White specks in the esophageal mucosa: An endoscopic manifestation of non-reflux eosinophilic esophagitis in children.
BACKGROUND
White specks in the esophageal mucosa have been observed in children with eosinophilic esophagitis. The aim of this study was to determine the relationship between white specks in the esophageal mucosa and allergic (non-reflux) eosinophilic esophagitis.


METHODS
Endoscopic data, pH probe results, and histopathology reports for children with esophageal endoscopic abnormalities seen during a 17-month period were reviewed. Eosinophilic esophagitis was grouped according to the number of eosinophils per high power field (non-allergic, <15 eosinophils/high power field; allergic, > or =15 eosinophils/high power field).


RESULTS
Of 1041 endoscopies performed during the study period, 153 revealed evidence of eosinophilic esophagitis. Of these 153, 61 had fewer than 15 eosinophils/high power field and 92 had 15 or more eosinophils/high power field. At 31 of the 153 procedures, white specks were noted in the esophageal mucosa. The sensitivity of white specks in the esophageal mucosa for allergic eosinophilic esophagitis was only 30%, but the specificity was 95%. pH probe testing was performed in 21 patients with white specks and was normal in all.


CONCLUSIONS
This report describes a new endoscopic finding associated with allergic eosinophilic esophagitis in children. Eosinophilic esophagitis tends to be severe when white specks are present (> or =15 eosinophils/high power field) and is not associated with pathologic gastroesophageal reflux, as demonstrated by pH probe testing.
Lim
Joel R
JR
Division of Pediatric, Gastroenterology/Hepatology/Nutrition, Division of Pediatric Pathology, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, Indiana 46202-5225, USA.
Gupta
Sandeep K
SK
Croffie
Joseph M
JM
Pfefferkorn
Marian D
MD
Molleston
Jean P
JP
Corkins
Mark R
MR
Davis
Mary M
MM
Faught
Philip P
PP
Steiner
Steven J
SJ
Fitzgerald
Joseph F
JF
D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003877:Dermatitis, Contact; D004804:Eosinophils / Q000473:pathology*; D004941:Esophagitis / Q000175:diagnosis* / Q000209:etiology / Q000378:metabolism / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000378:metabolism / Q000473:pathology*; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D006967:Hypersensitivity / Q000150:complications; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D009092:Mucous Membrane / Q000473:pathology; D011237:Predictive Value of Tests