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Eosinophilic Esophagitis in Infants and Toddlers

Dysphagia volume 22, pages 44–48 (2007)Cite this article

Abstract

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.

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References

  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, 1982

    PubMed  CAS  Google Scholar 

  2. Rothenburg ME: Eosinophilic gastrointestinal disorders (EGID). J Allergy Clin Immunol 113:11–28, 2004

    Article  Google Scholar 

  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, 2004

    PubMed  Article  CAS  Google Scholar 

  4. Bates B: ‘Explosion’ of eosinophilic esophagitis in children. Pediatr News 34:4, 2000

    Google Scholar 

  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]

  6. Noel RJ, Putnam PE, Rothenberg ME: eosinophilic esophagitis. N Engl J Med 351:940–941, 2004

    PubMed  Article  CAS  Google Scholar 

  7. Straumann A, Simon H: Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol 115:418–419, 2005

    PubMed  Article  Google Scholar 

  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, 1995

    PubMed  Article  CAS  Google Scholar 

  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, 1998

    PubMed  Article  CAS  Google Scholar 

  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, 2000

    PubMed  Article  CAS  Google Scholar 

  11. Langdon DE: Fluticasone in eosinophilic corrugated ringed esophagus. Am J Gastroenterol 96:926–927, 2001

    PubMed  Article  CAS  Google Scholar 

  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, 2004

    PubMed  Article  Google Scholar 

  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, 2002

    PubMed  Article  CAS  Google Scholar 

  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, 1998

    PubMed  Article  Google Scholar 

  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, 2003

    PubMed  Article  Google Scholar 

  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, 2003

    Article  Google Scholar 

  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, 1982

    PubMed  CAS  Google Scholar 

  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, 2003

    PubMed  Article  CAS  Google Scholar 

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Affiliations

  1. Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, 45229, USA

    Scott P. Pentiuk MD, Claire Kane Miller PhD & Ajay Kaul MD

  2. Department of Speech Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, 45229, USA

    Scott P. Pentiuk MD, Claire Kane Miller PhD & Ajay Kaul MD

  3. Department of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, 45229, USA

    Scott P. Pentiuk MD, Claire Kane Miller PhD & Ajay Kaul MD

  4. Department of Gastroenterology, Hepatology, and Nutrition, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Mail Location 2010, Cincinnati, OH, 45229, USA

    Ajay Kaul MD

Authors
  1. Scott P. Pentiuk MD
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  2. Claire Kane Miller PhD
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  3. Ajay Kaul MD
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Correspondence to Ajay Kaul MD.

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Pentiuk, S.P., Miller, C.K. & Kaul, A. Eosinophilic Esophagitis in Infants and Toddlers. Dysphagia 22, 44–48 (2007). https://doi.org/10.1007/s00455-006-9040-9

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  • DOI: https://doi.org/10.1007/s00455-006-9040-9

Keywords

  • Eosinophilic esophagitis
  • Oral aversion
  • Pediatrics
  • Deglutition
  • Deglutition disorders