Investigating Swallowing Difficulties and Allergies in Pediatric and Young Adult Populations

Journal of the Canadian Medical Association

Children and young adults with allergies or eczema who have difficulty swallowing may have eosinophilic esophagitis . A review published in CMAJ (Canadian Medical Association Journal) provides guidance on how to diagnose and manage this chronic inflammatory disease.

In people with eosinophilic esophagitis , the lining of the esophagus is inflamed, which can lead to lesions and narrowing of the throat. Although it can affect anyone, the risk is highest in children aged 5 to 14 and in adults aged 20 to 45, and is 3 to 4 times more common in men than in women.

Incidence is increasing and rates are highest in North America and Europe. It is unclear whether the increase in detection is due to increased awareness or reflects a true increase in disease in our communities.

Key points:

Difficulty swallowing and food getting stuck in the esophagus are the most common symptoms in adolescents and adults, while children are more likely to experience abdominal pain, heartburn/reflux, poor appetite, chronic cough, vomiting, or slowness. of growth.
Most patients (75%) have at least one atopic (allergic) condition, such as food or environmental allergies, asthma, or eczema.
Diagnosis is based on patient history and 4 to 6 esophageal biopsies taken from at least 2 sites during gastroscopy/endoscopy.
Treatment in the form of diet, medications and/or esophageal dilation, known as the "3 Ds", is recommended to prevent long-term complications.

It is important to distinguish between eosinophilic esophagitis and eating disorders in adults, which may appear similar. "Eating disorders can be difficult to differentiate from eosinophilic esophagitis, as restrictive eating behaviors, including food aversions, mealtime anxiety, and chewing behaviors, are a potential feature of both conditions," write Drs. Milli Gupta and Michelle Grinman, Cumming Faculty of Medicine, University of Calgary, Calgary, Alberta. "A detailed dietary history is essential to decipher what types of foods a patient avoids and why. Patients with eosinophilic esophagitis may avoid meat and bread due to previous choking episodes, while patients with eating disorders may do so due to caloric content".

The authors recommend shared decision-making between doctor and patient to mitigate the impact of both the disease and its treatment on quality of life. They suggest a multifaceted approach that encompasses dietary changes and medications, depending on the severity of the disease and the risk of future complications. Patients at high risk for food impaction may require esophageal dilation and consultation with a gastroenterologist and dietician is recommended to personalize care.

The authors call for more research to better understand the disease, as well as optimal ways to diagnose, treat and manage eosinophilic esophagitis.

Investigating Swallowing Difficulties and Allergies in Pediatric and Young Adult Populations

Incidence of swallowing difficulties and allergies is on the rise, particularly among pediatric and young adult demographics.