Eosinophilic esophagitis: a 10-year experience in 381 children.
OBJECTIVE
Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus unresponsive to aggressive acid blockade but responsive to the removal of dietary antigens. We present information relating to our 10-year experience in children diagnosed with EoE.


METHODS
We conducted a retrospective study between January 1, 1994, and January 1, 2004, to evaluate all patients diagnosed with EoE. Clinical symptoms, demographic data, endoscopic findings, and the results of various treatment regimens were collected and evaluated.


RESULTS
A total of 381 patients (66% male, age 9.1 +/- 3.1 years) were diagnosed with EoE: 312 presented with symptoms of gastroesophageal reflux; 69 presented with dysphagia. Endoscopically, 68% of patients had a visually abnormal esophagus; 32% had a normal-appearing esophagus despite a severe histologic esophageal eosinophilia. The average number of esophageal eosinophils (per 400 x high power field) proximally and distally were 23.3 +/- 10.5 and 38.7 +/- 13.3, respectively. Corticosteroids significantly improved clinical symptoms and esophageal histology; however, upon their withdrawal, the symptoms and esophageal eosinophilia recurred. Dietary restriction or complete dietary elimination using an amino acid-based formula significantly improved both the clinical symptoms and esophageal histology in 75 and 172 patients, respectively.


CONCLUSIONS
Medications such as corticosteroids are effective; however, upon withdrawal, EoE recurs. The removal of dietary antigens significantly improved clinical symptoms and esophageal histology in 98% of patients.
Liacouras
Chris A
CA
Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA. liacouras@email.chop.edu
Spergel
Jonathan M
JM
Ruchelli
Eduardo
E
Verma
Ritu
R
Mascarenhas
Maria
M
Semeao
Edisio
E
Flick
Jonathan
J
Kelly
Janice
J
Brown-Whitehorn
Terry
T
Mamula
Petar
P
Markowitz
Jonathan E
JE
D000284:Administration, Oral; D000730:Androstadienes / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001706:Biopsy; D002648:Child; D004205:Cromolyn Sodium / Q000627:therapeutic use*; D016099:Endoscopy, Gastrointestinal; D004802:Eosinophilia / Q000178:diet therapy / Q000188:drug therapy / Q000473:pathology*; D004941:Esophagitis / Q000178:diet therapy / Q000188:drug therapy / Q000473:pathology*; D005260:Female; D000068298:Fluticasone; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D000068298:Fluticasone; D004205:Cromolyn Sodium; D008775:Methylprednisolone