Management of eosinophilic esophagitis in children

Eosinophilic esophagitis has recently emerged as a distinct clinical entity in children. The clinical spectrum varies with age and ranges from failure to thrive and food aversion in the toddler to gastroesophageal reflux disease-like symptoms in school-age children to solid food dysphagia and food impaction in adolescents. The diagnosis is based on the presence of at least 15 eosinophils per high power field in the esophageal biopsy in children pretreated with at least 8 weeks of adequate acid-suppression therapy. Although elemental diet is a more effective therapy than other less restrictive elimination diets, the latter has practical advantages over elemental therapy. Topical and systemic corticosteroids have also been used. Studies are underway to establish the safety and efficacy of anti-interleukin-5 monoclonal antibodies. The natural history of eosinophilic esophagitis is not known and prospective studies are required to understand the etiopathogenesis, optimal therapies and find noninvasive surrogate tests to monitor histological remission and the natural history of this enigmatic disorder.