Food allergy, anaphylaxis, dermatology, and drug allergy
Pediatric patients with eosinophilic esophagitis: An 8-year follow-up

https://doi.org/10.1016/j.jaci.2006.10.044Get rights and content

Background

Eosinophilic esophagitis (EE) is a gastrointestinal disorder that is increasingly diagnosed in pediatric patients.

Objective

We aimed to define, in pediatric patients with EE, their demographic and atopic characteristics, the histopathology of all segments of the gastrointestinal tract, and the effect of therapeutic interventions on the natural history.

Methods

We conducted a retrospective analysis of a database of pediatric patients with EE followed over a period of 8 years.

Results

In 89 pediatric patients with EE, male sex (78.6%), white race (94.4%), young age at diagnosis, mean ± SD, 6.2 ± 4.8 years, and atopy with sensitization to environmental and food allergens in 79% and 75%, respectively, were prevalent. Patients had EE of the proximal and distal esophagus, and 77% had in addition either mucosal eosinophilia or noneosinophilic histopathology in the stomach, duodenum, and colon. EE was chronic, with a duration of mean ± SD, 0.91 ± 0.84 years, until first resolution, and was recurrent; of 66% of the patients who had resolution, 79% later relapsed.

Conclusion

Eosinophilic esophagitis in the pediatric population is a chronic and relapsing condition, associated with atopy and sometimes with subsequent histopathology in segments of the gastrointestinal tract other than the esophagus.

Clinical implications

Physicians evaluating pediatric patients with chronic gastrointestinal symptoms should consider the diagnosis of EE, particularly in young white male patients with atopy. Once diagnosed and treated, the physicians should follow the patients over a period of several years because the course of the disease is protracted, other gastrointestinal segments may be affected, and relapses are common.

Section snippets

Patients

Pediatric patients evaluated in our center with gastrointestinal symptoms who had esophagogastroduodenoscopy with the diagnosis of EE were included. After obtaining informed consent, patients' data were entered in a database approved by the Institutional Review Board of Cincinnati Children's Hospital Medical Center.

Demographics and symptoms

Data were extracted from the medical history obtained at the patient's first visit to our center. The age of onset and the age at diagnosis were defined as the age at which the

Patients

Eighty-nine patients who had at least 1 esophagogastroduodenoscopy with 1 histopathologic diagnosis of EE were included in the study. All patients were evaluated in our center between March 31, 1997, and November 30, 2004. The initial histopathologic diagnosis was made in our center for 57 patients. Thirty-two patients whose initial histopathology was interpreted at other institutions and was not available for interpretation at our center were included in our analysis because at least 1

Discussion

Herein we report several new findings concerning pediatric EE. The first is the prolonged lag of time, as long as 3 years, between onset of symptoms and the first diagnostic endoscopy. The symptoms had remained the same at the time of onset and at the time of the first endoscopy, which suggests that the persistence of symptoms, rather than their severity, was the reason for the endoscopic evaluation. Another intriguing finding is the age distribution of the affected children. The highest

References (22)

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Supported by a 2005 American Academy of Allergy, Asthma & Immunology/Sanofi Aventis Women Physicians in Allergy Project Grant Award (A.H.A.) and a 2004 American Academy of Allergy, Asthma & Immunology Clinical Fellowship Award (J.Z.B.).

Disclosure of potential conflict of interest: A. H. Assa'ad has consulting arrangements with and has received grant support from GlaxoSmithKline. M. H. Collins has consulting arrangements with GlaxoSmithKline and Ception Therapeutics. R. J. Noel has consulting arrangements with Ception Therapeutics. M. E. Rothenberg has consulting arrangements with GlaxoSmithKline, Ception Therapeutics, Cambridge Antibody Technology, Tanox, and MedaCorp; owns stock in Ception Therapeutics; has received grant support from Cambridge Antibody Technology; and is on the speakers' bureau for Merck. The rest of the authors have declared that they have no conflict of interest.

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