PURPOSE OF THE STUDY.
Some patients with eosinophilic esophagitis (EoE) demonstrate an increased number of eosinophils in gastric mucosa. These researchers sought to assess clinical and therapeutic differences in children with EoE and either no gastric eosinophils (EE-N) or an increased number of gastric eosinophils (EE-A).
Children aged 1 to 18 years who had had an esophagogastroduodenoscopy (EGD) over an 8-year period (1999–2007) were assessed. The study was conducted at a children's hospital in Indianapolis, Indiana.
A retrospective chart review was performed to identify children with EE-A, defined as EoE with ≥10 eosinophils per high-powered field in a gastric biopsy. Clinical characteristics and response to swallowed fluticasone between children with EE-A and children with EE-N were compared by using 2-sample t and χ2 tests.
A total of 356 children with EoE were identified: 41(12%) met criteria for EE-A. When compared to a randomly selected group of 50 children with EE-N, there was no difference regarding gender, age, presenting symptoms, atopy history, or esophageal histology. Both groups had similar responses to swallowed fluticasone (significant reductions in the number of esophageal eosinophils). In 11 children with EE-A treated with swallowed fluticasone, 9 (82%) had a reduction in the number of gastric eosinophils (to <5 eosinophils per high-powered field). No differences were observed between responders and nonresponders.
Twelve percent of the children with EoE had an increased number of gastric eosinophils; however, the presence of increased numbers of gastric eosinophils does not portend a worse clinical presentation or result in a reduced response to swallowed fluticasone.
Just when we thought we were starting to understand EoE, gastroenterologists are now identifying children with clinical symptoms and an increased number of eosinophils in areas distal to the gastroesophageal junction. Although the authors admitted that they did not have a study group of patients with only eosinophilic gastritis, the lack of differences between EE-N and EE-A was reassuring. This study's results offer another twist in the continuing story of eosinophilic gastrointestinal disorders.
- Copyright © 2011 by the American Academy of Pediatrics