Case Report
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World J Gastroenterol. Dec 21, 2014; 20(47): 18038-18043
Published online Dec 21, 2014. doi: 10.3748/wjg.v20.i47.18038
Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia
Sirvart Kassabian, Virginia Baez-Socorro, Thomas Sferra, Reinaldo Garcia
Sirvart Kassabian, Reinaldo Garcia, Department of Pediatric Gastroenterology, Nutrition and Hepatology, Akron Children’s Hospital, Akron, OH 44308, United States
Virginia Baez-Socorro, Thomas Sferra, Division of Pediatric Gastroenterology, Nutrition and Hepatology, Rainbow Babies and Children’s Hospital, Cleveland, OH 44106, United States
Author contributions: Kassabian S and Baez-Socorro V wrote the original manuscript; Sferra T helped with editing; Garcia R had seen multiple patients with this association and guided the writing of the manuscript; all the authors contributed to the manuscript.
Correspondence to: Sirvart Kassabian, MD, Department of Pediatric Gastroenterology, Nutrition and Hepatology, Akron Children’s Hospital, One Perkins Square, Akron, OH 44308, United States. skassabian@chmca.org
Telephone: +1-330-5434488 Fax: +1-330-5435060
Received: March 13, 2014
Revised: July 22, 2014
Accepted: September 18, 2014
Published online: December 21, 2014
Processing time: 282 Days and 16.7 Hours
Abstract

Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE.

Keywords: Eosinophilic esophagitis; Esophageal atresia; Tracheoesophageal fistula; Dysphagia

Core tip: Dysphagia is frequently seen in patients with repaired esophageal atresia (EA). It has been attributed to recurrent strictures, poor esophageal motility and persistent gastroesophageal reflux disease. Anastomitic strictures are common after repair of a gap that is greater than 2.5 cm contributing to this complication. The pathophysiology of later onset dysphagia is not well defined. Eosinophilic esophagitis (EoE) has been reported to play a role in the reoccurrence of strictures in patients with EA. It is very likely that if these patients are treated for EoE early in the course of the disease, stricture formation might be prevented.