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Eosinophilic Esophagitis in Adolescents – Entity Should Be Known to Adult Gastroenterologists

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Villalona, Juan F., M.D.; Rossi, Thomas, M.D.; Brown, Marilyn R., M.D.; Shah, Ashok, M.D.; Katzman, Philip, M.D.; Matur, Jay, M.D.

American Journal of Gastroenterology: September 2005 - Volume 100 - Issue - p S48
Supplement Abstracts Submitted for the 70th Annual Scientific Meeting of the American College of Gastroenterology: ESOPHAGUS
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Pediatric and Adult Gastroenterology, University of Rochester Medical Center, Rochester, NY.

Purpose: A majority of adolescent patients are scoped for esophageal symptoms by adult gastroenterologists. The eosinophilic esophagitis (EE) should be in the differential diagnosis of patients with esophageal symptoms in these patients. This study was done in collaboration with the pediatric gastroenterologists to study the occurrence of EE, it's symptomatology and endoscopic findings.

30 adolescent patients with EE were studied to evalute their symptoms, endoscopic findings and relationship to allergy. All of these patients met the accepted criteria for the diagnosis of eosinophilic esophagitis (EE).

Methods: 30 charts of patient with the diagnosis of EE were reviewed for sex, age at presentation, onset of symptoms, specific symptoms, pH probe test results, endoscopic findings, RAST tests (if done) and biopsy results.

Results: There were 22 (73%) males and 8 (27%) females. The predominant symptoms were dysphagia in 21 (70%) patients, heartburn in 16 (53%) patients, food impaction in 14 (47%) patients, and abdominal pain in 13 (43%) patients. 22 patients with EE had a pH probe study of which 17 (77%) tested positive, 19 (63%) had allergies to food, medications or environmental allergies. RAST test was done in 22 (73%) of cases and 13 (59%) were positive. The common allergic food was milk. The most common endoscopic finding was linear groves in 14 (47%), white spots in 8 (27%) and rings in 5 (17%) of cases. The biopsy revealed 15 to 80 eosinophils/HPF in 26 (87%) cases. There was eosinophilic gastroenteritis in 5 (10.4%) cases. 27(90%) of the cases responded to elimination of allergen and flucortisone.

Conclusions: Adult gastroenterologists should be aware of this entity as they will be treating a majority of these adolescents with esophageal symptoms. Dysphagia, heart burn, food impaction and abdominal pain were common presenting symptoms. The characteristic endoscopic and biopsy findings are diagnostic of EE. A majority of patients responded to elimination of allergen and flucortisone.

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