Abstract
Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive esophageal symptoms (11 male), median age 5 years, and identified to have eosinophilic esophagitis with >5 eosinophils per high-power field (eos/hpf) are reported. Of these, four had strictures, six had impactions, and two had only dysphagia. A diagnostic evaluation included esophagogastroduodenoscopy with biopsies in all and upper gastrointestinal series, IgE, radioallergosorbent tests, and skin tests for food allergies in some cases. Esophageal histology specimens were independently analyzed for eosinophil density by two authors. Four of five children with >20 eos/hpf responded to elimination diets/steroids. The fifth child responded to a fundoplication. Seven children had 5–20 eos/hpf and three of them with no known food allergies responded to antireflux therapy alone. Three others in this group with positive food allergies responded to treatment with elimination diets and/or steroids. The seventh patient in this group was lost to follow-up. In conclusion, on the basis of response to therapy, eosinophilic esophagitis can be subdivided into two groups: those with likely gastroesophageal reflux disease if <20 eos/hpf and no food allergies, and others with allergic eosinophilic esophagitis associated with food allergies and often with >20 eos/hpf.
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REFERENCES
Winter HS, Madara JL, Stafford RJ, Grand RJ, Quinlan J-E, Goldman H: Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis. Gastroenterology 83:818-823, 1983
Orenstein SR, Shalaby TM, Di Lorenzo C, Putnam PE, Sigurdsson L, Kocoshis SA, Ricci A Jr, Sylvester FA, Hyams JS, Kreutzer DL: The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterology 95:1422-1430, 2000
Ruchelli E, Wenner W, Voytek T, Brown K, Liacouras C: Severity of esophageal eosinophilia predicts response to conventional gastroesophageal reflux therapy. Pediatr Dev Pathol 2:15-18, 1999
Justinich C, Kalafus D, Esposito P, et al: Mucosal mast cells distinguish allergic from gastroesophgeal reflux-induced esophagitis. J Pediatr Gastroenterol Nutr 23:342, 1996 (abstract)
Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA: Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 109:1503-1512, 1995
Walsh SV, Antonioli DA, Goldman H, Fox VL, Bousvaros A, Leichtner AM, Furuta GT: Allergic esophagitis in children. A clinicopathologic entity. Am J Surg Pathol 23:390-396, 1999
Dobbins JW, Sheahan DG, Behar J: Eosinophilic gastroenteritis with esophageal involvement. Gastroenterology 72:1312-1316, 1977
Matzinger MA, Daneman A: Esophageal involvement in eosinophilic gastroenteritis. Pediatr Radiol 13:35-38, 1983
FaubionWA Jr, Perrault J, Burgart LJ, Zein NN, Clawson M, Freese DK: Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenerol Nutr 27:90-93, 1998
Black DD, Haggitt RC, Orenstein SR, Whitington PF: Esophagitis in infants: Morphometeric histologic diagnosis and correlation with measures of gastroesophageal reflux. Gastroenterology 98:1408-1414, 1990
Lowichik A, Weinberg AG: A quantitative evaluation of mucosal eosinophils in the pediatric gastrointestinal tract. Mod Pathol 9:110-114, 1996
Mishra A, Hogan SP, Brandt EB, Rothenberg ME: An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 107:83-90, 2001
Mishra A, Hogan SP, Brandt EB, Rothenberg ME: IL-5 promotes eosinophil trafficking to the esophagus. J Immunol 168:2464-2469, 2002
Justinich CJ, Ricci A Jr, Kalafus DA, Treem WR, Hyams JS, Kreutzer DL: Activated eosinophils in esophagitis in children: a transmission electron microscopic study. J Pediatr Gastroenterol Nutr 25:194-198, 1997
Aliakbari J, Sreedharen SP, Turck CW, Goetzel EJ: Selective localization of vasoactive intestinal peptide and substance P in human eosinophils. Biochem Biophys Res Commun 148:1440-1445, 1987
Attwood SEA, Smyrk TC, Demeester TR, Jones JB: Esophageal eosinophilia with dysphagia.Adistinct clinicopathologic syndrome. Dig Dis Sci 38:109-116, 1993
Vitellas KM, Bennett WF, Bova JG, Johnston JC, Caldwell JH, Mayle JE: Idiopathic eosinophilic esophagitis. Radiology 186:789-793, 1993
Gupta SK, Fitzgerald JF, Chong SKF, Croffie JM, Collins MH: Vertical lines in distal esophageal mucosa (VLEM): a true endoscopic manifestation of esophagitis in children? Gastrointest Endosc 45:485-489, 1997
Blei E, Gonzalez-Crussi F, Lloyd-Still JD: Eosinophilic infiltration of the esophageal muscle layer: a difficult diagnostic problem. J Pediatr Gastroenterol Nutr 15:93-96, 1992
Landres RT, Kuster GG, Strum WB: Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology 74:1298-1301, 1978
Hempel SL, Elliott DE: Chest pain in an aspirin-sensitive asthmatic patient. Eosinophilic esophagitis causing esophageal dysmotility. Chest 110:1117-1120, 1996
Feczko PJ, Halpert RD, Zonca M: Radiographic abnormalities in eosinophilic esophagitis. Gastrointest Radiol 10:321-324, 1985
Picus D, Frank P: Eosinophilic esophagitis. AJR Am J Roentgenol. 136:1001-1003, 1981
Liacouras CA, Wenner WJ, Brown K, Rucelli E: Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr 26:380-385, 1998
Mahajan L, Wyllie R, Petras R, Steffen R, Kay M: Idiopathic eosinophilic esophagitis with stricture formation in a patient with long-standing eosinophilic gastroenteritis. Gastrointestinal Endoscopy 46:557-560, 1997
Teitelbaum JE, Fox VL, Twarog FJ, Nurko S, Antonioli D, Gleich G, Badizadegan K, Furuta GT: Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology 122:1216-1225, 2002
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Khan, S., Orenstein, S.R., Di Lorenzo, C. et al. Eosinophilic Esophagitis: Strictures, Impactions, Dysphagia. Dig Dis Sci 48, 22–29 (2003). https://doi.org/10.1023/A:1021769928180
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DOI: https://doi.org/10.1023/A:1021769928180