Endoscopic Differential Diagnosis of Eosinophilic Esophagitis from Other Esophageal Diseases in the Pediatric Population
T. N. Budkina,
M. M. Lokhmatov,
S. G. Makarova,
L. M. Kuzenkova,
E. L. Semikina,
E. A. Kopyltsova,
S. S. Akulova,
E. V. Uvakina,
S. S. Vyazankina,
V. I. Oldakovsky,
G. A. Korolev,
A. V. Tupylenko,
A. V. Lazareva,
K. A. Kulikov,
E. I. Khvatova https://doi.org/10.46563/2686-8997-2026-7-1-229
Abstract
Introduction. Endoscopic diagnosis of eosinophilic esophagitis in children remains challenging due to insufficient familiarity among endoscopists with characteristic endoscopic findings, the non-specific nature of mucosal changes, and the necessity of differential diagnosis with other esophageal disorders.
Aim: to develop endoscopic differential diagnostic criteria for distinguishing eosinophilic esophagitis from other pediatric esophageal diseases.
Materials and methods. Differential diagnostic features were identified through retrospective analysis of upper endoscopy data from 102 children with histologically confirmed eosinophilic esophagitis (≥15 eosinophils/high-power field) and 110 pediatric controls with non-eosinophilic esophageal diseases: reflux esophagitis (n=62), esophageal candidiasis (n=32), and Crohn’s disease with esophageal involvement (n=16).
Results. Reflux esophagitis was characterized by longitudinal erosions predominantly localized to the distal third of the esophagus. White plaques were absent, and mucosal striation (both longitudinal and transverse) was mild and transient. Esophageal candidiasis presented with discrete white plaques exhibiting characteristic distribution and morphology, a preserved mucosal vascular pattern, and absence of striation; diagnosis was confirmed by cytological examination. Esophageal involvement in Crohn’s disease was distinguished by aphthous or linear ulcerations, longitudinal striation associated with mucosal healing, and a previously established diagnosis of Crohn’s disease. Marked eosinophil-predominant inflammation (≥15 eosinophils/hpf ) was exclusively observed in the eosinophilic esophagitis cohort and was absent in all control groups. eosinophilic esophagitis in children with comorbid neurological disorders exhibited endoscopic and histologic activity profiles comparable to those observed in neurologically intact pediatric patients.
Conclusion. The differential diagnostic features proposed herein enable reliable endoscopic distinction of eosinophilic esophagitis from esophagitis of alternative etiologies in children. Implementation of these criteria may enhance diagnostic accuracy for eosinophilic esophagitis, and reduce unnecessary invasive procedures in cases of non-eosinophilic esophagitis.
Keywords
eosinophilic esophagitis,
children,
endoscopy,
reflux esophagitis,
esophageal candidiasis,
Crohn’s disease,
histology,
cytology,
differential diagnosis,
cerebral palsy
Supporting agencies: The study was been conducted as part of the research project «Improving the Diagnosis and Prognosis of Severe Eosinophilic Esophagitis in Children» and received no external funding.
About the Authors
T. N. Budkina
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Tatyana N. Budkina - MD, Cand. Sci. (Medicine), Endoscopist, Senior Researcher of the Department of Endoscopic Examinations, National Medical Research Center for Children’s Health.
119991, Moscow
M. M. Lokhmatov
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Maksim M. Lokhmatov - MD, Dr. Sci. (Medicine), Head of the Department of Endoscopic Examinations, Principal Researcher, National Medical Research Center for Children’s Health.
Moscow
S. G. Makarova
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Svetlana G. Makarova - MD, Dr. Sci. (Medicine), Deputy director, Professor of the Department of Pediatrics and Public Health of the Institute for Medical Personnel Training, Chief freelance specialist of the Russian Ministry of Health for medical care in educational institutions in the Central Federal District of Moscow, National Medical Research Center for Children’s Health.
Moscow
L. M. Kuzenkova
National Medical Research Center for Children’s Health; First Sechenov Moscow State Medical University
Russian Federation
Russian Federation
Lyudmila M. Kuzenkova - MD, Dr. Sci. (Medicine), Professor, Head, Center for Child Neuropsychiatry And Neurorehabilitation, Neurologist, National Medical Research Center for Children’s Health; N.F. Filatov Clinical Institute of Children’s Health, I.M. Sechenov First Moscow State Medical University (Sechenov University).
Moscow
E. L. Semikina
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Elena L. Semikina - MD, Dr. Sci. (Medicine), Head, Laboratory Department, Chief Researcher, Doctor of Laboratory Diagnostics, National Medical Research Center for Children’s Health.
Moscow
E. A. Kopyltsova
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Elena A. Kopyltsova - MD, Cand. Sci. (Medicine), Doctor of Laboratory Diagnostics, National Medical Research Center for Children’s Health.
Moscow
S. S. Akulova
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Svetlana S. Akulova - MD, Cand. Sci. (Medicine), Head, Laboratory Department, Associate Professor of the Department of Pediatrics and Public Health, National Medical Research Center for Children’s Health.
Moscow
E. V. Uvakina
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Eugeniya V. Uvakina - MD, Cand. Sci. (Medicine), Head, Department of Neuropsychiatry and Neurorehabilitation, Deputy Director, Neurologist, National Medical Research Center for Children’s Health.
Moscow
S. S. Vyazankina
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Svetlana S. Vyazankina - Junior Researcher, Laboratory of Clinical Immunology and Nutrition, National Medical Research Center for Children’s Health.
119991, Moscow
V. I. Oldakovsky
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Vladislav I. Oldakovsky - Endoscopist, Researcher of the Department of Endoscopic Examinations, National Medical Research Center for Children’s Health.
Moscow
G. A. Korolev
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Grigory A. Korolev - MD, Cand. Sci. (Medicine), Endoscopist, Researcher of the Department of Endoscopic Examinations, National Medical Research Center for Children’s Health.
Moscow
A. V. Tupylenko
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Artem V. Tupylenko - MD, Cand. Sci. (Medicine), Endoscopist, Senior Researcher of the Department of Endoscopic Examinations, National Medical Research Center for Children’s Health.
Moscow
A. V. Lazareva
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Anna V. Lazareva - MD, Dr. Sci. (Medicine), Chief Researcher, Laboratory of Molecular Microbiology, Head, Laboratory of microbiology, National Medical Research Center for Children’s Health.
Moscow
K. A. Kulikov
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Kirill A. Kulikov - Pathologist, Department Head, National Medical Research Center for Children’s Health.
Moscow
E. I. Khvatova
National Medical Research Center for Children’s Health
Russian Federation
Russian Federation
Elizaveta I. Khvatova - Endoscopist of the Department of Endoscopic Examinations, National Medical Research Center for Children’s Health.
Moscow
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For citations:
Budkina T.N., Lokhmatov M.M., Makarova S.G., Kuzenkova L.M., Semikina E.L., Kopyltsova E.A., Akulova S.S., Uvakina E.V., Vyazankina S.S., Oldakovsky V.I., Korolev G.A., Tupylenko A.V., Lazareva A.V., Kulikov K.A., Khvatova E.I. Endoscopic Differential Diagnosis of Eosinophilic Esophagitis from Other Esophageal Diseases in the Pediatric Population. L.O. Badalyan Neurological Journal. 2026;7(2):100-110. (In Russ.) https://doi.org/10.46563/2686-8997-2026-7-1-229
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