Factors predicting long-term outcomes in pediatric-onset eosinophilic esophagitis (EoE)

Pediatric eosinophilic esophagitis (EoE) is a newly recognized antigen-induced form of chronic esophagitis (CE).

This study from Cincinnati Children's Hospital, one of the leading centers for EoE research, included histologic review of 4,000 pediatric esophageal biopsy specimens.

At an average of 15 years after initial endoscopy, quality of life was decreased among patients with retrospectively identified histologic eosinophilic esophagitis (rEoE) and chronic esophagitis (CE).


"Multi-ring esophagus" in eosinophilic esophagitis (left), infiltration of eosinophils (right). Source: Wikipedia.

Rates of dysphagia were 49% in patients with rEoE and 37% in CE.

Food impaction was reported in 40% of patients with rEoE and 14% in CE.

Increased esophageal eosinophil counts (odds ratio [OR], 1.6) during childhood were predictive of dysphagia during early adulthood.

Food allergy (OR, 2.7), allergic rhinitis (OR, 3.5), and asthma (OR, 2.1) were associated with dysphagia. Food impaction was more common among patients with reported food allergy (OR, 3.1).

Eosinophilic esophagitis (EoE) is associated with reduced quality of life and persistent symptoms 15 years after presentation. Increased esophageal eosinophil counts and the occurrence of food allergy and atopy in childhood increase the rate of dysphagia in young adulthood.

The risk factors discussed in the study are part of the allergic (atopic) march shown below:



Allergic (atopic) march (click here to enlarge the image).

Treatment modalities for EoE include the 3Ds: drugs, diet, and dilation (Allergy, 2012).

References:

Long-term outcomes in pediatric-onset esophageal eosinophilia. Debrosse CW, Franciosi JP, King EC, Buckmeier Butz BK, Greenberg AB, Collins MH, Abonia JP, Assa'ad A, Putnam PE, Rothenberg ME. J Allergy Clin Immunol. 2011 May 31.