ORIGINAL PAPER
Clinico-pathological characteristics of children with eosinophilic esophagitis – single-centre experience
 
More details
Hide details
1
Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
 
2
Department of Pediatric Endoscopy and Gastrointestinal Function Testing, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
 
3
Student Research Club Paediatric, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
 
 
Submission date: 2024-04-11
 
 
Final revision date: 2024-05-28
 
 
Acceptance date: 2024-06-10
 
 
Publication date: 2024-09-30
 
 
Corresponding author
Adam Główczewski
Department of Pediatrics, Allergology and Gastroenterology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
 
 
Pediatr Pol 2024;99(3):187-193
 
KEYWORDS
TOPICS
ABSTRACT
Introduction::
The aim of this study was to analyse the clinical picture of children with eosinophilic esophagitis (EoE).

Material and methods::
The medical histories of 45 patients with EoE were retrospectively analysed. Analysis included demographic data, body weight, chronic diseases, family history, occurrence, and duration of symptoms, and endoscopic and histopathological findings.

Results::
The study included 45 children, of whom 60% were boys and 40% girls. The mean age was 10 years (1–17 years). Twenty-eight (62.2%) children had at least one coexisting allergic disease. The co-occurrence of EoE and food allergy was significantly more common in younger children: the median age of patients with EoE and food allergy was 7 years, while the median age of those without food allergy was 12 years. The most common symptoms were eating or feeding difficulties (51.1%). Older children were more likely to have odynophagia, heartburn, dysphagia and abdominal pain. The mean age of children with vomiting was significantly lower than that in children without vomiting. The mean diagnostic delay was 16.3 months (1.4 years). Patients with regurgitation reported a significantly longer median duration of symptoms (21 months) than those without. A significantly shorter diagnostic delay was also noted among children with asthma. The most common type of endoscopic finding was linear oesophageal furrows. The numbers of eosinophils in oesophageal biopsies was in the range 15–100 in the high power field. A higher number of oesophageal eosinophils was noted in patients without chest pain.

Conclusions::
The most common symptoms of EoE were difficulty with food intake, abdominal pain and food impaction. The clinical course varied in children according to age. Children with EoE and co-occurring asthma had a shorter diagnostic delay. The most common feature of EoE on endoscopy was linear oesophageal furrowing. The number of eosinophils in histopathology was not related to the endoscopic result.
REFERENCES (38)
1.
Lucendo AJ, Molina‐Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence‐based statements and recommendations for diagnosis and management in children and adults. United Eur Gastroenterol J 2017; 5: 335-358.
 
2.
Navarro P, Arias Á, Arias-González L, Laserna-Mendieta EJ, Ruiz-Ponce M, Lucendo AJ. Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 2019; 49: 1116-1125.
 
3.
Votto M, Castagnoli R, Filippo MD, et al. Behavioral issues and quality of life in children with eosinophilic esophagitis. Minerva Pediatr 2020; 72: 424-432.
 
4.
Schoepfer AM, Safroneeva E, Bussmann C, et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology 2013; 145: 1230-1236.e2.
 
5.
Kennedy KV, Umeweni CN, Alston M, et al. Esophageal remodeling correlates with eating behaviors in pediatric eosinophilic esophagitis. Am J Gastroenterol 2024; 119: 1167-1176.
 
6.
González-Cervera J, Arias Á, Redondo-González O, CanoMollinedo MM, Terreehorst I, Lucendo AJ. Association between atopic manifestations and eosinophilic esophagitis. Ann Allergy Asthma Immunol 2017; 118: 582-590.e2.
 
7.
Hirano I, Chan ES, Rank MA, et al. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. Gastroenterology 2020; 158: 1776-1786.
 
8.
Arias Á, Pérez-Martínez I, Tenías JM, Lucendo AJ. Systematic review with meta-analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 2016; 43: 3-15.
 
9.
Hollænder M, Terkelsen JH, Kramme F, et al. The incidence of eosinophilic oesophagitis in 2007–2017 among children in North Denmark Region is lower than expected. BMC Pediatr 2022; 22: 183.
 
10.
Van Rhijn BD, Verheij J, Smout AJPM, Bredenoord AJ. Rapidly increasing incidence of eosinophilic esophagitis in a large cohort. Neurogastroenterol Motil 2013; 25: 47.
 
11.
Hahn JW, Lee K, Shin JI, et al. Global incidence and prevalence of eosinophilic esophagitis, 1976–2022: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2023; 21: 3270-3284.e77.
 
12.
Votto M, Lenti MV, De Silvestri A, et al. Evaluation of diagnostic time in pediatric patients with eosinophilic gastrointestinal disorders according to their clinical features. Ital J Pediatr 2023; 49: 9.
 
13.
Hiremath G, Yazdian A, Onuh I, Willey J, Choksi Y. Race and gender influences the presentation of eosinophilic esophagitis. Dysphagia 2023; 38: 1511-1518.
 
14.
Chehade M, Jones SM, Pesek RD, et al. Phenotypic characterization of eosinophilic esophagitis in a large multicenter patient population from the consortium for food allergy research. J Allergy Clin Immunol Pract 2018; 6: 1534-1544.e5.
 
