, Volume 22, Issue 1, pp 44–48 | Cite as

Eosinophilic Esophagitis in Infants and Toddlers

  • Scott P. Pentiuk
  • Claire Kane Miller
  • Ajay Kaul


Feeding refusal is often described in conjunction with the diagnosis of eosinophilic esophagitis (EE) in pediatric patients; however, there are little data regarding the specific clinical manifestations and effective management of this condition in very young children. The aim of this study was to evaluate the presentation of EE in infants and toddlers referred to the Interdisciplinary Feeding Team Clinic of a tertiary referral center and to document responses to treatment. Database matching was performed (from January 2000 to June 2003) to identify infants and toddlers diagnosed with EE who had been referred to the Interdisciplinary Feeding Team Clinic. Endoscopic features required for a diagnosis of EE included esophageal mucosal furrowing, erythema, exudates, or decreased vascular markings. Histologic features of EE were more than 24 eosinophils per high-power field (HPF), thickening of basal cell layer, and papillary (rete peg) lengthening or elongation. All study patients were treated with a combination of proton pump inhibitors (PPI) and fluticasone (swallowed). In addition, elemental diet was instituted in those documented to have a food allergy. Treatment success was defined by an improved oral intake, adequate weight gain, and improved endoscopic and histologic findings at 3–6-month followup. A total of 15 subjects [mean age = 19.9 months (SD = 9.7 months)] who fulfilled the entry criteria during the study period were identified. All 15 children had documented endoscopic improvement and 14/15 children had histologic resolution of EE after therapy. In 13 of the 15 children, this translated to clinical improvement as well.


Eosinophilic esophagitis Oral aversion Pediatrics Deglutition Deglutition disorders 


  1. 1.
    Winter HS, Madara JL, Stafford RJ, Grand RJ, Quinlin JE, Goldman H: intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis. Gastroenterology 83:818–823, 1982PubMedGoogle Scholar
  2. 2.
    Rothenburg ME: Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 113:11–28, 2004CrossRefGoogle Scholar
  3. 3.
    Noel RJ, Putnam PE, Collins MH, Assa’ad AH, Guajardo JR, Jameson SC, Rothenberg ME: Clinical and immunopathologic effects of swallowed Fluticasone for eosinophilic esophagitis. Clin Gastroenterol Hepatol 2:568–575, 2004PubMedCrossRefGoogle Scholar
  4. 4.
    Bates B: ‘Explosion’ of eosinophilic esophagitis in children. Pediatr News 34:4, 2000Google Scholar
  5. 5.
    Liacouras CA, Spergel J, Ruchelli E, Mamula, P, Markowitz, J: Eosinophilic esophagitis: An 8 year experience. Presented at World Congress of Pediatric Gastroenterology and Nutrition, Paris, 2004 [abstract]Google Scholar
  6. 6.
    Noel RJ, Putnam PE, Rothenberg ME: eosinophilic esophagitis. N Engl J Med 351:940–941, 2004PubMedCrossRefGoogle Scholar
  7. 7.
    Straumann A, Simon H: Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol 115:418–419, 2005PubMedCrossRefGoogle Scholar
  8. 8.
    Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA: Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino-based formula. Gastroenterology 109:1503–1512, 1995PubMedCrossRefGoogle Scholar
  9. 9.
    Liacouras CA, Wenner WJ, Brown K, Ruchelli E: Primary esophagitis in children: Successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr 26:380–385, 1998PubMedCrossRefGoogle Scholar
  10. 10.
    Orenstein SR, Shalaby TM, Di Lorenzo C, Putnam PE: The spectrum of pediatric eosinophilic esophagitis beyond infancy: A clinical series of 30 children. Am J Gastroenterol 95:1422–1430, 2000PubMedCrossRefGoogle Scholar
  11. 11.
    Langdon DE: Fluticasone in eosinophilic corrugated ringed esophagus. Am J Gastroenterol 96:926–927, 2001PubMedCrossRefGoogle Scholar
  12. 12.
    Sundaram S, Sunku B, Nelson S, Sentongo T, Melin-Aldana H, Kumar R, Li BU: Adherent white plaques: An endoscopic finding in eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 38:208–212, 2004PubMedCrossRefGoogle Scholar
  13. 13.
    Teitelbaum JE, Fox VL, Twarog FJ, Nurko S, Antonioli D, Gleich G, Bdizadegan K, Furuta GT: Eosinophilic esophagitis in children: Immunopathological analysis and response to fluticasone propionate. Gastroenterology 122:1216–1225, 2002PubMedCrossRefGoogle Scholar
  14. 14.
    Faubion WA, Perrault J, Burgart LJ, Zein NN, Clawson M, Freese DK: Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr 27(1):90–93, 1998PubMedCrossRefGoogle Scholar
  15. 15.
    Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU: Natural history of primary eosinophilic esophagitis: A follow-up of 30 adult patients for up to 11.5 years. Gastroenterology 125:1660–1669, 2003PubMedCrossRefGoogle Scholar
  16. 16.
    Kahn S, Orenstein SR, DiLorenzo C, Kocoshis SA, Putnam PE, Sigurdsson L, Shalaby TM: Eosinophilic esophagitis: strictures, impactions, dysphagia. Dig Dis Sci 48:22–29, 2003CrossRefGoogle Scholar
  17. 17.
    Fomon SJ, Haschke F, Ziegler EE, Nelson SE: Body composition of reference children from birth to age 10 years. Am J Clin Nutr 35:1169–1175, 1982PubMedGoogle Scholar
  18. 18.
    Mishra A, Rothenberg ME: Intratracheal IL-13 induces eosinophilic esophagitis by an IL-5, Eotaxin-1, and STAT6-dependent mechanism. Gastroenterology 125:1419–1427, 2003PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • Scott P. Pentiuk
    • 1
    • 2
    • 3
  • Claire Kane Miller
    • 1
    • 2
    • 3
  • Ajay Kaul
    • 1
    • 2
    • 3
    • 4
  1. 1.Department of PediatricsCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  2. 2.Department of Speech PathologyCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  3. 3.Department of Gastroenterology, Hepatology, and NutritionCincinnati Children’s Hospital Medical CenterCincinnatiUSA
  4. 4.Department of Gastroenterology, Hepatology, and NutritionCincinnati Children’s Hospital Medical CenterCincinnatiUSA

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