Virtual Conference
Anastasiia Merkulova

Anastasiia Merkulova

Clinical and Research Institute of Emergency Pediatric Surgery and Trauma, Russia

Title: Challenging pediatric Eosinophilic Esophagitis (EoE): Endoscopic diagnosis and treatment


Introduction: The incidence of EoE have increased recently. Clinical manifestation of pediatric EoE varies widely whereas complications have serious prognosis. The study aims to determine characteristics of the disease in children and demonstrate a clinical case of comorbid EoE with esophageal stenosis and Crohn’s disease (CD). 

Methods: The data were retrospectively (2016-2021) collected from 35 children with biopsy-proven EoE. Demographic, clinical and endoscopic features were examined.

Results: Median age was 13 ± 3,5 years. 89% of patients with EoE were male. Gastroduodenitis symptoms were the most common, gastroesophageal reflux and dysphagia were the others. Whitish exudates and furrows were endoscopically noticed in 26 (74,3%) patients, esophageal strictures – in 3 (8,6%) children. Histological confirmation of EoE was higher when biopsy included at least 3 specimens from esophageal mucosa. 7 patients required several procedures for differential diagnosis with reflux or mycosis esophagitis, Barrett’s esophagus or esophageal hiatus hernia. The incidence of EoE is constantly growing: 1 case was reported in 2017; 14 - in 2021.

Clinical case: 17-year-old boy with dysphagia, retrosternal pain, periodic food impaction and concomitant atopic skin diseases and anal fissure was examined in the Institute. During upper endoscopy EoE with stenosis (<9 mm) of lower third of esophagus was found. Histology confirmed the eosinophilic origin of the stricture. Proton pump inhibitor (PPI) therapy for 1 month wasn’t effective. Endoscopic balloon dilatation of the stricture was performed under general anesthesia without any complications. Esophageal lumen was widened to 12 mm. Further colonoscopy revealed erosive ileitis, CD was biopsy-proven. 

Conclusion: These results can help in better understanding of the characteristics of pediatric EoE for better diagnosis. Timely diagnosis prevents complications and allows to avoid surgery. Co-occurrence of EoE and CD in one patient requires detail and individual approach. Endoscopic dilatation of pediatric eosinophilic esophageal stenosis is effective and minimally invasive.


Anastasiia Merkulova is an endoscopist and a research fellow at Clinical and Research Institute of Emergency Pediatric Surgery and Trauma. She has about 20 publications.