Day 1 :
Dr. Mohamad Miqdady is American Board certified in Pediatric Gastroenterology, Hepatology and Nutrition. He is the Division Chief, Ped. GI, Hepatology & Nutrition Division at Sheikh Khalifa Medical City in UAE. Also an Adjunct Staff at Cleveland Clinic, Ohio USA. He is also the Member of the FISPGHAN Council (Federation of International Societies of Pediatric Gastruenterology Hepatology, and Nutrition) Expert member FISPGHAN Malnutrition/Obesity Expert team. Dr. Miqdady completed his Fellowship in Pediatric Gastroenterology at Baylor College of Medicine and Texas Children’s Hospital in Houston, TX, USA. He held the position of Assistant Professor at Jordan University of Science and Technology in Jordan for six years prior joining SKMC. His main research interests include feeding difficulties, picky eating, obesity, procedural sedation, allergic GI disorders and celiac disease.
It’s believed that the prevalence of atopic disorders is increasing worldwide. Gastrointestinal allergic disorders are no stranger to this phenomenon. Over the last two decades a new disease was described called eosinophilic esophagitis which simply means an allergic inflammatory reaction in the esophagus. This could be related to ingested or possibly inhaled allergens. Typically these young children present with difficulty in swallowing and dysphagia and frequently with food impaction with regular food. They have functional obstruction rather than at anatomical obstruction.
During endoscopy an abnormal esophageal mucosa can be noted sometimes with some white spots indicated some eosinophilic abscesses, linear furrows and during formation of the esophagus. Biopsy should be taken to confirm the diagnosis which normally shows increased number of eosinophils. A cutoff point is described to be more than 15 eosinophils per high-power field. Typically these patients they don’t have eosinophilic infiltrates in other parts of the gastrointestinal system.
The mainstay of treatment is elemental diet avoiding the commonest food allergies that includes milk, eggs, wheat, soy, nuts and seafood. In the Middle East allergy to sesame seems to be another common allergen. Also these patients that will require “swallowed topical steroid” in addition to a proton pump inhibitor.
Unfortunately this is a chronic disorder and these patients need to be in diet for a long period of time with the above medications. Dilatation if required can be associated with higher increased risk of perforation.