PP-027 Esophageal stricture secondary to eosinophilic esophagitis in an infant

• Published in: BMJ paediatrics open Vol. 8; no. Suppl 5; p. A76
• Main Authors: Cakmak, Selen Ceren, Altay, Selin Guner, Polat, Esra
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd 11.07.2024; BMJ Publishing Group LTD
• Subjects: Babies; Case reports; eosinophil; eosinophilic esophagitis; Esophageal diseases; esophagitis; Esophagus; Pediatrics; Poster Presentation; stricture
• ISSN: 2399-9772
• DOI: 10.1136/bmjpo-2024-EPAC.171

AimEosinophilic esophagitis (EoE) is a chronic allergic disorder marked by esophageal inflammation from eosinophil infiltration, linked to hypersensitivity to allergens. Genetic predisposition, especially with a family history, raises the risk. Symptoms and pathology are reversible with reduced exposure to specific food antigens and anti-inflammatory therapy, but ongoing treatment is crucial to prevent relapse. Management includes medical and dietary strategies to reduce inflammation, prevent esophageal fibrosis, and address allergic triggers through dietary elimination. A rare case is presented: a 7-month-old male diagnosed with esophageal stricture, a complication of EoE.Material and MethodA 7-month-old male infant with no specific medical or family history presented to the pediatric gastroenterology clinic with recurrent vomiting, weight loss, and a lack of appetite. Physical examination, except for weight (Z score: 5.2), was normal, and initial laboratory tests showed no specific pathology. Suspecting cow’s milk protein allergy, an oligoantigenic diet was recommended for both the patient and the mother, and a specific amino acid-based formula was initiated. Despite these measures, symptoms persisted.ResultsAbdominal ultrasonography revealed an 8 mm thickened esophageal wall. Barium contrast esophagography and upper gastrointestinal system endoscopy (UGE) identified a well-defined distal esophageal narrowing and significant stenosis. Histopathological evaluation confirmed eosinophilic esophagitis (EoE). Treatment involved a two-month course of methylprednisolone (1 mg/kg/day) and lansoprazole (1 mg/kg/day) (PPI). Symptoms improved, and follow-up UGE revealed regression of stenosis and improved histopathological findings. PPI treatment continued for four months, gradually tapered, and eventually discontinued.ConclusionsThis case highlights the uncommon development of esophageal stricture due to eosinophilic esophagitis in an infant. A collaborative approach among gastroenterologists, pediatricians, and allergists is crucial for accurate diagnosis and the development of an effective treatment strategy. Ongoing research and clinical awareness are vital to deepen our understanding of eosinophilic esophagitis, especially in the pediatric context.