Peculiarities of eosinophilic gastrointestinal diseases in children: combined eosinophilic lesions of the esophagus and stomach. A clinical case

Introduction. Eosinophilic gastrointestinal diseases are a group of chronic immune-mediated diseases of the gastrointestinal tract characterized by gastrointestinal symptoms and pathological eosinophilic infiltration of certain parts of the gastrointestinal tract in the absence of secondary causes of eosinophilia. Depending on the lesion level, eosinophilic esophagitis, eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis are distinguished. The absence of specific symptoms of eosinophilic gastrointestinal diseases complicate the diagnostic process, the key element of which is the morphological examination of biopsies of the mucous membrane of the corresponding part of the gastrointestinal tract to determine eosinophilic infiltration. To date, eosinophilic esophagitis in children is a well-defined disease with established recommendations, which facilitates the diagnosis and treatment of this pathology, which cannot be said about eosinophilic gastritis, which remains a clinical mystery with evidence based on limited individual case reports.
Presentation of the clinical case. The publication presents a clinical case of a 9-year-old girl with combined eosinophilic lesions of the esophagus and stomach. An endoscopic examination of the upper gastrointestinal tract performed on an outpatient basis, followed by a morphological assessment of biopsies of the esophageal mucosa, made it possible to diagnose eosinophilic esophagitis. A biopsy of the gastric mucosa and small intestine was not performed. The lack of stable positive dynamics against the background of prescribed treatment led to hospitalization and repeated examination, including morphological examination of the mucous membrane of the esophagus, stomach and intestines. The examination revealed eosinophilic infiltration not only of the mucous membrane of the esophagus (>15/1PH*400), but also of the antrum of the stomach (up to 67 eosinophils*5PH*400). As a result, eosinophilic esophagitis was diagnosed in combination with eosinophilic gastritis, for which diet therapy, proton pump inhibitors and glucocorticosteroids were prescribed, which led to an improvement in the child’s condition, relief of pain and symptoms of dyspepsia, and the formation of clinical remission.
Conclusion. Despite the increasing number of studies and publications on the problem of eosinophilic gastrointestinal diseases, the criteria for diagnosis and treatment of such patients remain controversial. The presented clinical case demonstrated the difficulties that arise for a practicing physician in managing children with eosinophilic gastrointestinal diseases, in particular combined eosinophilic lesions of the esophagus and stomach, given the low symptoms and atypical clinical manifestations of this pathology, which necessitates further study of the mechanisms of development and improvement of the algorithm for the diagnosis and treatment of these diseases.

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