Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids.
BACKGROUND
The histologic appearance of esophageal eosinophils has been correlated with esophagitis and gastroesophageal reflux disease in children. Esophageal eosinophilia that persists despite traditional antireflux therapy may not represent treatment failure, but instead may portray early eosinophilic gastroenteritis or allergic esophagitis. In this study, a series of pediatric patients with severe esophageal eosinophilia who were unresponsive to aggressive antireflux therapy were examined and their clinical and histologic response to oral corticosteroid therapy assessed.


METHODS
Of 1809 patients evaluated prospectively over 2.5 years for symptoms of gastroesophageal reflux, 20 had persistent symptoms and esophageal eosinophilia, despite aggressive therapy with omeprazole and cisapride. These patients were treated with 1.5 mg/kg oral methylprednisolone per day, divided into twice-daily doses for 4 weeks. All patients underwent clinical, laboratory, and histologic evaluation before and after treatment.


RESULTS
Histologic findings in examination of specimens obtained in pretreatment esophageal biopsies in children with primary eosinophilic esophagitis indicated significantly greater eosinophilia (34.2+/-9.6 eosinophils/high-power field [HPF]) compared with that in children with gastroesophageal reflux disease who responded to medical therapy (2.26+/-1.16 eosinophils/HPF; p < 0.001). After corticosteroid therapy, all but one patient with primary eosinophilic esophagitis had dramatic clinical improvement, supported by histologic examination (1.5 +/-0.9 eosinophils/HPF, p < 0.0001).


CONCLUSIONS
Pediatric patients in a series with marked esophageal eosinophilia and chronic symptoms of gastroesophageal reflux disease unresponsive to aggressive medical antire-flux therapy had both clinical and histologic improvement after oral corticosteroid therapy.
Liacouras
C A
CA
Division of Gastroenterology and Nutrition, The University of Pennsylvania School of Medicine, The Children's Hospital of Philadelphia 19104, USA.
Wenner
W J
WJ
Brown
K
K
Ruchelli
E
E
D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004802:Eosinophilia / Q000188:drug therapy* / Q000473:pathology; D004804:Eosinophils; D004941:Esophagitis / Q000188:drug therapy* / Q000473:pathology; D004947:Esophagus / Q000473:pathology; D005764:Gastroesophageal Reflux / Q000188:drug therapy; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007223:Infant; D007958:Leukocyte Count; D008775:Methylprednisolone / Q000627:therapeutic use*; D011446:Prospective Studies
D000893:Anti-Inflammatory Agents; D007073:Immunoglobulin E; D008775:Methylprednisolone