Allergic esophagitis in children - A clinicopathological entity

Infiltration of esophageal epithelium by eosinophils is seen in reflux esop hagitis and allergic gastroenteritis. This study was performed to identify differences between patients with acid reflux esophagitis and those with no n-acid reflux, possibly allergic, esophagitis. Intraepithelial eosinophils were demonstrated in posttherapy esophageal biopsy specimens in 28 children treated for gastroesophageal reflux disease (GERD). These patients were di vided into three groups based on their response to treatment and the result s of esophageal pH probe monitoring. Eleven patients (Group A) had incomple te clinical response and normal pH probe monitoring results. Ten patients ( Group B) had incomplete response but did not have pH probe monitoring. Thes e two groups formed the index population. Seven patients (Group C) had clin ical improvement with GERD therapy and abnormal pH probe monitoring charact eristic of GERD; they constituted the control population. Clinical, laborat ory, and pathologic features were evaluated to detect differences between i ndex and control populations. Dysphagia, food impaction, failure to thrive, peripheral eosinophilia, and abnormal allergen skin test results were dete cted only in Group A and B patients. Biopsy specimens of the distal 9 cm of the esophagus, after GERD therapy, contained larger numbers of eosinophils in Groups A and B than in Group C as shown on high-power fields (HPF) (A: 31/HPF +/- 19.5; B: 28/HPF +/- 23.7; versus C: 5/HPF +/- 6.7; p = 0.009). E osinophil aggregates were identified only in Groups A and B (p = 0.07). Eos inophils located preferentially in the superficial layers of the squamous e pithelium were noted only in Groups A and B (p = 0.02). Group A and B patie nts demonstrated clinical improvement when given antiallergic therapy. The authors identified a group of pediatric patients characterized by an allerg ic history, lack of adequate response to GERD therapy, normal esophageal pH probe monitoring results, and large numbers of eosinophils in esophageal b iopsy specimens obtained after GERD treatment. On the basis of these featur es, the authors propose that these patients represent examples of allergic esophagitis.