Clinical presentation of patients with eosinophilic inflammation of the esophagus

Gastrointest Endosc. 2006 Oct;64(4):473-8. doi: 10.1016/j.gie.2006.03.931. Epub 2006 Jul 26.


Background: Allergic eosinophilic esophagitis (AEE) is defined by a dense infiltrate of eosinophils within the esophageal mucosa and the absence of pathological gastroesophageal reflux.

Objective: To characterize a pediatric population with AEE to determine if AEE can be diagnosed based on history; to compare patients with varying degrees of esophageal eosinophilic inflammation to determine if moderate esophageal inflammation is part of a continuum of AEE.

Design: Medical records of 112 patients with eosinophils on esophageal biopsy specimens were reviewed. Patients were grouped according to eosinophils per high power field (eos/hpf): group 1 (1-5 eos/hpf, n = 31), group 2 (6-14 eos/hpf, n = 13), and group 3 (> or =15 eos/hpf, n = 68) and compared.

Setting: University Children's Hospital.

Patients: Children and adolescents with eosinophils on esophageal mucosal biopsy specimens.

Interventions: Analysis of clinical information.

Main outcome measurements: Clinical characterization of patients with esophageal eosinophilia.

Results: There was no significant difference in patient demographics. Patients in groups 2 and 3 had multiple food allergens identified. Patients in group 3 with a positive type I allergic response were significantly younger than those with a negative response (mean, 4.6 years old vs mean, 8.5 years old; P = .0065). In group 2, 3 of 13 patients responded histologically to acid-suppressive therapy, whereas 6 patients had improved histology with corticosteroids; 4 of these 6 patients had not responded histologically to acid-suppression.

Limitations: Retrospective study.

Conclusions: History and clinical presentation were not useful in predicting the severity of histologic esophageal inflammation in this cohort. Patients with moderate esophageal eosinophilia (group 2) exhibited a variable response to medical therapy.

MeSH terms

  • Adolescent
  • Biopsy
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Endoscopy
  • Eosinophilia / diagnosis*
  • Eosinophilia / pathology
  • Eosinophils / pathology
  • Esophageal pH Monitoring
  • Esophagitis / diagnosis*
  • Esophagitis / pathology
  • Esophagitis, Peptic / diagnosis
  • Esophagitis, Peptic / pathology
  • Esophagoscopy
  • Esophagus / pathology
  • Female
  • Food Hypersensitivity / diagnosis*
  • Food Hypersensitivity / pathology
  • Humans
  • Infant
  • Intradermal Tests
  • Leukocyte Count
  • Male
  • Mucous Membrane / pathology
  • Radioallergosorbent Test
  • Retrospective Studies
  • Statistics as Topic