Eosinophilic Esophagitis in Children: Endoscopic Findings at Diagnosis and Post-intervention

Abstract

Gold standard of diagnosis and assessment of response to therapy in EoE requires multiple endoscopies with biopsies for histology, which allows for observation of the esophageal mucosa. Typical endoscopic findings in patients with EoE include edema, exudate, furrowing, concentric rings, and strictures. Endoscopic findings have been broadly characterized into inflammatory features (edema, exudate, furrowing) and fibro-stenotic features (rings, stricture), in order to better reflect their underlying pathophysiology. Recent studies suggest strong correlations between endoscopic findings, through composite scoring systems, and histology, and therefore may be helpful as part of disease surveillance. The EoE Endoscopic Reference Score (EREFS) classification system was proposed in 2013 as an outcome metric for standardization in reporting endoscopic signs of EoE. Subsequent studies support utility of composite scoring, which utility has similarly been seen in pediatric treatment trials. Endoscopy in children provides insight into the natural history of EoE, with progressively more fibro-stenotic features occurring over time, giving an additional perspective into esophageal remodeling and response to treatment. Recognition of typical endoscopic findings at diagnosis and upon repeat endoscopy has allowed a clinician to monitor visual changes in esophageal mucosal health. Further studies to assess the role of composite scoring in disease management are needed.

Correlation of clinical symptoms, endoscopic features and density of oesophageal eosinophilia in children with newly-diagnosed eosinophilic esophagitis

“…In the presented cohort of patients, white exudates and furrows were the 2 most typical endoscopic findings. This result are similar to those of a recent review of endoscopic findings that analysed almost 2,000 children and adolescents with newly-diagnosed EoE [15]. In addition, one of the most important papers on EoE, a meta-analysis of more than 100 studies of both children and adults with EoE, (Kim et al, 2012) reported that there were significant differences between children and adults.…”

“…In this study, 27.6% of all the children had visually normal oesophageal mucosa at the time of EoE diagnosis. Bolton et al found that between 10% -33% of children with EoE presented with a macroscopically normal oesophagus [15]. In the current study, no differences were observe in this subgroup in terms of clinical symptoms, or in the density of eosinophilic infiltration.…”

Clinical Features of Eosinophilic Esophagitis: A Single Center Experience in Ecuador

“…The pattern of abnormality varies between patients [ 7 ], and each sign may occur in isolation or in combination. Typical endoscopic findings in patients with EoE include edema, exudates, furrowing, concentric rings, and strictures [ 9 ]. In our study, the most common endoscopic features were furrowing (82.9%), edema (74.3%), rings (47.5%), and exudates (22.9%).…”

Diagnostic Value of Ultrasound Findings in Eosinophilic Esophagitis Versus Gastroesophageal Reflux Disease in Children

“…About 10%-33% of children diagnosed with EoE have normal esophageal mucosa with common endoscopic findings of adults, such as esophageal rarely observed in children. Consequently, in children, the valuable features of adult endoscopy alone do not make a reliable diagnosis of EoE or assess disease activity, and adult-like scoring is less important in diagnosing or evaluating response to treatment (20,21). Recent studies suggested that ultrasound can be used for examining esophageal diseases, such as GERD-caused esophagitis.…”