Eosinophilic esophagitis and Barrett's esophagus: an occasional association or an overlap disease? Esophageal 'double trouble' in two children

Background: Esophageal diseases are common in infants and children, and may present with several clinical and pathological aspects. Eosinophilic esophagitis (EE) is characterized by inflammatory, predominantly eosinophilic infiltrate (> or =15 eosinophils per high-power field (HPF)) that is not responsive to acid suppression therapy. An immunoallergic pathogenesis has been hypothesized, likely related to food allergy. Barrett's esophagus (BE) is due to chronic gastroesophageal reflux. The pathological consequence is the replacement of normal stratified squamous epithelium by columnar mucosa with goblet cells.

Methods: We present 2 children with a history of food allergy. Endoscopy revealed linear furrows and yellow plaques in the mid-distal esophagus.

Results: In both patients histology showed a high number of eosinophils (>30 at HPF) in the mid-distal esophagus and intestinal metaplasia with goblet cells in distal esophagus. Diagnosis of EE associated to BE was made. Restriction diet was administered to treat EE whereas, in 1 case, laparoscopic fundoplication was performed to treat BE. Follow-up showed a remission of endoscopic and histological aspects.

Conclusions: The unusual, possibly fortuitous association of EE and BE, two conditions differing in etiopathogenesis, clinical and pathological features, calls for a correct diagnosis to offer suitable treatment and prognosis.