Identification, epidemiology, and chronicity of pediatric esophageal eosinophilia, 1982-1999.
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.
DeBrosse
Charles W
CW
Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
Collins
Margaret H
MH
Buckmeier Butz
Bridget K
BK
Allen
Casey L
CL
King
Eileen C
EC
Assa'ad
Amal H
AH
Abonia
J Pablo
JP
Putnam
Philip E
PE
Rothenberg
Marc E
ME
Franciosi
James P
JP
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