Oesophageal eosinophilia and oesophageal diseases in children: are the limits clear?

Abstract

Gastro-oesophageal reflux disease, eosinophilic oesophagitis and oesophageal motility disorders are among the most common diseases accompanying oesophageal eosinophilia. They have similarities and their limits are frequently not well defined. This article reviews the main characteristics relating to their similarities and differences, highlighting existing controversies among these diseases, in addition to current knowledge. In the case of a patient with symptoms of oesophageal dysfunction, it is suggested to carry out an integral analysis of the clinical features and diagnostic test results, including histology, while individualising each case before confirming a definitive diagnosis. Future investigation in paediatric patients is necessary to assess eosinophilic infiltration in the various layers of the oesophageal tissue, along with its clinical and pathophysiological implications.

Pathologist’s approach to paediatric and neonatal eosinophilic gastrointestinal disorders

“…Only if no other pathologic specific alteration is detected and all other possible causes of a hyper-eosinophilic reaction are excluded, should a diagnosis of primary EoGID be considered. Hypereosinophilic syndrome, usually accompanied by peripheral blood hypereosinophilia, is considered when the peripheral blood eosinophil count is > 1500 × 109 cells/L, which is not typical in primary EoGIDs 23 . Food hypersensitivity and other allergic disorders often induce an eosinophilic reaction in the digestive tract that is morphologically indistinguishable from primary EoGIDs.…”

Diagnosing eosinophilic esophagitis

“…However, in the 2018 consensus, in addition to including PPI-responsive esophageal eosinophilia within the spectrum of EoE, it is stated that the diseases listed as conditions associated with esophageal eosinophilia should be evaluated rather than require their exclusion, since they can coexist in some cases, such as gastroesophageal reflux disease (GERD), which is one of the most complex differential diagnoses 3 . The esophageal motility disorders can also be clinically difficult to differentiate and an overlap has been described 4 . Other causes of esophageal eosinophi-lia are rare or have distinctive clinical features.…”

“…In school children, dysphagia can already be reported in the directed questioning, food impaction, choking /gagging with coarse textures of food, abdominal or chest pain, odynophagia, as well as symptoms compatible with GERD such as regurgitation and heartburn, vomiting, nausea, sleep disturbance, and decreased appetite. In adolescents and adults, the most characteristic symptoms of EoE are reported more frequently, such as dysphagia and impaction of food, in addition to food avoidance, intractable heartburn, regurgitation, and retrosternal or chest pain 4 . Therefore, in the presence of esophageal symptoms, always take a biopsy sample of the esophagus in distal and middle/ proximal thirds to be evaluated.…”

“…This score has not yet become generalized in routine diagnostic practice; perhaps more prospective studies are necessary before its general use. 4 1 Departamento de Gastroenterología Pediátrica, Instituto de Gastroenterología, La Habana, Cuba.…”

“…3 Departamento de Investigaciones, Instituto de Gastroenterología, La Habana, Cuba. 4 Sección de Parasitología, Instituto de Investigaciones Clínicas, Universidad del Zulia, Maracaibo, Venezuela.…”