title: Severe dysphagia in children with eosinophilic esophagitis and esophageal stricture: an indication for balloon dilation?
abstract: BACKGROUND
  Esophageal stricture is one of the most severe complications in eosinophilic esophagitis (EoE). Clinical practice is based on limited data and some treatments are still considered controversial. We report on our experience in the treatment of severe dysphagia and esophageal strictures in EoE, especially using balloon dilation, showing the clinical practice in our pediatric population.
  
  
  METHODS
  This was a single-center retrospective study between December 2002 to November 2007, identifying all of the pediatric patients with severe dysphagia in the context of EoE. Demographic data and the results of various treatment regimens were reviewed.
  
  
  RESULTS
  Severe dysphagia was identified in 13 cases (77% male, mean age 12.8 +/- 4.4 years). Endoscopic findings were mucosal edema (62%), long segment strictures, esophagitis, and off-white appearance in 31%. Histologically, >20 eosinophils per high-power field were present in all of the patients. Medical treatment consisted of proton pump inhibitor PPI (77%), montelukast (31%), local corticosteroids (54%), systemic corticosteroids (8%), elemental diet (15%), and food elimination diet (61%). A combined therapeutic approach was performed in all of the cases, due to clinical relapse or no response to monotherapy. Good response was obtained clinically in 70%, endoscopically in 62%, and histologically in 75%. Relapses were observed in 46% of the cases. Balloon dilation was necessary in 31% of the cases (mean dilation sessions 3.3 +/- 0.95), being effective in 100% of patients, without complications.
  
  
  CONCLUSIONS
  In our pediatric series, combined medical (corticosteroids, elemental diet, and food elimination diet) and endoscopic approach (repeated balloon dilation) were effective and safe in patients with severe EoE and esophageal stricture.
authors.affiliation: *Department of Hepatogastroenterology, Edouard Herriot Hospital, Lyon, France. carlosoakm@yahoo.es
authors.forename: Carlos
authors.initials: C
authors.lastname: Robles-Medranda
authors.forename: Florence
authors.initials: F
authors.lastname: Villard
authors.forename: Catherine
authors.initials: C
authors.lastname: le Gall
authors.forename: Hannah
authors.initials: H
authors.lastname: Lukashok
authors.forename: Christine
authors.initials: C
authors.lastname: Rivet
authors.forename: Raymonde
authors.initials: R
authors.lastname: Bouvier
authors.forename: Jerome
authors.initials: J
authors.lastname: Dumortier
authors.forename: Alain
authors.initials: A
authors.lastname: Lachaux
mesh_terms: D000293:Adolescent; D002404:Catheterization; D002648:Child; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy*; D004487:Edema / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D004802:Eosinophilia / Q000150:complications / Q000628:therapy*; D004804:Eosinophils / Q000378:metabolism*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy*; D004941:Esophagitis / Q000150:complications / Q000473:pathology / Q000628:therapy*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D009092:Mucous Membrane / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index