Pediatric eosinophilic esophagitis: Single-center experience in northwestern USA

Department of Pediatrics, Oregon Health and Science University, Portland, Oregon, USA.
Pediatrics International (Impact Factor: 0.73). 10/2009; 51(5):612-6. DOI: 10.1111/j.1442-200X.2008.02796.x
Source: PubMed

ABSTRACT Eosinophilic esophagitis (EE) is an emerging disease. Its incidence and prevalence have been exponentially increasing in the last decade. The clinical manifestations of EE vary especially in children. Allergic reaction is strongly implicated in the disease. The aim of the present study was to retrospectively examine the demographic, clinical, laboratory, and endoscopic features of pediatric patients with EE, in order to better understand the diversity of the disease, thereby improving clinical diagnosis and treatment.
The data were retrospectively collected from 20 pediatric patients with biopsy-proven EE. Demographic information, clinical symptoms and duration, as well as endoscopic findings were correlated and statistically analyzed.
Median age at diagnosis was 11 years. Male patients had higher prevalence of EE. Thirty-five percent of the children had food allergy on either skin prick test or IgE radioallergosorbent test, and atopic diseases were common in the group. Gastroesophageal reflux appeared to be the major symptom in younger children, whereas dysphagia and food impaction were more common in older patients. The referral and final diagnosis were often delayed. Esophageal white exudates were the most prominent feature in the younger age group, whereas esophageal ring-like lesion occurred more often in older children.
EE is more common in male subjects. The clinical and endoscopic features depend upon the age. Allergic processes are strongly involved in pathogenesis. The present results will improve understanding of the characteristics of the disease in the pediatric population and enhance clinicians' vigilance for the diagnosis of EE.

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    • "The age of initial diagnosis varies widely (0–18 years, mean 6.2 years), with higher rates in Caucasians (84%) and males (75%). (Assa'ad et al., 2007; Eroglu et al., 2009; Franciosi, Tam, Liacouras, & Spergel, 2009; Spergel et al., 2009). Accurate EGID diagnosis can be challenging, often requiring patients to undergo several invasive procedures including food allergy testing, colonoscopy , or upper endoscopy. "
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    Journal of Pediatric Psychology 01/2012; 37(5):523-32. DOI:10.1093/jpepsy/jsr118 · 2.91 Impact Factor
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    ABSTRACT: Recent consensus guidelines for diagnosis of eosinophilic esophagitis (EoE) have been published. Whether these guidelines have standardized diagnostic criteria for EoE is unknown. We aimed to determine if the EoE guidelines had an impact on the diagnostic criteria reported in the EoE literature, and whether the previously observed variability in diagnostic criteria has become more uniform. Two investigators independently conducted a MEDLINE search from 1 January 2007 through 30 June 2010 for all publications reporting EoE in human subjects, and also searched the proceedings of the 2007-2010 American College of Gastroenterology and American Gastroenterological Association meetings, using a predefined search strategy. Data were extracted from all relevant publications. Of the 799 publications identified, 149 original reports, 99 reviews, and 165 abstracts were included. In all, 32 original reports (21%) used diagnostic criteria consistent with each of the three components of the consensus guidelines. There was a significant increase when comparing original articles published after the release of the guidelines with those published earlier (31 vs. 6%, P<0.001). The proportion of original articles using 15 eosinophils per high-power field (eos/hpf) as a histological cut-point increased significantly (P=0.001). There was still substantial variability in biopsy protocols and eosinophil count methodology. The majority of original articles did not report microscope high-power field (HPF) area. The proportion of original reports with diagnostic criteria consistent with the consensus guidelines has increased significantly. However, the majority of articles still did not conform to all three of the criteria in the guidelines, and biopsy and eosinophil count protocols continue to demonstrate significant variability. Standardization of biopsy and eosinophil count protocols is needed.
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