Dysphagia and oesophageal disorders — formative SAQs

Two formative SAQs on dysphagia and the oesophageal disorders of childhood: a teenager with a food bolus impaction, solid-food dysphagia and atopy, testing the recognition and diagnosis of eosinophilic oesophagitis, the need to biopsy at the impaction endoscopy, and the treatment ladder; and a child with progressive dysphagia to solids and liquids, regurgitation of undigested food and weight loss, testing the differential of achalasia, its confirmation on high-resolution manometry and barium, and the definitive options.

Prompt

Dysphagia and oesophageal disorders

SAQ 1 — The teenager with a stuck steak (10 marks, 15 minutes)

A 14-year-old boy presents to the emergency department drooling and unable to swallow his saliva after a mouthful of steak became stuck in his chest. His parents mention that for a year he has eaten slowly, chewed for a long time and always drinks to wash food down. He has asthma and eczema. [1]

a) What is the immediate management of the impaction, and what single procedure must be performed at the same time to secure the underlying diagnosis? (3 marks) [16] [2]

b) What is the most likely underlying diagnosis, and what biopsy finding and endoscopic features confirm it? (4 marks) [2] [1]

c) Outline the first-line treatment options and the role of dupilumab and dilation. (3 marks) [3] [4]

Paediatrics Fellowship Pro

You have read the opening of this SAQ. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References16Show ledger

[1]Amil-Dias J; Oliva S; Papadopoulou A; et al Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr, 2024.PMID 38923067
[2]Dellon ES; Liacouras CA; Molina-Infante J; et al Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology, 2018.PMID 30009819
[3]Dellon ES; Muir AB; Katzka DA; et al ACG Clinical Guideline: Diagnosis and Management of Eosinophilic Esophagitis. Am J Gastroenterol, 2025.PMID 39745304
[4]Dellon ES; Rothenberg ME; Collins MH; et al Dupilumab in Adults and Adolescents with Eosinophilic Esophagitis. N Engl J Med, 2022.PMID 36546624
[5]Franklin AL; Petrosyan M; Kane TD Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management. World J Gastrointest Endosc, 2014.PMID 24748917
[6]Khashab MA; Vela MF; Thosani N; et al ASGE guideline on the management of achalasia. Gastrointest Endosc, 2020.PMID 31839408
[7]Zhong C; Tan S; Huang S; et al Clinical outcomes of peroral endoscopic myotomy for achalasia in children: a systematic review and meta-analysis. Dis Esophagus, 2021.PMID 33316041
[8]Mencin AA; Kramer RE; Bortolin K; et al Peroral Endoscopic Myotomy (POEM) in Children: A State of the Art Review. J Pediatr Gastroenterol Nutr, 2022.PMID 35653433
[9]Rosen R; Vandenplas Y; Singendonk M; et al Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr, 2018.PMID 29470322
[10]Ebbott D; Meisner J; Rentea RM; et al Long-Term Aerodigestive Morbidities After Esophageal Atresia/Tracheoesophageal Fistula Repair. J Pediatr Surg, 2025.PMID 40441419
[11]Bashir A; Sharma N; Rao S; et al Esophagitis, treatment outcomes, and long-term follow-up in children with esophageal atresia. J Pediatr Gastroenterol Nutr, 2024.PMID 39415542
[12]Arnold M; Numanoglu A Caustic ingestion in children-A review. Semin Pediatr Surg, 2017.PMID 28550877
[13]Mubarak A; Benninga MA; Broekaert I; et al Diagnosis, Management, and Prevention of Button Battery Ingestion in Childhood: A European Society for Paediatric Gastroenterology Hepatology and Nutrition Position Paper. J Pediatr Gastroenterol Nutr, 2021.PMID 33555169
[14]Calderone A; Latella D; Cardile D; et al Swallowing disorders in cerebral palsy: a systematic review of oropharyngeal Dysphagia, nutritional impact, and health risks. Ital J Pediatr, 2025.PMID 39985076
[15]Yadlapati R; Kahrilas PJ; Fox MR; et al Esophageal motility disorders on high-resolution manometry: Chicago classification version 4.0(©). Neurogastroenterol Motil, 2021.PMID 33373111
[16]Esparaz JR; Jeziorczak PM; Mowrer AR; et al Esophageal Foreign Body Management in Children: Can It Wait? J Laparoendosc Adv Surg Tech A, 2020.PMID 33121359