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Longitudinal Growth Outcomes Following First-line Treatment for Pediatric Patients With Eosinophilic Esophagitis

Jensen, Elizabeth T.*,†; Huang, Kevin Z.; Chen, Hannah X.; Landes, Lisa E.; McConnell, Kristen A.; Almond, Mary Angie; Safta, Anca M.; Johnston, Douglas T.§; Durban, Raquel§; Jobe, Laura||,¶; Frost, Carrie; Donnelly, Sarah#; Antonio, Brady#; Quiros, Antonio#; Markowitz, Jonathan E.||,¶; Dellon, Evan S.†,**

Journal of Pediatric Gastroenterology and Nutrition: January 2019 - Volume 68 - Issue 1 - p 50–55
doi: 10.1097/MPG.0000000000002114
Original Article: Gastroenterology: Eosinophilic GI Disease

Objectives: No formal comparative effectiveness studies have been conducted to evaluate the effect of eosinophilic esophagitis (EoE) treatment choice on long-term growth in pediatric patients. Long-term studies of inhaled corticoid steroids in asthma, however, suggest possible effects on linear growth. The aim of this study was to compare longitudinal, anthropometric growth in children with EoE according to treatment approach.

Methods: We conducted a retrospective, multicenter cohort study of anthropometric growth (height and body mass index [BMI] z scores) in pediatric (<18 years of age) patients newly diagnosed with EoE across 5 clinical sites between 2005 and 2014. We compared differences in growth according to treatment approach over a 12-month period. Modification by sex and age was examined and sensitivity analyses were conducted to assess robustness of results given study assumptions.

Results: In the 409 patients identified, the mean age and proportion male differed by treatment (P = < 0.01 and P = 0.04, respectively). Baseline growth measures were associated with slight impairment of height at diagnosis (median baseline height z score of −0.1 [interquartile range −0.9, 0.8]). In general, treatment approach was not associated with any significant increase or decrease in expected growth over a 12-month period. Subtle decrease in linear growth was observed with treatment using a combined elemental and topical steroid (Δ height z score [adjusted]: −0.04; 95% confidence interval [CI]: −0.08, −0.01). Differences in linear growth differed by sex (P for interaction <0.01). For elemental formula in combination with topical steroids, only girls exhibited a significant decline in linear growth (Δ height z score [adjusted]: −0.24; 95% CI: −0.32, −0.17). A slight reduction in BMI was observed for patients treated with a combination of elemental diet and dietary elimination (Δ BMI z score [adjusted]: −0.07; 95% CI: −0.13, −0.01).

Conclusions: Treatment of EoE, in general, is not associated with major anthropometric growth changes in most pediatric patients. Slight linear growth impairment was observed for topical steroid treatment, and sex differences in growth by treatment approach were observed. Future prospective studies should evaluate the effect of treatment on optimal growth and development and over a longer period of follow-up.

*Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem

Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill

Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Wake Forest Baptist Medical Center, Winston-Salem

§Asthma and Allergy Specialists, Charlotte

||University of South Carolina School of Medicine

Greenvile Children's Hospital, Greenville

#Pediatric Gastroenterology and Nutrition, MUSC Children's Hospital, Charleston

**Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC.

Address correspondence and reprint requests to Elizabeth T. Jensen, MPH, PhD, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157 (e-mail:

Received 24 January, 2018

Accepted 4 June, 2018

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (

This study was funded, in part, by an investigator-initiated grant from Nutricia and by NIH grant T35 DK007386.

E.S.D. has received research funding from Meritage, Miraca, Nutricia, Receptos/Celgene, Regeneron, and Shire. He is a consultant for Adare, Banner, GSK, Receptos/Celgene, Regeneron, and Shire. D.T.J. is a consultant for Shire, CSL Behring, Biocryst Pharmaceuticals, Nutricia, Merck, and Novartis. The other authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,