As a selected group of children with uncomplicated GERD or EoE were without nutritional deficiencies but had maladaptive feeding, providing anticipatory guidance to minimize mealtime challenges, monitoring for improvement, or referring to a feeding therapist, may be beneficial. A trial of food allergen restriction may provide additional benefit for those with EoE.

Objectives In contrast to peptic strictures, clinically significant strictures in patients with EoE may be subtle and go unrecognized at the time of endoscopy. We aimed to identify how often stricture was identified by endoscopy as compared to contrast esophagram. Methods We retrospectively reviewed esophagram and endoscopy examinations of all EoE patients with esophageal stricture seen at a tertiary care pediatric hospital over a 6 year period who had both procedures completed within a 3-month time frame. Medical charts were reviewed for clinicopathologic information including age, duration of symptoms, histology and treatment. Results Twenty-two children with EoE associated stricture completed both esophagram and endoscopic assessments. Esophageal strictures were identified by esophagram, and not endoscopy, in 55% of these children. Patients with stricture identified at esophagram alone had a shorter duration of symptoms (2.1 years duration vs. 5.4 years duration, p = 0.03) than the group identified by endoscopy. Pre-operative radiographic identification of a stricture was associated with dilation more often being performed. Conclusions Esophagram is a valuable test to assess esophageal anatomy in children with complicated EoE. Esophagram may be able to detect subtle fibrostenosis earlier in the natural history of the disease than endoscopy.