Eosinophilic esophagitis and refractory esophagitis in children: Complicated course with esophageal stricture formation

Esophageal stenosis is a rare but very dangerous condition that can lead not only to obstruction of food passage, but also to esophageal ruptures. Many different disease processes can cause pediatric esophageal stenosis, but the underlying cause is always a long-term inflammatory process accompanied by organ remodeling. Considering that esophageal stenosis is more often described in adult patients with eosinophilic esophagitis (EoE), which is associated with a long-term course of the disease, we have addressed this issue in the pediatric population. Esophageal stenosis treatment includes topical steroid on a thick carrier for oral administration accompanied by strict compliance with six-food elimination diet (SFED), and the use of proton pump inhibitors (PPIs), as well as biological therapy. For non-eosinophilic stenosis, PPIs, antacids, and a gentle diet for a short period of time are sufficient for a short-term course treatment. In some cases, surgical correction techniques are applied. A universal method comprises the use of a combination therapy with an esophageal protector containing hyaluronic acid and chondroitin sulfate on a viscous carrier (poloxamer 407), which have been shown to increase drug exposure in the esophagus and rapidly achieve clinical and endoscopic restoration of the esophageal mucosa without scarring at the sites of esophageal erosions and ulcers. This article presents two clinical observation reports of young children with esophageal stenosis of various etiologies. The first case involved a 6.5-year-old boy, who was observed and treated due to significant changes in the esophageal mucosa with stenosis and widespread signs of eosinophilic esophagitis (EoE) found during upper gastrointestinal endoscopic examination. The second case involved a 5-year-old girl with stenosis of the middle third of the esophagus and ulcerative esophagitis. This article demonstrated an atypical and severe course of reflux esophagitis with stenosis formation and erosive and ulcerative lesions of the mucosa, secondary to a sliding hiatal hernia in a child.