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Laryngoscope. 2018 Apr;128(4):798-805. doi: 10.1002/lary.26838. Epub 2017 Sep 2.

Eosinophilic esophagitis in children under the age of 5 years: Clinical characteristics.

Author information

1
Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
2
Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A.
3
Department of Pediatrics, Division of Allergy and Immunology, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
4
Department of Pediatrics, Division of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas.

Abstract

OBJECTIVES/HYPOTHESIS:

To delineate clinical characteristics and treatment outcomes of eosinophilic esophagitis (EoE) in the youngest of children.

STUDY DESIGN:

Retrospective chart review.

METHODS:

A 7-year retrospective chart review of children with clinicopathologic diagnosis of EoE was performed with specific analysis of patients under 5 years old. EoE was defined as the presence of symptoms of esophageal dysfunction with pathologically proven eosinophilic inflammation (≥15 eosinophils per high-power field [EOS/HPF]) unresponsive to reflux therapy. Patient parameters and clinical results were systematically reviewed.

RESULTS:

Of 558 children diagnosed with EoE, 127 (22.8%) were younger than 5 years old (mean age 2.5 years). This subgroup presented with reflux symptoms (90.1%), vomiting (86.2%), diarrhea (55.3%), liquid dysphagia (52.0%), and constipation (50.0%), whereas food impaction (1.6%) was rare. Liquid dysphagia was present at all ages but significantly more common in younger children (P = .0101). The most common food and environmental allergens were egg whites (39.7%), cow's milk (36.5%), peanuts (34.9%), animal dander (15.1%), and weed pollen (11.1%). Patients were managed with antireflux medication (100%), elimination diet (83.5%), and steroid medication (68.5%). After treatment, 86% of parents reported symptom improvement. Mean reduction of EOS in pos-treatment biopsy was 33.5 EOS/HPF (P < .0001), and 67 patients showed histologic resolution of EoE (56.8%, P < .0001).

CONCLUSIONS:

Approximately one-quarter of children with EoE present under 5 years of age with multiple esophageal symptoms, comorbidities, and allergen-sensitization profiles. These patients demonstrate substantial clinicohistologic improvement following therapy.

LEVEL OF EVIDENCE:

4. Laryngoscope, 128:798-805, 2018.

KEYWORDS:

Eosinophilic esophagitis; atopy; children; dysphagia; pediatric; reflux

PMID:
28865084
DOI:
10.1002/lary.26838

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