Contribution of Esophagram to the Evaluation of Complicated Pediatric Eosinophilic Esophagitis

Abstract

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.

Influence of Age and Eosinophilic Esophagitis on Esophageal Distensibility in a Pediatric Cohort

“…[4, 5]. Endoscopic evaluation itself may in fact underestimate clinically significant narrowing of the esophagus [6, 7]. Barium swallow studies may be more accurate in detecting abnormalities but these tests have their own limitations, particularly in the pediatric population [7].…”

Association Between Body Mass Index and Clinical and Endoscopic Features of Eosinophilic Esophagitis

“…Esophageal narrowing may drive decreased BMI, and weight loss or low BMI in a patient suspected of having EoE should raise concern for esophageal remodeling causing narrow caliber esophagus. Evaluation in this setting should include barium swallow which has previously been shown to be a sensitive test for esophageal narrowing in EoE [31,32]. Further research should assess whether treatment of EoE and resolution of esophageal narrowing cause changes to BMI.…”

Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis

“…1, 15, 16 In a cohort of 22 pediatric patients with EoE with strictures who underwent esophagram and endoscopy within 3 months of each other, 12 had esophageal strictures identified by esophagram alone and only 1 had a stricture identified by endoscopy but not esophagram. 16 Furthermore, 3 of 4 patients who received a barium pill had evidence of impaction or delayed pill transit. 16 Although not specific to EoE, these findings may provide valuable adjunctive monitoring and diagnostic information before performing an upper endoscopy.…”

“…16 Furthermore, 3 of 4 patients who received a barium pill had evidence of impaction or delayed pill transit. 16 Although not specific to EoE, these findings may provide valuable adjunctive monitoring and diagnostic information before performing an upper endoscopy. Characterizing a patients’ anatomy may also be useful in preventing unwanted complications, including esophageal perforation.…”

“…An esophagram is helpful in patients with EoE who present with dysphagia or feeding difficulty and may diagnose strictures or narrowing more reliably. 16, 42 …”