Eosinophilic esophagitis
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Rare but probably often non-diagnosed. Esophageal chronic disease of allergic origin. Seems more common among boys. The pathophysiology is unknown but appears to involve a combination of immediate allergy (IgE) and delayed allergy to some food (egg, peanut, soya) or airborne allergens (pollen, mites). Children less than 4 years old are more often allergic to a food while older children and adolescents are more often allergic to airborne allergens.
Diagnosis: symptoms of esophageal dysfunction + histological picture of predominantly eosinophilic inflammation.
Symptoms: pain upon swallowing, food refusal, dysphagia (sometimes food blockage), which do not respond to anti-reflux treatment or antacids; growth retardation.
Endoscopy: macroscopically normal in 30 % of cases; sometimes "train rails" picture.
Treatment: removal of the identified allergen, corticosteroid therapy.
Anesthetic implications:
other signs of atopy (dermatitis, asthma, allergic rhinitis); corticosteroid therapy. There no contraindication to the use of propofol.
References :
- Chadha SN, Li W, Correa H, Moulton D, Hummell DS.
Pediatric eosinophilic esophagitis : the Vanderbilt experience.
Ann Allergy Asthma Immunol 2014; 113: 445-51.
- Metha P, Sundaram S, Furuta GT et al.
Propofol use in pediatric patients with food allergy and esosinophilic esophagitis.
J Pediatr Gastroenterol Nutr 2017; 64: 546-9.
- Fernandez PG, Mikhael M.
Perioperative considerations for the food-allergic pediatric patient.
Pediatr Anesth 2017; 27: 461-70.
- Dewachter P, Kopac P, Laguna JJ, Mertes PM et al.
Anaesthetic management of patients with pre-existing allergic conditions: a narrative review.
Br J Anaesth 2019; 123 (1): e65-81.
Updated: August 2019