Digestive Diseases and Sciences

, Volume 55, Issue 4, pp 973–982 | Cite as

Eosinophilic Esophagitis: Perspectives of Adult and Pediatric Gastroenterologists

Original Article

Abstract

To survey pediatric (PGI) and adult gastroenterologists (AGI) regarding their perceptions about the etiology, diagnosis, and management of eosinophilic esophagitis (EoE), and to assess whether differences in the clinical approach to EoE exist between these subspecialists. A 21-item survey related to EoE was emailed to PGI who subscribe to the PEDSGI Bulletin Board, and to two AGI per Electoral College vote in the US, randomly selected from each state. The survey was voluntary, and consent was assumed based on survey submission. The responses were submitted anonymously and results compiled in a secure Web site. A total of 249 physicians from across the globe responded to the survey, 68% of whom were PGI. The majority of respondents worked primarily in an academic institution or teaching hospital. Respondents revealed diagnosing an average of six cases (median 8, range 0–30) of EoE in the past 6 months. Ninety-two percent of AGI who see a patient with dysphagia and suspected EoE proceed to endoscopy with biopsies, compared to only 54% of PGI (P < 0.05); 38% of PGI would first perform an upper GI study. Both subspecialties agreed that biopsies of the proximal and distal esophagus are needed to make a definitive diagnosis of EoE. Fifty-eight percent PGI and 44% AGI defined EoE as an eosinophilic density of ≥20 per high power field (hpf) in esophageal biopsies. Seventy-seven percent of PGI but only 16% of AGI reported routine referral of patients for food allergy evaluation (P < 0.05). While 77% PGI and 91% of AGI would rely on a symptom-based follow-up, 27% PGI versus 9% AGI follow patients with biopsies according to a pre-determined schedule and another 38% repeat biopsies as needed, versus 15% AGI. This survey exposes a few inconsistencies among gastroenterologists in the diagnosis, management, and follow-up of patients with EoE. The currently available practice guidelines for the diagnosis and management of EoE are largely based on retrospective studies and expert opinion. The results of this survey suggest that a collaborative effort based on robust research is required upon us to develop evidence for how we care for these patients.

Keywords

Esophagitis Eosinophilic Pediatrics 

References

  1. 1.
    Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978;74(6):1298–1301.PubMedGoogle Scholar
  2. 2.
    Picus D, Frank PH. Eosinophilic esophagitis. AJR Am J Roentgenol. 1981;136(5):1001–1003.PubMedGoogle Scholar
  3. 3.
    Orenstein SR, et al. The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol. 2000;95(6):1422–1430. doi: 10.1111/j.1572-0241.2000.02073.x.CrossRefPubMedGoogle Scholar
  4. 4.
    Collins MH. Histopathologic features of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18(1):59–71. doi: 10.1016/j.giec.2007.09.014. viii-ix.CrossRefPubMedGoogle Scholar
  5. 5.
    Mishra A, et al. An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest. 2001;107(1):83–90. doi: 10.1172/JCI10224.CrossRefPubMedGoogle Scholar
  6. 6.
    Mishra A, et al. IL-5 promotes eosinophil trafficking to the esophagus. J Immunol. 2002;168(5):2464–2469.PubMedGoogle Scholar
  7. 7.
    Blanchard C, Rothenberg ME. Basic pathogenesis of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18(1):133–143. doi: 10.1016/j.giec.2007.09.016. x.CrossRefPubMedGoogle Scholar
  8. 8.
    Kelly KJ, et al. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995;109(5):1503–1512. doi: 10.1016/0016-5085(95)90637-1.CrossRefPubMedGoogle Scholar
  9. 9.
    Liacouras CA, et al. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol. 2005;3(12):1198–1206. doi: 10.1016/S1542-3565(05)00885-2.CrossRefPubMedGoogle Scholar
  10. 10.
    Schaefer ET, et al. Comparison of oral prednisone and topical fluticasone in the treatment of eosinophilic esophagitis: a randomized trial in children. Clin Gastroenterol Hepatol. 2008;6(2):165–173. doi: 10.1016/j.cgh.2007.11.008.CrossRefPubMedGoogle Scholar
  11. 11.
    Khan S, et al. Eosinophilic esophagitis: strictures, impactions, dysphagia. Dig Dis Sci. 2003;48(1):22–29. doi: 10.1023/A:1021769928180.CrossRefPubMedGoogle Scholar
  12. 12.
    Straumann A. The natural history and complications of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18(1):99–118. doi: 10.1016/j.giec.2007.09.009. ix.CrossRefPubMedGoogle Scholar
  13. 13.
    Putnam PE. Eosinophilic esophagitis in children: clinical manifestations. Gastrointest Endosc Clin N Am. 2008;18(1):11–23. doi: 10.1016/j.giec.2007.09.007. vii.CrossRefPubMedGoogle Scholar
  14. 14.
    Chang F, Anderson S. Clinical and pathological features of eosinophilic oesophagitis: a review. Pathology. 2008;40(1):3–8. doi: 10.1080/00313020701716482.CrossRefPubMedGoogle Scholar
  15. 15.
    Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic esophagitis. N Engl J Med. 2004;351(9):940–941. doi: 10.1056/NEJM200408263510924.CrossRefPubMedGoogle Scholar
  16. 16.
    Cherian S, Smith NM, Forbes DA. Rapidly increasing prevalence of eosinophilic oesophagitis in Western Australia. Arch Dis Child. 2006;91(12):1000–1004. doi: 10.1136/adc.2006.100974.CrossRefPubMedGoogle Scholar
  17. 17.
    Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol. 2005;115(2):418–419. doi: 10.1016/j.jaci.2004.11.006.CrossRefPubMedGoogle Scholar
  18. 18.
    Markowitz JE, et al. Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol. 2003;98(4):777–782. doi: 10.1111/j.1572-0241.2003.07390.x.CrossRefPubMedGoogle Scholar
  19. 19.
    Roy-Ghanta S, Larosa DF, Katzka DA. Atopic characteristics of adult patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2008;6(5):531–535.CrossRefPubMedGoogle Scholar
  20. 20.
    Gonsalves N, et al. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc. 2006;64(3):313–319. doi: 10.1016/j.gie.2006.04.037.CrossRefPubMedGoogle Scholar
  21. 21.
    Potter JW, et al. Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc. 2004;3(3):355–361. doi: 10.1016/S0016-5107(03)02713-5.CrossRefGoogle Scholar
  22. 22.
    Furuta GT, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133(4):1342–1363. doi: 10.1053/j.gastro.2007.08.017.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  1. 1.Division of Pediatric GastroenterologyKapiolani Medical Center for Women and ChildrenHonoluluUSA
  2. 2.Division of Pediatric Gastroenterology & NutritionAlfred I du Pont Hospital for ChildrenWilmingtonUSA
  3. 3.Thomas Jefferson University & Jefferson Medical CollegePhiladelphiaUSA

Personalised recommendations