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The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children.
Am J Gastroenterol 2000; 95(6):1422-30AJ

Abstract

OBJECTIVES

Eosinophilic esophagitis, previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms; its relation to allergy, respiratory disease, and reflux; its endoscopic and histological findings; and its diagnosis and therapy.

METHODS

We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as > or =5 eosinophils per high power field in the distal esophageal epithelium. Retrospective chart review was supplemented by prospective, blinded, duplicate quantitative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the series as a whole is preceded by a case illustrating a typical presentation with dysphagia and recurrent esophageal food impactions.

RESULTS

Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic esophagitis. Histological characteristics include peripapillary or juxtaluminal eosinophil clustering in certain cases. Association with eosinophilic gastroenteritis occurs, but is not common. Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials. Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy.

CONCLUSION

Awareness of the spectrum of eosinophilic esophagitis should promote optimal diagnosis and treatment of this elusive entity, both in children and in adults.

Authors+Show Affiliations

Division of Pediatric Gastroenterology, University of Pittsburgh School of Medicine, and Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

10894574

Citation

Orenstein, S R., et al. "The Spectrum of Pediatric Eosinophilic Esophagitis Beyond Infancy: a Clinical Series of 30 Children." The American Journal of Gastroenterology, vol. 95, no. 6, 2000, pp. 1422-30.
Orenstein SR, Shalaby TM, Di Lorenzo C, et al. The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol. 2000;95(6):1422-30.
Orenstein, S. R., Shalaby, T. M., Di Lorenzo, C., Putnam, P. E., Sigurdsson, L., Mousa, H., & Kocoshis, S. A. (2000). The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. The American Journal of Gastroenterology, 95(6), pp. 1422-30.
Orenstein SR, et al. The Spectrum of Pediatric Eosinophilic Esophagitis Beyond Infancy: a Clinical Series of 30 Children. Am J Gastroenterol. 2000;95(6):1422-30. PubMed PMID: 10894574.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. AU - Orenstein,S R, AU - Shalaby,T M, AU - Di Lorenzo,C, AU - Putnam,P E, AU - Sigurdsson,L, AU - Mousa,H, AU - Kocoshis,S A, PY - 2000/7/14/pubmed PY - 2000/8/1/medline PY - 2000/7/14/entrez SP - 1422 EP - 30 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 95 IS - 6 N2 - OBJECTIVES: Eosinophilic esophagitis, previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms; its relation to allergy, respiratory disease, and reflux; its endoscopic and histological findings; and its diagnosis and therapy. METHODS: We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as > or =5 eosinophils per high power field in the distal esophageal epithelium. Retrospective chart review was supplemented by prospective, blinded, duplicate quantitative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the series as a whole is preceded by a case illustrating a typical presentation with dysphagia and recurrent esophageal food impactions. RESULTS: Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic esophagitis. Histological characteristics include peripapillary or juxtaluminal eosinophil clustering in certain cases. Association with eosinophilic gastroenteritis occurs, but is not common. Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials. Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy. CONCLUSION: Awareness of the spectrum of eosinophilic esophagitis should promote optimal diagnosis and treatment of this elusive entity, both in children and in adults. SN - 0002-9270 UR - https://www.unboundmedicine.com/medline/citation/10894574/The_spectrum_of_pediatric_eosinophilic_esophagitis_beyond_infancy:_a_clinical_series_of_30_children_ L2 - http://Insights.ovid.com/pubmed?pmid=10894574 DB - PRIME DP - Unbound Medicine ER -