15.
Sessions J, Purington N, Wang Y, et al. Pediatric eosinophilic esophagitis outcomes vary with co-morbid eczema and pollen food syndrome. Front Allergy 2022; 3: 981961.
 
16.
Altamimi E, Ahmad B, Abu-Aqoulah A, Rawabdeh N. Clinico-pathological characteristics of eosinophilic esophagitis in Jordanian children. Gastroenterol Rev 2022; 17: 207-212.
 
17.
Mansoor E, Cooper GS. The 2010–2015 prevalence of eosinophilic esophagitis in the USA: a population-based study. Dig Dis Sci 2016; 61: 2928-2934.
 
18.
Votto M, Raffaele A, De Filippo M, et al. Eosinophilic gastrointestinal disorders in children and adolescents: a single-center experience. Dig Liver Dis 2022; 54: 214-220.
 
19.
Votto M, Marseglia GL, de Filippo M, Brambilla I, Caimmi SME, Licari A. Early life risk factors in pediatric eoe: could we prevent this modern disease? Front Pediatr 2020; 8: 263.
 
20.
Vernon N, Shah S, Lehman E, Ghaffari G. Comparison of atopic features between children and adults with eosinophilic esophagitis. Allergy Asthma Proc 2014; 35: 409-414.
 
21.
Kottyan LC, Parameswaran S, Weirauch MT, Rothenberg ME, Martin LJ. The genetic etiology of eosinophilic esophagitis. J Allergy Clin Immunol 2020; 145: 9-15.
 
22.
Allen-Brady K, Firszt R, Fang JC, Wong J, Smith KR, Peterson KA. Population-based familial aggregation of eosinophilic esophagitis suggests a genetic contribution. J Allergy Clin Immunol 2017; 140: 1138-1143.
 
23.
Redd WD, Ocampo AA, Xue Z, et al. Eosinophilic esophagitis patients with multiple atopic conditions. Ann Allergy Asthma Immunol 2023; 131: 109-115.e2.
 
24.
Moawad FJ, Dellon ES, Achem SR, et al. Effects of race and sex on features of eosinophilic esophagitis. Clin Gastroenterol Hepatol 2016; 14: 23-30.
 
25.
Votto M, de Filippo M, Caimmi S, et al. A practical update on pediatric eosinophilic esophagitis. Children 2023; 10: 1620.
 
26.
Gonsalves NP, Aceves SS. Diagnosis and treatment of eosinophilic esophagitis. J Allergy Clin Immunol 2020; 145: 1-7.
 
27.
Sun RW, Bonilla‐Velez J, Pesek RD, Johnson AB, Cleves MA, Richter GT. Eosinophilic esophagitis in children under the age of 5 years: clinical characteristics. Laryngoscope 2018; 128: 798-805.
 
28.
Laserna-Mendieta EJ, Navarro P, Casabona-Francés S, et al. Differences between childhood- and adulthood-onset eosinophilic esophagitis: An analysis from the EoE connect registry. Dig Liver Dis 2023; 55: 350-359.
 
29.
Chehade M, McGowan EC, Wright BL, et al. Barriers to timely diagnosis of eosinophilic gastrointestinal diseases. J Allergy Clin Immunol Pract 2024; 12: 302-308.
 
30.
Shaheen NJ, Mukkada V, Eichinger CS, Schofield H, Todorova L, Falk GW. Natural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course. Dis Esophagus 2018; 31: doy015.
 
31.
Lucendo AJ, Arias Á, Molina-Infante J, Arias-González L. The role of endoscopy in eosinophilic esophagitis: from diagnosis to therapy. Expert Rev Gastroenterol Hepatol 2017; 11: 1135-1149.
 
32.
Muir AB, Merves J, Liacouras CA. Role of endoscopy in diagnosis and management of pediatric eosinophilic esophagitis. Gastrointest Endosc Clin N Am 2016; 26: 187-200.
 
33.
Kim HP, Vance RB, Shaheen NJ, Dellon ES. The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 988-996.e5.
 
34.
Cheng E, Souza RF, Spechler SJ. Tissue remodeling in eosinophilic esophagitis. Am J Physiol-Gastrointest Liver Physiol 2012; 303: G1175-G1187.
 
35.
Collins MH, Martin LJ, Alexander ES, et al. Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring: Eosinophilic esophagitis pathology. Dis Esophagus 2017; 30: 1-8.
 
36.
Dellon ES. Diagnostics of eosinophilic esophagitis: clinical, endoscopic, and histologic pitfalls. Dig Dis 2014; 32: 48-53.
 
37.
Marlais M, Francis N, Fell J, Rawat D. Blood tests and histological correlates in children with eosinophilic oesophagitis. Acta Paediatr 2011; 100: e75-79.
 
38.
Choudhury S, Kozielski R, Hua J, Wilding GE, Baker S. Do histological features of eosinophilic esophagitis in children correlate with peripheral eosinophils? J Pediatr Gastroenterol Nutr 2020; 70: 604-607.
 
Journals System - logo
Scroll to top