Paeds SAQs · gastroenterology-hepatology-and-nutrition
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.
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Target exams
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]
SAQ 2 — The child who regurgitates undigested food (10 marks, 15 minutes)
A 9-year-old girl has 8 months of progressive difficulty swallowing both solids and liquids. She regurgitates undigested food, worse when lying down, coughs at night and has lost weight. She has been treated for reflux without benefit. [5]
a) What is the most likely diagnosis, and what does the pathophysiology involve? (3 marks) [5] [15]
b) What investigation is the gold standard, what would it show, and what other tests support the diagnosis? (4 marks) [15] [5]
c) List the definitive treatment options and the role of botulinum toxin. (3 marks) [6] [7]
References
- [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