[Eosinophilic esophagitis in 29 pediatric patients].
BACKGROUND
Eosinophilic esophagitis is a recently described entity with esophageal symptoms like gastroesophageal reflux disease and significant esophageal eosinophilic infiltration.


OBJECTIVE
To present our clinical series of 29 children with eosinophilic esophagitis, describing the clinical and diagnostic features, treatment and outcome.


METHODS
We describe 29 patients (22 boys), 1-18 years-old, with 20 eosinophils per high-power field in esophageal biopsy specimens and absence of eosinophilic inflammation in the stomach and duodenum. Evaluation of the clinical, endoscopic and histologic findings, treatment and outcome was undertaken.


RESULTS
The most common presenting symptoms included vomiting in 15 patients (52%) and abdominal pain in 11 patients (38%). Children under the age of 4 years presented with feeding disorder and failure to thrive. Patients between 5 and 8 years of age presented commonly with abdominal pain or symptoms that may be associated with reflux (heartburn and/or vomiting). Patients over the age of 8 presented most often with abdominal pain, dysphagia and occasional food impaction. Endoscopic features included vertical furrowing in 14 patients (48%), whitish papules in 12 (41%), corrugated rings in 2 patients (7%) and esophageal erosions in 3 patients (10%). In seven patients endoscopy was normal (24%). Treatment included swallowed fluticasone propionate in 19 patients and restriction diet in 7 patients. Patients who returned for follow-up had either improvement or remission of symptoms. After treatment, endoscopic biopsies were repeated in 11 patients, and a significant decrease in esophageal eosinophil counts was observed.


CONCLUSIONS
The diagnosis of eosinophilic esophagitis must be considered when symptoms of reflux do not respond to conventional treatment. Upper gastrointestinal endoscopy must be complemented by a detailed analysis of histologic findings and eosinophil counts.
Ferreira
Cristina Targa
CT
Instituto do Aparelho Digestivo, Porto Alegre, RS. cristinatarga@terra.com.br
Vieira
Mário C
MC
Vieira
Sandra Maria Gonçalves
SM
Silva
Giovana Stival da
GS
Yamamoto
Danielle Reis
DR
Silveira
Themis Reverbel da
TR
D000293:Adolescent; D000730:Androstadienes / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D004802:Eosinophilia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D000068298:Fluticasone; D006801:Humans; D007223:Infant; D008297:Male; D009853:Omeprazole / Q000627:therapeutic use
D000730:Androstadienes; D004791:Enzyme Inhibitors; D000068298:Fluticasone; D009853:Omeprazole