Purpose Data on eosinophilic esophagitis (EoE) in South America is scarce. Moreover, no studies are available in Ecuador. We evaluated the clinical, endoscopic, and histological characteristics of Ecuadorian children with EoE. Methods Medical records of 2,711 children who underwent upper gastrointestinal endoscopy (UGE) between 2009 and 2020 at Hospital Metropolitano de Quito, Ecuador were reviewed. Esophageal mucosal biopsies were obtained from 72 patients and the features of 35 children with EoE were described. EoE was diagnosed when there were more than 15 eosinophils in the esophagus, per high power field. Results EoE was diagnosed in 35 children (9.4±4.5 years) with a male predominance (74%). Abdominal pain (51.4%) and vomiting (31.4%) were dominant symptoms. A history of allergic diseases was noted in 47.1% of the children, which mainly included allergic rhinitis (37.1%) and atopic dermatitis (11.4%). The most common endoscopic findings were furrowing (82.9%) and edema (74.3%). All patients were initially treated with proton-pump inhibitors (PPIs). Those who did not respond to PPIs received steroids (5.7%) and diet therapy (5.7%), and five patients were referred to an allergist. Clinical and histological resolution was observed in 65% of the patients who underwent a second UGE after 6–8 weeks of PPI. Conclusion Our study describes the clinical features of pediatric EoE in Ecuador. This is the first retrospective study in Ecuador that describes the clinical, endoscopic, and histological manifestations of EoE in a small pediatric population. Almost half of the children who underwent a biopsy had EoE.

PurposeOesophageal squamous papilloma (OSP) is a rare epithelial lesion with an unclear aetiology, found incidentally in upper gastrointestinal endoscopy (UGE). We evaluate the epidemiology, general features and endoscopic and histological characteristics of OSP in children in a single centre.MethodsWe conducted a retrospective search of 3568 medical records of children under 18 years old who underwent UGE between 2004 and 2022, at Hospital Metropolitano de Quito, Ecuador. We described the general features of 15 patients diagnosed with OSP. Histopathology reports were analysed, including a chromogenic in situ hybridisation (CISH) for human papillomavirus (HPV) 6/11.ResultsOSP was diagnosed in 15 patients between 10 and 16 years of age, with an estimated prevalence of 0.4%. The gender ratio male to female was 1:1.1. Most patients (n=14) underwent UGE due to abdominal pain. Lesions were found predominantly in the upper and lower part of the oesophagus; 12 patients had isolated lesions, and none of the lesions tested positive for HPV on CISH 6/11 analysis. Additionally,Helicobacter pyloriand eosinophilic oesophagitis (EoE) were diagnosed in one patient each.ConclusionOur study describes the clinical features of paediatric OSP in a single centre. The prevalence was similar to that in the adult population but higher than in other paediatric populations, and none of our patients had HPV.

Food protein-induced enterocolitis syndrome (FPIES) is a gastrointestinal, non-IgE mediated, and food hypersensitivity syndrome, and particularly occurs in infants during the introduction of new foods. There is no specific diagnostic test for FPIES, and therefore, diagnosis relies on medical records, symptoms presented, oral food challenges, and symptomatic relief after dietary avoidance. 1 Contrastingly, necrotizing enterocolitis (NEC) is a lifethreatening emergency of the gastrointestinal tract that almost exclusively affects newborns, with 70% of these cases occurring in preterm infants (<36 weeks of gestation). 2 This condition warrants treatment with broad-spectrum antibiotics, bowel rests, inotropes, and fluid support. 3 The diagnosis of FPIES can be challenging, as its clinical manifestations may mimic other diseases such as NEC, leading to misdiagnosis. Symptoms that arise in both conditions include vomiting, abdominal distention, diarrhea, bloody stools, feeding difficulties, lethargy, apnea, and shock. Additionally, in both conditions, diagnostic tests, such as abdominal radiography, may show intestinal dilatation, pneumatosis intestinalis (PI), and portal venous gas. 4 We present a case of FPIES in a 1-month-old, exclusively breastfed male, initially diagnosed with NEC, showing persistent PI on radiography and metabolic acidosis in the venous blood gas test. Our objective was to highlight the diagnostic difficulties associated with FPIES in exclusively breastfed infants. | CLINICAL CASEThe patient was a 1-month-old male, born at 38 + 6 weeks of gestation, with a history of transient tachypnea (requiring oxygen for less than 24 h) and a patent foramen ovale. He had no personal or family history of allergic conditions