ABSTRACTS: Poster Session Abstracts
P1175 EOSINOPHILIC ESOPHAGITIS, ANOTHER REASON FOR SYSTEMATIC ENDOSCOPIC BIOPSIES.
Introduction: Eosinophilic oesophagitis is a clinicopathologic disease characterized by persistent upper intestinal symptoms despite the patient’s treatment with antagonist agents of gastric acidity. An allergic background is frequently present although the exact etiologic agent remains elusive. Infiltration of the esophageal squamous epithelium with large numbers of eosinophils is specific.
Methods: Following the diagnosis of eosinophilic esophagitis in a 5 year-old boy with growth retardation we reviewed the eosophageal biopsies of 1156 children who underwent an upper GI endoscopy during the last three years.
Results: An elevated count (> 20 eosinophils per 40 high power magnification field) was found in 8 boys (NO GIRLS) aged 3 months to 19 years (mean age 9 years). An allergic familial background was present in 6 and a personal history of allergy in 5. Gastro-esophageal reflux in early life was reported in 5, diabetes in 1, celiac disease in 1 and helicobacter pylori related gastritis in 2. The esophageal mucosa presented with a typical endoscopic aspect with subtle granularity, furrows or rings and fragility in 4/8 patients but was normal in the other 4/8 although a heavy eosinophilic infitration (30 to 68 eosinophils) was present in all 8/8 children. A follow up of successful treatment with inhaled-ingested fluticazone propionate for 8–12 weeks is currently available in 2/8 patients.
Conclusion: Thickening of the esophageal wall, narrowing of the esophageal lumen and severe motor disturbances can be observed but the disease is often misdiagnosed due to lack of awareness and reluctance of clinicians to biopsy an apparently normal oesophagus in dysphagic patients.
An esophageal biopsy with count of eosinophil should be part of any upper GI endoscopy in children.© 2004 Lippincott Williams & Wilkins, Inc.