title: Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982-1999.
abstract: BACKGROUND
  Eosinophilic esophagitis (EE) is now a commonly encountered disorder that was rarely diagnosed a decade ago.
  
  
  OBJECTIVE
  We aimed to determine the epidemiologic and histologic features of retrospective pediatric esophageal eosinophilia before the first case of EE at our institution was recognized.
  
  
  METHODS
  Esophageal biopsy specimens obtained between 1982 and 1999 with reflux esophagitis were re-examined and reorganized into 2 groups based on peak esophageal eosinophil number (<15 eosinophils per high-powered field [hpf] and > or =15 eosinophils/hpf). The epidemiology and histology of the entire cohort and a population-based cohort were evaluated.
  
  
  RESULTS
  Eight hundred seven biopsy specimens from 666 patients were re-examined; 198 patients had 15 eosinophils/hpf or greater. Among a population-based cohort of patients with 15 eosinophils/hpf or greater, there was a modest increase in incidence (P < .001; incidence rate ratio, 1.18; 95% CI, 1.09-1.28). After correcting for a 40-fold increase in the number of endoscopies during this time period, the proportion of biopsy specimens with 15 eosinophils/hpf or greater did not change (0.08 in 1982 vs 0.08 in 1996 [peak]; P = .9; incidence rate ratio, 1.02; 95% CI, 0.73-1.44). Patients who had as few as 5 eosinophils/hpf were more likely to have persistent esophageal eosinophilia on repeat esophagogastroduodenoscopy, evidence of basal layer hyperplasia, and lamina propria fibrosis compared with patients with less than 5 eosinophils/hpf (P < .001).
  
  
  CONCLUSIONS
  Esophageal eosinophilia at levels consistent with EE was present among 30% of patients given diagnoses of reflux esophagitis, and the incidence of esophageal eosinophilia did not change over time. Patients with 5 eosinophils/hpf or greater had evidence of other histologic abnormalities and were likely to have persistent esophageal eosinophilia.
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: DeBrosse
authors.forename: Margaret H
authors.initials: MH
authors.lastname: Collins
authors.forename: Bridget K
authors.initials: BK
authors.lastname: Buckmeier Butz
authors.forename: Casey L
authors.initials: CL
authors.lastname: Allen
authors.forename: Eileen C
authors.initials: EC
authors.lastname: King
authors.forename: Amal H
authors.initials: AH
authors.lastname: Assa'ad
authors.forename: J Pablo
authors.initials: JP
authors.lastname: Abonia
authors.forename: Philip E
authors.initials: PE
authors.lastname: Putnam
authors.forename: Marc E
authors.initials: ME
authors.lastname: Rothenberg
authors.forename: James P
authors.initials: JP
authors.lastname: Franciosi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004802:Eosinophilia / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D004941:Esophagitis / Q000175:diagnosis* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D006801:Humans; D008297:Male; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors