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158. Case Series: Eosinophilic Esophagitis Presenting as an Eating or Feeding Disorder

      Purpose

      Eosinophilic esophagitis (EoE) is a multifactorial allergic disease associated with chronic inflammation of the upper gastrointestinal tract. A variety of genetic, epigenetic, dietary, and environmental factors have been implicated in the pathophysiology of EoE, though the etiology is still not fully understood. Symptoms of EoE typically reflect esophageal dysmotility, and can be relatively nonspecific in children of all ages. While younger children may present with abdominal pain, vomiting, coughing, regurgitation, poor weight gain or food refusal, older children and adolescents more commonly complain of dysphagia, dyspepsia, choking on foods (food impaction), slow eating, and weight loss. Up to 5 years may elapse between symptom onset and diagnosis, indicating a need for improved screening and detection. This care series highlights the similarities between EoE and an eating/feeding disorder, and discusses the symptoms that should prompt further investigation.

      Methods

      This presentation is a retrospective care series. All patients presented to the University of Rochester Pediatric Ambulatory Clinics in 2020.

      Results

      Patients 1-3 were presumed to have an eating disorder, and were subsequently diagnosed with EoE. Patient 4 had a history of previously diagnosed and inadequately treated EoE, but later was found to also have a longstanding eating disorder.

      Conclusions

      The symptomatology associated with EoE can overlap with that of an eating or feeding disorder. Therefore, the assessment of a patient for either EoE or an eating disorder should include questions about a variety of symptoms. Symptoms that should raise suspicion of EoE are indigestion, acute (vs chronic) weight loss, and dysphagia, including the inability to swallow pills, particularly in the presence of personal or family history of atopic disease. This case series illustrates that EoE can either present as an eating disorder or complicate the diagnosis and/or treatment of an eating disorder, making prompt diagnosis and treatment of EoE essential for successful management of both conditions.

      Sources of Support

      None.