27 The observation of a high prevalence of EoE in children with cerebral palsy1,28 raises the possibility that in some cases EoE may arise in the context of poor esophageal motility rather than the reverse.29,30 The first-line treatment of EoE in infants and young children commonly relies on elemental diets or the elimination of specific food allergens. Young infants often respond to cow’s milk protein elimination alone as a first-line therapy,31–33 and it appears that EoE in this context aligns with the spectrum of cow’s milk allergy. In older children and adults, treatment usually involves swallowed Pictilisib purchase topical corticosteroids, including aerosolized fluticasone or budesonide.1,34
In asymptomatic patients where the diagnosis has been incidental at endoscopy, expectant management may be considered as it is yet unclear if treatment should aim for complete mucosal remission or merely control of clinical symptoms.1 It is not known whether asymptomatic EoE is associated with a less severe prognosis or lower risk of developing of esophageal strictures. Further investigation of this management dilemma is urgently needed so that evidence-based advice can be provided to parents and patients regarding the need for ongoing monitoring. This would require repeat gastroscopic examination and esophageal biopsies. In infants and young children,
the requirement for repeated gastroscopy during dietary elimination and challenge MCE公司 trials needs to be balanced against the relative invasive nature of endoscopic procedures. Eosinophilic esophagitis can present at any age with a Y 27632 diverse range of symptoms, including regurgitation, vomiting, abdominal pain, food refusal, weight loss, dysphagia or food bolus impaction.1 In infancy, irritability, feeding refusal and failure to thrive are classic presenting features of EoE.5 Food bolus impaction is the most characteristic presentation in school-aged children and young adults. Patients frequently,
but not always, have co-existent IgE-mediated food allergy, eczema, allergic rhinitis, asthma or at least a family history of atopy. A significant proportion of patients with EoE have no clinical symptoms, although no prevalence data on asymptomatic EoE is available in children. It is currently unknown whether the presence of mucosal eosinophilia in the esophagus requires treatment in asymptomatic patients and further research is urgently required to prevent unnecessary over-diagnosis or management of these patients. A large population-based study in Swedish adults showed that asymptomatic EoE was relatively common.9 In that study, about 1% had evidence of likely EoE, and half of these individuals were asymptomatic. A recent longitudinal study suggests that even small numbers of esophageal eosinophils > 5/HPF may have prognostic significance and indicate chronic EoE.