Eosinophilic esophagitis in children under the age of 5 years: Clinical characteristics. (2nd September 2017)

• Record Type: Journal Article
• Authors: Sun, Ravi W.; Bonilla‐Velez, Juliana; Pesek, Robert D.; Johnson, Adam B.; Cleves, Mario A.; Richter, Gresham T.
• Is Part Of: Laryngoscope. Volume 128:Number 4(2018)
• Page Start: 798
• Page End: 805
• Publication Date: 2017-09-02
• Subjects: Eosinophilic esophagitis -- children -- dysphagia -- atopy -- pediatric -- reflux; Otolaryngology -- Periodicals; 617.51005
• DOI: 10.1002/lary.26838
• Languages: English
• ISSNs: 0023-852X

Abstract

Abstract : Objectives/Hypothesis: To delineate clinical characteristics and treatment outcomes of eosinophilic esophagitis (EoE) in the youngest of children. Study Design: Retrospective chart review. Methods: A 7‐year retrospective chart review of children with clinicopathologic diagnosis of EoE was performed with specific analysis of patients under 5 years old. EoE was defined as the presence of symptoms of esophageal dysfunction with pathologically proven eosinophilic inflammation (≥15 eosinophils per high‐power field [EOS/HPF]) unresponsive to reflux therapy. Patient parameters and clinical results were systematically reviewed. Results: Of 558 children diagnosed with EoE, 127 (22.8%) were younger than 5 years old (mean age 2.5 years). This subgroup presented with reflux symptoms (90.1%), vomiting (86.2%), diarrhea (55.3%), liquid dysphagia (52.0%), and constipation (50.0%), whereas food impaction (1.6%) was rare. Liquid dysphagia was present at all ages but significantly more common in younger children ( P = .0101). The most common food and environmental allergens were egg whites (39.7%), cow's milk (36.5%), peanuts (34.9%), animal dander (15.1%), and weed pollen (11.1%). Patients were managed with antireflux medication (100%), elimination diet (83.5%), and steroid medication (68.5%). After treatment, 86% of parents reported symptom improvement. Mean reduction of EOS in pos‐treatment biopsy was 33.5 EOS/HPF ( P < .0001), and 67 patients showed histologic resolution of EoE (56.8%, P < .0001). Conclusions: Approximately one‐quarter of children with EoE present under 5 years of age with multiple esophageal symptoms, comorbidities, and allergen‐sensitization profiles. These patients demonstrate substantial clinicohistologic improvement following therapy. Level of Evidence: 4. Laryngoscope, 128:798–805, 2018