Spergel JM, Brown-Whitehorn TF, Beausoleil JL, et al. J Pediatr Gastroenterol Nutr. 2009;48(1):30–36
PURPOSE OF THE STUDY. To define the presenting symptoms of eosinophilic esophagitis (EE) and describe the clinical course of treated and untreated patients with EE.
STUDY POPULATION. Patients referred to the Children's Hospital of Philadelphia over a 14-year period who were diagnosed with EE.
METHODS. Retrospective and prospective chart review of patients diagnosed with EE and followed for ≥1 year.
RESULTS. A total of 330 children were identified, of whom 68% were <6 years of age at the time of diagnosis; the majority were male. Children who presented at a younger age had symptoms of failure to thrive, feeding difficulties, gastroesophageal reflux disease, and vomiting, whereas older children presented with abdominal pain, dysphagia, and food impaction. When foods exacerbated EE (up to 17% for milk), 7 foods (milk, egg, wheat, soy, corn, beef, and chicken) accounted for two thirds of the cases. During the follow-up period, <5% had complete resolution of their EE, but those who did achieve resolution had fewer foods (2.4 foods) identified at initial testing. Untreated patients who returned years after their initial diagnosis had continued progression of disease.
CONCLUSIONS. Avoidance of causative foods and medical treatment can significantly improve EE symptoms; however, the chances of long-term resolution of EE are disappointing, with <5% of patients achieving complete resolution.
REVIEWER COMMENTS. As the experience builds at tertiary referral centers, more is understood regarding EE. One should think EE when presented with the triad of male gender, atopy, and gastrointestinal symptoms. One impressive aspect of this cohort was that >2500 biopsies were performed for 330 patients. Allergy skin-prick testing and patch testing with subsequent food avoidance are important, but continued surveillance of local tissue changes and not relying strictly on reported clinical symptoms is equally important.
- Copyright © 2009 by the American Academy of Pediatrics