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Methods: We followed 7 p (4 male) with EE; dysphagia/slow growth in 4, epigastric pain/vomiting in 2, heartburn/chest pain in 1. They underwent EGDS before/after therapy, endoscopic ultrasonography (EUS), barium esophagogram, 24hours pHmetry.
Acute therapy: Savary dilations, oral prednisone (1.5 mg/kg/2 weeks), diet restriction (cow milk/eggs proteins).
Maintenance therapy: fluticasone (2 swallowed puffs/six months), diet.
Results: Familiarity of allergy in 6 p; 4 allergic p.
Mean age at beginning of symptoms: 6y7m (range: 4y–17y).
Endoscopy before diagnosis: 3 p strictures (in 2: endoscopic food disimpaction) treated by dilation (mean 3) but dysphagia persisted; in 2 p aspecific esophagitis, partially sensitive to PPI. Mean age at diagnosis: 12y 4m (7y-18y10m). Diagnosis latency: 5m-13y. In all p, 24hours pHmetry disclosed GERD; esophageal manometry: normal motility; esophagogram: normal in 3 p, GER in 2, esophageal stricture in 3. Endoscopy: granularity in 1 p, vertical linear furrow in 4, concentric rings in 2 p. Biopsy proximal/distal esophagus: 6–45 eosinophils /HPF (median: 32) within squamous epithelium; no eosinophilia in stomach and duodenum of 6 p, mild in 1. EUS (miniprobe 20MHz): asymmetric thickening of mucosa, submucosa and muscularis propria. Allergologic test for common allergens: positive in 3 p. Peripheral eosinophilia in 1 p. 6 p successfully treated with prednisone; in 3 of them: elimination diet. 1 p had immediately a good response to diet and didn’t undergo corticotherapy. In all p symptom relief was complete, endoscopy and histology improved. In all p fluticasone; 4 p followed diet. In mean follow up of 9 m (range: 2–19), 5 p were asymptomatic; in 2 mild dysphagia persisted. In 1 (none antigen identified) a relapse occurred after 1 y from diagnosis, successfully treated with prednisone.
Conclusion: The esophagus is an active participant in immune responses. The antigen involved in inflammatory cascade is unique to the individual patients. Diet and steroids may lead to symptoms resolution but a specific therapy could be necessary. A better knowledge of EE with a precocious treatment avoid the delay in diagnosis and severe complications such as stricture.
