The spectrum of pediatric eosinophilic esophagitis beyond infancy: A clinical series of 30 children

OBJECTIVES: Eosinophilic esophagitis, previously confused with esophageal i nflammation due to gastroesophageal reflux, has recently begun to be distin guished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms, its r elation to allergy, respiratory disease, and reflux; its endoscopic and his tological findings; and its diagnosis and therapy. METHODS: We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as greater than or equal to 5 eosino phils per high power field in the distal esophageal epithelium. Retrospecti ve chart review was supplemented by prospective, blinded, duplicate quantit ative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the se ries as a whole is preceded by a case illustrating a typical presentation w ith dysphagia and recurrent esophageal food impactions. RESULTS: Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an a ssociated finding in most patients, and many have concomitant asthma or oth er chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic e sophagitis. Histological characteristics include peripapillary or juxtalumi nal eosinophil clustering in certain cases. Association with eosinophilic g astroenteritis occurs, but is not common. Differentiation from gastroesopha geal reflux disease is approached by analyzing eosinophil density and respo nse to therapeutic trials. Therapy encompasses dietary elimination and anti -inflammatory pharmacotherapy. CONCLUSION: Awareness of the spectrum of eosinophilic esophagitis should pr omote optimal diagnosis and treatment of this elusive entity, both in child ren and in adults. (Am J Gastroenterol 2000;95:1422-1430. (C) 2000 by Am. C oll. of Gastroenterology).