Pediatric eosinophilic esophagitis among children attending a tertiary hospital in Nairobi, Kenya: a case series.

Abstract

Background: Eosinophilic esophagitis (EoE) is an emerging chronic immune-mediated esophageal disorder characterized by esophageal dysfunction and dense eosinophilic infiltration of the epithelium. Despite increasing global recognition, data from sub-Saharan Africa remain scarce.

Objective: The aim of this work is to describe the clinical spectrum, endoscopic and histopathologic features, and treatment outcomes of pediatric EoE cases diagnosed at a tertiary private hospital in Nairobi, Kenya.

Methods: We conducted a retrospective case series of eight children, aged 4-17 years, who were diagnosed with EoE at The Aga Khan University Hospital, Nairobi. Data collected included demographics, presenting symptoms, laboratory findings, endoscopic features, histology, treatment regimens, and follow-up outcomes. Diagnosis was based on the presence of ≥15 eosinophils per high-power field in esophageal biopsies, alongside clinical and endoscopic correlation, and exclusion of other causes of esophageal eosinophilia.

Results: Of the eight patients (six boys, two girls), common symptoms included dysphagia (n = 2, 25%), chronic abdominal pain (n = 5, 62%), and globus sensation (n = 1, 12%). Endoscopic findings included edema, furrows, exudates, and white plaques, classified using the Eosinophilic Esophagitis Endoscopic Reference Score (EREFS). Eosinophil counts ranged from 10 to 40 eosinophils per high-power field, demonstrating variability in symptom presentation and endoscopic findings. Two patients with eosinophil counts <15/hpf were classified as suspected EoE and treated empirically. Five patients had a history of atopy, and two had positive food allergy panels for wheat and dairy. Treatment with budesonide slurry and dietary elimination of wheat and dairy achieved clinical remission in six of eight cases. Follow-up endoscopy and histopathological assessment were available for three patients, all of whom achieved histological remission, defined as the resolution of esophageal eosinophilia on repeat biopsy. No severe adverse events were reported.

Conclusion: This case series highlights EoE as an important yet often overlooked cause of upper gastrointestinal symptoms in Kenyan children. Its ability to mimic other gastrointestinal disorders warrants heightened clinical suspicion, particularly in cases of refractory gastritis or dysphagia unresponsive to proton pump inhibitors. Effective management includes dietary elimination and topical corticosteroids. Larger multicenter studies are needed to define the epidemiology, diagnostic challenges, and long-term outcomes of pediatric EoE in sub-Saharan Africa and to inform clinical guidelines.