Journal of Pediatric Gastroenterology & Nutrition:
ABSTRACTS: Oral Presentation Abstracts
1Gastroenterology and Nutrition, 2Allergy and Immunology, 3Pathology, Children’s Hospital of Philadelphia, Philadelphia, United States
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Introduction: Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus with symptoms similar to gastroesophageal reflux disease or dysphagia. EoE is unresponsive to aggressive acid blockade but instead responds to the removal of food antigen(s).
Methods: Between 1/1/94 and 1/1/03, 309 patients diagnosed with EoE were reviewed. EoE was diagnosed if a patient had symptoms of reflux or dysphagia and an upper endoscopy demonstrating > 20 eosinophils/HPF (in the most densely involved field) isolated to the esophagus. We describe the demographic and clinical data as well as dietary/medical therapy of patients with EoE. We compare this group to a subgroup of pts with reflux esophagitis (GERD).
Results: Of all EoE patients, 250 pts (159 males, age 8.1±2.9) with 34.9±10.2 eos/HPF had symptoms of reflux; 59 pts (45 males, age 12.8±3.2) with 56.2±18.7 eos/HPF presented with dysphagia; 102 GERD pts (55 male, age 7.5±2.4) had 2.3±0.6 eos/HPF. Of the pts with EoE, 52% had bronchospasm, eczema or rhinitis and 43% had a family history of food allergy. The number of pts diagnosed with EoE per year increased from 2 in ’94 to 63 in ’02; 34% of EoE pts were 5–10 years old at time of diagnosis while 72% were greater than 5 years of age. Between 1/1/00 and 12/31/02, 5.7% of all pts presenting with reflux symptoms and 66% of all patients with dysphagia were diagnosed with EoE. Endoscopically, when comparing EoE pts to those with GERD, EoE pts had significantly more histologic eosinophilic abscesses, visual white plaques, and esophageal “trachealization” or furrowing. In contrast, GERD pts had more visual erosions. The following therapies were instituted with the results reported as the number of eos/HPF before (pre-), during and post-therapy. Oral solumedrol (32 pts;1.5mg/kg/d; max 48 mg): pre-31.3±8.5, during 0.8±0.5, post-27.9±6.2, p<0.0001. Ingested aerosolized steroids (12 pts;110–220ìg bid): pre-29.4±6.4, during 10.7±2.9, i post-24.8±3.7, p<0.0001. Oral cromolyn (14 pts;100 mg qid): pre-28.3±6.4, during 25.4±4.3, post-27.6±4.4, p<0.2. Diet therapy (amino acid based formula) 137 patients (108 NG tube, 6 non-compliant, 2 failed): pre-39.8±9.6, during 1.0±0.6, post-1.1±0.5, p<0.0001. There was no significant difference in serum IgE or total eosinophil levels between patients with EoE or GERD.
Conclusion: The incidence of EoE has been increasing over the past decade and makes up approximately 6% of all patients presenting with GER. While some medical therapy may prove effective, only strict avoidance of allergenic foods prevents reoccurrence of disease. Currently, endoscopy remains the only effective laboratory tool for diagnosis.