.

RESULTS

A total of 22 patients, 19 males, median age 9.5 years (range: 0.8-19 years) were reviewed: 7 presented isolated dysphagia, 6 presented GERD symptoms, and 9 both dysphagia and GERD symptoms. Endoscopically, 14 had multiple esophageal white plaques, 7 had linear furrowing, 5 had circular "tracheal" rings, and 5 esophageal narrowing. The median number of esophageal eosinophils/high power field (×400) was 30 (range: 15-80). Eosinophils were localized in the distal, middle, and upper esophagus. Immunoallergy analysis findings were: high peripheral eosinophil count (74%), high total IgE level (65%), high eosinophil cationic protein (ECP) level (90%) with a median value of 69.5 μg/l and high urinary leukotriene E4 (88%). Food antigen sensitization was positive in skin-prick testing in 11 of 18 and in atopy-patch testing in 9 of 17. Dietary restriction improved clinical symptoms in 5 of 10 and local corticotherapy with viscous budesonide improved clinical symptoms in 9 out of 10.

CONCLUSION

EE diagnosis must be considered in children with dysphagia or GERD who do not respond to acid blockade therapy. ECP may be used to guide diagnosis. Local corticotherapy is effective.