title: Distinguishing eosinophilic esophagitis in pediatric patients: clinical, endoscopic, and histologic features of an emerging disorder.
abstract: OBJECTIVE
  To determine the clinical, endoscopic, and histologic criteria that distinguish children with eosinophilic esophagitis (EE) from those with non-EE diagnoses.
  
  
  BACKGROUND
  EE is a disease of escalating incidence. Distinguishing children with EE from those with non-EE diagnosis can be difficult before endoscopy.
  
  
  METHODS
  A retrospective case-control study was performed for children with any degree of esophageal eosinophilic inflammation who underwent esophageal biopsy at Children's Hospital San Diego from January 1998 to December 2002. A database containing children who met histologic criteria for EE and an equivalent number of children who had milder esophageal eosinophilia (non-EE patients) was created to compare the 2 groups.
  
  
  RESULTS
  The number of EE cases increased from 15 in 1998 to 35 in 2002. EE patients were predominantly school-aged boys; 5 of 102 were suspected to have EE before biopsy. Although EE and non-EE patients complained of vomiting and abdominal pain at equivalent rates, EE patients were 3 times more likely to complain of dysphagia [odds ratio (OR)=3.11, 95% confidence interval (CI) 1.55-6.65] and twice as likely to have stricture formation (OR=2.43, 95% CI 0.72-11.75). On endoscopy, patients with EE were 19-times more likely than non-EE patients to have endoscopic abnormalities (OR=19, 95% CI 9.0-45.88). Histologically, EE patients were more likely to have basal zone hyperplasia and degranulated eosinophils (OR=45 and 157, respectively).
  
  
  CONCLUSIONS
  We demonstrate that school-aged children, particularly boys, who complain of dysphagia should raise the index of suspicion for EE. We also suggest that EE-associated strictures are more common than peptic strictures in children.
authors.affiliation: Division of Allergy, Rady Children's Hospital San Diego, University of California, San Diego, CA 92123, USA. saceves@chsd.org
authors.forename: Seema S
authors.initials: SS
authors.lastname: Aceves
authors.forename: Robert O
authors.initials: RO
authors.lastname: Newbury
authors.forename: Ranjan
authors.initials: R
authors.lastname: Dohil
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schwimmer
authors.forename: John F
authors.initials: JF
authors.lastname: Bastian
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology; D004802:Eosinophilia / Q000175:diagnosis*; D004940:Esophageal Stenosis / Q000209:etiology; D004941:Esophagitis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies