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The Coexistence and Severity of Acid and Alkaline Reflux in Pediatric and Adult Patients with Eosinophilic Esophagitis

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Shah, Asif MBBS1; Virarkar, Mayur MBBS, MS1; Chandrasekhar, Rameela MA2; Ambrus, Julian MD, PhD, FACP1; Moore, Michael MD, FACP1; Srivastava, Maya MD, PhD, FAAP1

American Journal of Gastroenterology: October 2010 - Volume 105 - Issue - p S4–S5
Abstracts: ESOPHAGUS
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1. Department of Medicine, SUNY at Buffalo, Buffalo, NY; 2. Department of Biostatistics, SUNY at Buffalo, Buffalo, NY.

Purpose: Eosinophilic Esophagitis (EE) and gastroesophageal reflux disease (GERD) can have similar clinical presentations, but treatment differs (steroids versus proton pump inhibitors). There continues to be controversy regarding the coexistence and clinical significance of EE and GERD in the same patient, with most studies from tertiary centers. The aim of this study was to determine the frequency of pathologic acid and alkaline reflux in patients seen in a private practice setting with biopsy proven EE, and compare reflux severity to control patients with only GERD.

Methods: All patients in the practice identified by record review for diagnostic code for eosinophilic esophagitis were included (2006-present, with 41 cases identified). Thirty-one patients (age 3-67 years) completed ph-impedance and were included for study. All cases with EE had ≥ 20 eosinophils (mean 38 ± 17) per high power field and had been advised to undergo routine evaluation for reflux. A sex and age matched control group (n=21) with GERD was obtained from our pH - impedance database, all also had esophagogastroduodenoscopy (EGD) documenting absence of eosinophilia. Diagnosis of pathological GERD was based on the results of 24 hr esophageal pH monitoring, satisfying the following criteria: i) Reflux index >4%; ii) DeMeester Score > 14.72. Univariate statistical methods were applied to compare variables among groups.

Results: The mean acid index (5.55±6.61 vs. 6.32±2.00, p-value=0.0088) and DeMeester score (19.27±21.50 vs. 22.15±7.39, p-value=0.0095) were significantly lower in patients with EE than in patients with GERD. The median acid index (3.8 vs. 5.6, p-value=0.0042) and DeMeester score (13.24 vs. 19.38, p-value=0.0063) were also significantly lower in EE compared to patients with GERD. Alkaline reflux, bolus transit time, and number of reflux episodes were similar. Approximately half of EE patients met the criteria for pathological reflux based on reflux index (48%) and DeMeester score (44%).

Conclusion: In the private practice setting, EE and GERD frequently coexist, but the reflux is less severe than in patients treated solely for GERD. Patients with EE should be evaluated for GERD and treated to optimize medical outcome.

© The American College of Gastroenterology 2010. All Rights Reserved.