Pediatric patients with eosinophilic esophagitis: An 8-year follow-up

Background: Eosinophilic esophagitis (EE) is a gastrointestinal disorder that is increasingly diagnosed in pediatric patients. Objective: We aimed to define, in pediatric patients with EE, their demographic and atopic characteristics, the histopathology of all segments of the gastrointestinal tract, and the effect of therapeutic interventions on the natural history. Methods: We conducted a retrospective analysis of a database of pediatric patients with EE followed over a period of 8 years. Results: In 89 pediatric patients with EE, male sex (78.6%), white race (94.4%), young age at diagnosis, mean ± SD, 6.2 ± 4.8 years, and atopy with sensitization to environmental and food allergens in 79% and 75%, respectively, were prevalent. Patients had EE of the proximal and distal esophagus, and 77% had in addition either mucosal eosinophilia or noneosinophilic histopathology in the stomach, duodenum, and colon. EE was chronic, with a duration of mean ± SD, 0.91 ± 0.84 years, until first resolution, and was recurrent; of 66% of the patients who had resolution, 79% later relapsed. Conclusion: Eosinophilic esophagitis in the pediatric population is a chronic and relapsing condition, associated with atopy and sometimes with subsequent histopathology in segments of the gastrointestinal tract other than the esophagus. Clinical implications: Physicians evaluating pediatric patients with chronic gastrointestinal symptoms should consider the diagnosis of EE, particularly in young white male patients with atopy. Once diagnosed and treated, the physicians should follow the patients over a period of several years because the course of the disease is protracted, other gastrointestinal segments may be affected, and relapses are common.