The Journal of Allergy and Clinical Immunology
Volume 119, Issue 3 , Pages 731-738, March 2007

Pediatric patients with eosinophilic esophagitis: An 8-year follow-up

  • Amal H. Assa'ad, MD

      Affiliations

    • From the Division of Allergy and Immunology
    • Corresponding Author InformationReprint requests: Amal H. Assa'ad, MD, Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 2000, Cincinnati, OH 45229.
    • ,
  • Philip E. Putnam, MD

      Affiliations

    • Division of Gastroenterology, Hepatology and Nutrition
    • ,
  • Margaret H. Collins, MD

      Affiliations

    • Division of Pathology
    • ,
  • Rachel M. Akers, MPH

      Affiliations

    • Division of Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center
    • ,
  • Sean C. Jameson

      Affiliations

    • From the Division of Allergy and Immunology
    • ,
  • Cassie L. Kirby

      Affiliations

    • From the Division of Allergy and Immunology
    • ,
  • Bridget K. Buckmeier

      Affiliations

    • From the Division of Allergy and Immunology
    • ,
  • Jennifer Z. Bullock, MD

      Affiliations

    • From the Division of Allergy and Immunology
    • ,
  • Ann R. Collier, MD

      Affiliations

    • From the Division of Allergy and Immunology
    • ,
  • Michael R. Konikoff, MD

      Affiliations

    • Division of Gastroenterology, Hepatology and Nutrition
    • ,
  • Richard J. Noel, MD, PhD

      Affiliations

    • Division of Gastroenterology and Nutrition, Medical College of Wisconsin and Children's Hospital of Wisconsin
    • ,
  • Jesus R. Guajardo, MD, MHPE

      Affiliations

    • Pulmonary/Allergy, Child Health, University of Missouri
    • ,
  • Marc E. Rothenberg, MD, PhD

      Affiliations

    • From the Division of Allergy and Immunology

Received 13 June 2006; received in revised form 13 October 2006; accepted 23 October 2006. published online 31 January 2007.

Cincinnati, Ohio, Milwaukee, Wis, and Columbia, Mo

Background

Eosinophilic esophagitis (EE) is a gastrointestinal disorder that is increasingly diagnosed in pediatric patients.

Objective

We aimed to define, in pediatric patients with EE, their demographic and atopic characteristics, the histopathology of all segments of the gastrointestinal tract, and the effect of therapeutic interventions on the natural history.

Methods

We conducted a retrospective analysis of a database of pediatric patients with EE followed over a period of 8 years.

Results

In 89 pediatric patients with EE, male sex (78.6%), white race (94.4%), young age at diagnosis, mean ± SD, 6.2 ± 4.8 years, and atopy with sensitization to environmental and food allergens in 79% and 75%, respectively, were prevalent. Patients had EE of the proximal and distal esophagus, and 77% had in addition either mucosal eosinophilia or noneosinophilic histopathology in the stomach, duodenum, and colon. EE was chronic, with a duration of mean ± SD, 0.91 ± 0.84 years, until first resolution, and was recurrent; of 66% of the patients who had resolution, 79% later relapsed.

Conclusion

Eosinophilic esophagitis in the pediatric population is a chronic and relapsing condition, associated with atopy and sometimes with subsequent histopathology in segments of the gastrointestinal tract other than the esophagus.

Clinical implications

Physicians evaluating pediatric patients with chronic gastrointestinal symptoms should consider the diagnosis of EE, particularly in young white male patients with atopy. Once diagnosed and treated, the physicians should follow the patients over a period of several years because the course of the disease is protracted, other gastrointestinal segments may be affected, and relapses are common.

Key words: Eosinophilic esophagitis, food allergy, atopy patch test, eosinophil, pediatric, eosinophilic gastroenteritis, environmental allergy, atopy, skin test

Abbreviations used: EE, Eosinophilic esophagitis, Hpf, High-power field, SPT, Skin prick test

 

 Supported by a 2005 American Academy of Allergy, Asthma & Immunology/Sanofi Aventis Women Physicians in Allergy Project Grant Award (A.H.A.) and a 2004 American Academy of Allergy, Asthma & Immunology Clinical Fellowship Award (J.Z.B.).Disclosure of potential conflict of interest: A. H. Assa'ad has consulting arrangements with and has received grant support from GlaxoSmithKline. M. H. Collins has consulting arrangements with GlaxoSmithKline and Ception Therapeutics. R. J. Noel has consulting arrangements with Ception Therapeutics. M. E. Rothenberg has consulting arrangements with GlaxoSmithKline, Ception Therapeutics, Cambridge Antibody Technology, Tanox, and MedaCorp; owns stock in Ception Therapeutics; has received grant support from Cambridge Antibody Technology; and is on the speakers' bureau for Merck. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(06)03792-4

doi:10.1016/j.jaci.2006.10.044

The Journal of Allergy and Clinical Immunology
Volume 119, Issue 3 , Pages 731-738, March 2007

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