Features of the endoscopic and morphological patterns of the esophageal mucosa in eosinophilic esophagitis in children of different age groups

Introduction. The incidence of eosinophilic esophagitis is 5.31 cases per 100,000 person-years. It is a multifactorial disease with a clear genetic predisposition, specifically involving the expression of the thymic stromal lymphopoietin and IL-33 genes. Eosinophilic esophagitis in the pediatric population is of scientific and clinical interest due to its distinct pathogenetic features. It is essential to emphasize the importance of comparative pathomorphological analysis of esophageal mucosal changes in children across different age groups, while also accounting for sex-based differences.
Purpose of the study. To determine the morphological criteria for eosinophilic esophagitis in children and evaluate their diagnostic significance for confirming the diagnosis and differentiating it from other inflammatory esophageal diseases.
Material and methods. This retrospective study included 76 children with eosinophilic esophagitis (ICD-10: K20; ICD-11: KB81.0) and 30 children in the control group without esophageal diseases. Inclusion criteria: age 1–18 years, confirmed EoE diagnosis with peak eosinophil count ≥15 cells per high-power field. Patients with other inflammatory gastrointestinal diseases were excluded. Methods: clinical examination, endoscopy with biopsy (≥6 samples), histological assessment using the EoEHSS scale (8 criteria), and statistical analysis.
Results. Morphological examination of esophageal mucosal biopsies in children with clinical signs of eosinophilic esophagitis revealed characteristic histological changes confirming the diagnosis. In all cases, there was an increase in eosinophil count in the epithelial layer – from 15 to 80 cells per high-power field. Most patients (approximately 70%) showed uneven infiltration with focal eosinophil accumulations and degranulation. In 62% of cases, eosinophil microabscesses were identified, predominantly in the superficial epithelium. In addition to eosinophilic infiltration, 58% of children exhibited signs of spongiosis and acanthosis of the epithelium, thickening of the basement membrane, and moderate interstitial fibrosis of the lamina propria. In isolated cases (about 20%), superficial erosions and mild neutrophilic infiltration were noted. Comparison of morphological data with clinical manifestations showed that the severity of eosinophilic infiltration correlated with disease duration and dysphagia severity. Children with recurrent EoE exhibited more pronounced epithelial structural changes, including basal layer hyperplasia and subepithelial fibrosis. Thus, the results confirm that morphological examination of esophageal biopsies is a key method for verifying eosinophilic esophagitis in children and should be considered a mandatory step in the diagnostic algorithm for this condition.
Conclusion. Eosinophilic esophagitis in children is characterized by pronounced inflammatory and structural changes in the esophageal mucosa, which progress with age. The data underscore the importance of comprehensive diagnostics using morphological assessment and biopsy, even in the absence of visible endoscopic changes.

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G.A. Demyashkin(1), M.P. Shalatonin(1), D.Yu. Yuferov(1),, V.V. Rostovskaya(1), D.A. Tsomartova(1),
Y.V. Shidlovskiy(1), A.I. Bobrov(1),A.I. Parfenova(1),V.E. Karev(2), K.S. Znamenshchikova(2)
1-Federal State Autonomous Educational Institution of Higher Education I.M. Sechenov First Moscow State Medical University
of the Ministry of Health of the Russian Federation (Sechenov University), Trubetskaya str., 8, build. 2, Moscow, 119991, Russian Federation; 2-Scientific-Clinical and Educational Center of Gastroenterology and Dietology of the Medical Institute of Saint-Petersburg
State University, Universitetskaya Embankment, 7, Saint-Petersburg, 199034, Russian Federation