Berezhnaya IrinaFederal State Budgetary Educational Institution of Further Professional Education, Russia
Title: Eosinophilic esophagitis. A rare disease in children. Analysis of a clinical case
Eosinophilic esophagitis (EoE) is a clinical and morphological diagnosis. The main clinical criterion for suspecting EoE is the presence of dysphagia (impaired swallowing, feeling of food getting stuck, pain when swallowing, obsessive cough after contact with an allergen). The criterion for diagnosing EoE is the presence of 15 or more eosinophils in the field of view of the microscope (at a resolution of ×400) in combination with clinical symptoms. Despite recent research, there are no non-invasive biomarkers with sufficient sensitivity or specificity to replace esophageal biopsy examination by an experienced pathologist. Data from our own studies (78 children aged 1 month to 17 years) showed that in half of the patients with clinical manifestations of dysphagia, typical endoscopic signs of EoE were not detected (swelling, the presence of exudate, grooves, concentric rings and strictures). It is extremely important to take several biopsies (from 2 to 6 samples) not only from the distal, but mainly from the proximal esophagus. During endoscopy, tissue samples should be taken not only from pathologically altered areas, but also from normal areas of the esophageal mucosa; it is advisable to take biopsies also from the antrum of the stomach and duodenum to exclude other eosinophilic lesions of the gastrointestinal tract.
Boy N., 11 years old: complaints about lack of weight gain: body weight did not exceed 6.8 kg from an early age, extremely low growth rates, reduced volume of food with preserved appetite - no more than 600 ml/day. Extremely severe course of the neonatal period: acute asphyxia during childbirth. Hypoxic-ischemic damage to the central nervous system. Convulsive syndrome. Swelling of the brain substance. From birth it is observed in connection with severe organic damage to the central nervous system, cerebral palsy - double hemiplegia, bulbar-pseudobulbar syndrome, severe delay in psychomotor development, severe protein-energy deficiency (cerebral cachexia). Attempts were repeatedly made to correct severe malnutrition in the child by prescribing high-protein, high-calorie mixtures - against this background, the opposite effect was noted in the form of a decrease in body weight and appetite. The diagnosis of EoE was confirmed morphologically: more than 20 in the field of view * 400. The use of an amino acid mixture and a topical steroid using an innovative technology of administration made it possible within a year to restore the nutritional status of up to 20 kg of weight, achieve a height increase of 8 cm, and restore the patency and function of the esophagus. Along with the restoration of nutritional status, an improvement in neurological symptoms was noted. Our own observations for 3 years: out of 1112 children with clinical gastroesophageal reflux and dysphagia, 78 patients (7%) met the criteria for the diagnosis of EoE. In the center of eosinophilic lesions of the gastrointestinal tract of the Children's City Clinical Hospital named after. BEHIND. Bashlyaeva has developed an innovative method of taking a topical steroid, which improves the therapeutic effect.
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