Eosinophilic esophagitis in children

Eosinophilic esophagitis is a newly described clinicopathologic entity that is being diagnosed with increasing frequency. Although accepted diagnostic criteria have not been established, the presence of dense eosinophilic inflammation of esophageal mucosa are key. Because of the reflux-type symptomatology, it is commonly misdiagnosed and treated as severe gastroesophageal reflux disease before an appropriate diagnosis is made. The role of food allergens in this disorder is well accepted but the task of identifying specific antigens remains a clinical challenge. Based on animal studies, the pathophysiology appears to involve inflammatory cytokines, interleukin 5 (IL-5) and eotaxin. Therapy remains problematic because of steroid side effects, the unpalatability of the elemental diet, and lack of rigorously designed trials.