Original article
Eosinophilic Esophagitis: A 10-Year Experience in 381 Children

https://doi.org/10.1016/S1542-3565(05)00885-2Get rights and content

Background & Aims: Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus unresponsive to aggressive acid blockade but responsive to the removal of dietary antigens. We present information relating to our 10-year experience in children diagnosed with EoE. Methods: We conducted a retrospective study between January 1, 1994, and January 1, 2004, to evaluate all patients diagnosed with EoE. Clinical symptoms, demographic data, endoscopic findings, and the results of various treatment regimens were collected and evaluated. Results: A total of 381 patients (66% male, age 9.1 ± 3.1 years) were diagnosed with EoE: 312 presented with symptoms of gastroesophageal reflux; 69 presented with dysphagia. Endoscopically, 68% of patients had a visually abnormal esophagus; 32% had a normal-appearing esophagus despite a severe histologic esophageal eosinophilia. The average number of esophageal eosinophils (per 400× high power field) proximally and distally were 23.3 ± 10.5 and 38.7 ± 13.3, respectively. Corticosteroids significantly improved clinical symptoms and esophageal histology; however, upon their withdrawal, the symptoms and esophageal eosinophilia recurred. Dietary restriction or complete dietary elimination using an amino acid–based formula significantly improved both the clinical symptoms and esophageal histology in 75 and 172 patients, respectively. Conclusions: Medications such as corticosteroids are effective; however, upon withdrawal, EoE recurs. The removal of dietary antigens significantly improved clinical symptoms and esophageal histology in 98% of patients.

Section snippets

Eosinophilic Esophagitis

All patients diagnosed with eosinophilic esophagitis from January 1, 1994, to January 1, 2004, in the Division of Gastroenterology and Nutrition at The Children’s Hospital of Philadelphia, were identified and their information reviewed.

The diagnosis of EoE was based on clinical criteria that included chronic symptoms of reflux or dysphagia that persisted despite a 2-month trial of a proton pump inhibitor (1 mg/kg; maximum dose, 40 mg/day). Also required was a lack of demonstrable anatomic

Statistical Analysis

Data were analyzed using the Wilcoxon sign-rank test and the Mann–Whitney U test for continuous variables, and the χ2 test for categorical variables. Statistical comparisons (mean ± standard deviation) were made using the statistical software package Stata 7.0 (Stata, College Station, TX).

Eosinophilic Esophagitis

Three hundred eighty-one patients (66% male) were diagnosed with EoE. Patients were categorized into 2 separate subgroups: a gastroesophageal reflux (GER) subgroup and a dysphagia subgroup. The GER subgroup consisted of 312 patients (82%) who initially presented with symptoms of gastroesophageal reflux; the dysphagia subgroup contained 69 patients (18%) who presented primarily with dysphagia. In the GER subgroup, 218 (70%) presented with either vomiting and/or regurgitation while 190 (61%) had

Discussion

Over the past 5 years, EoE has become a worldwide phenomenon with reports originating from the United States, Canada, Europe, Australia, and South America.5, 6, 7, 8 Pediatric gastroenterologists now recognize that children who present either with chronic symptoms of GERD or dysphagia (frequent or intermittent) unresponsive to aggressive acid blockade may have EoE. Noel et al reported on a specific population of children diagnosed with EoE between the years 2000 and 2003, and calculated a

References (45)

  • J.B. Morrow et al.

    The ringed esophagushistological features of GERD

    Am J Gastroenterol

    (2001)
  • C.G. Siafakas et al.

    Multiple esophageal rings: an association with eosinophilic esophagitis: case report and review of the literature

    Am J Gastroenterol

    (2000)
  • S.R. Orenstein et al.

    The spectrum of pediatric eosinophilic esophagitis beyond infancya clinical series of 30 children

    Am J Gastroenterol

    (2000)
  • R.J. Noel et al.

    Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis

    Clin Gastroenterol Hepatol

    (2004)
  • J.E. Teitelbaum et al.

    Eosinophilic esophagitis in childrenimmunopathological analysis and response to fluticasone propionate

    Gastroenterology

    (2002)
  • C. Fukushima et al.

    Oral candidiasis associated with inhaled corticosteroid usecomparison of fluticasone and beclomethasone

    Ann Allergy Asthma Immunol

    (2003)
  • A.S. Arora et al.

    Eosinophilic esophagitisasthma of the esophagus?

    Clin Gastroenterol Hepatol

    (2004)
  • E.K. Cury et al.

    Eosinophilic infiltration of the esophagusgastroesophageal reflux versus eosinophilic esophagitis in children—discussion on daily practice

    J Pediatr Surg

    (2004)
  • M.I. Fogg et al.

    Pollen and eosinophilic esophagitis

    J Allergy Clin Immunol

    (2003)
  • A.M. Sant’Anna

    Eosinophilic esophagitis in childrensymptoms, histology and pH probe results

    J Pediatr Gastroenterol Nutr

    (2004)
  • A. Straumann et al.

    Idiopathic eosinophilic esophagitisa frequently overlooked disease with typical clinical aspects and discrete endoscopic findings

    Schweiz Med Wochenschr

    (1994)
  • F. Borda et al.

    Eosinophilic esophagitisan underdiagnosed entity?

    Rev Esp Enferm Dig

    (1996)
  • Cited by (755)

    • Dietary Management of Eosinophilic Esophagitis

      2024, Immunology and Allergy Clinics of North America
    • Endoscopic Features of Eosinophilic Esophagitis

      2024, Immunology and Allergy Clinics of North America
    View all citing articles on Scopus
    View full text