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DOZ047.76: Eosinophilic esophagitis and esophageal atresia. Is there an association?


 
 
 Eosinophilic esophagitis (EoE) is a recently diagnosed entity and seems to be more prevalent in patients with esophageal atresia (EA). It can mimic dysphagia and gastroesophageal reflux (GER) symptoms frequently observed in EA, but treatment is different.
 
 
 
 Retrospective review (2002–2019) of patients with EA who underwent esophagogastroduodenoscopy (EGD) and esophageal biopsy was performed. EGD was performed in symptomatic patients and in all patients at 12–15 years. Diagnostic criteria for EoE included >15 eosinophils for a high-power field in the esophageal mucosa.
 
 
 
 From a total of 110 patients with EA, 27 lost follow-up. In the remaining 83, 56 patients (67, 5%) underwent EGD because of dysphagia or gastroesophageal reflux (GER) studies. Esophageal biopsies were performed in 35 patients and the diagnostic criteria for EoE were achieved in 5 (14,3%). The mean age at diagnosis of EoE was 10 + 2 years and the indication for EGD was GER symptoms (3) or dysphagia (2). In one case an antireflux surgery was previously performed but symptoms slightly persisted, while in 4 cases contrast studies and pH-metry showed no or minimal GER. EGD demonstrated light distal esophagitis in 2 cases, white exudates in 2, and was completely normal in the remaining one. On follow-up, 4 patients remain asymptomatic with proton pump inhibitor medication, and periodic EGD shows macroscopic improvement with a decreased eosinophilic peak on esophageal biopsies.
 
 
 
 Patients with EA seem to have a higher risk of developing EoE at early puberty. EGD on follow-up should be focused not only on studying GER or Barrett, but also on actively search for EoE with an esophageal biopsy, even when the macroscopic appearance is normal.
