title: Eosinophilic esophagitis in children and adolescents: epidemiology, clinical presentation and seasonal variation.
abstract: BACKGROUND
  Eosinophilic esophagitis (EoE) is defined by infiltration of eosinophils in the esophageal mucosa (>20 eosinophils/hpf). The epidemiology and seasonal variation have not been well studied in children and adolescents.
  
  
  METHODS
  Review of all esophageal biopsies performed from January 2001 to December 2006 on patients younger than 21 year of age, focusing on demographics, onset and duration of presenting symptoms, history of allergies and endoscopic findings.
  
  
  RESULTS
  A total of 753 upper endoscopies were performed, 44 of which showed histologic evidence of EoE (5.8 %). Fifty percent of all EoE endoscopies were grossly normal. Onset of symptoms was 23 % in the spring, 29 % in the summer, 23 % in the fall and 25 % in the winter. More cases (36 %) were diagnosed in the fall. Time between onset of symptoms and diagnosis was 115 ± 145 days (mean ± SD). The most common presenting symptoms were vomiting (61 %), dysphagia (39 %), abdominal pain (34 %), feeding disorders (14 %), heartburn (14 %), food impaction (7 %), vague chest pain (5 %) and diarrhea (5 %). Children presenting with vomiting and feeding disorders were younger (p < 0.02), whereas children presenting with heartburn and dysphagia were older (p < 0.02).
  
  
  CONCLUSIONS
  The incidence of EoE did not increase between 2001 and 2006. Onset of symptoms did not vary by season, indicating that allergens triggering EoE are present all year around. Vomiting and feeding disorders are seen in young children, while dysphagia and heartburn are seen in older children. As endoscopic findings were normal in 50 % of cases, an esophageal biopsy should be performed in all patients with suspected EoE.
authors.affiliation: Department of Gastroenterology, Providence Hospital, Southfield, MI 48075, USA. Serge.Sorser@stjohn.org
authors.forename: Serge Alexander
authors.initials: SA
authors.lastname: Sorser
authors.forename: Mohammed
authors.initials: M
authors.lastname: Barawi
authors.forename: Karen
authors.initials: K
authors.lastname: Hagglund
authors.forename: Mohammad
authors.initials: M
authors.lastname: Almojaned
authors.forename: Hernando
authors.initials: H
authors.lastname: Lyons
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001249:Asthma / Q000150:complications; D001706:Biopsy; D002637:Chest Pain / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003680:Deglutition Disorders / Q000209:etiology; D003876:Dermatitis, Atopic / Q000150:complications; D003967:Diarrhea / Q000209:etiology; D057765:Eosinophilic Esophagitis / Q000150:complications / Q000453:epidemiology* / Q000473:pathology*; D004945:Esophagoscopy; D004947:Esophagus / Q000473:pathology*; D005260:Female; D005512:Food Hypersensitivity / Q000150:complications; D006356:Heartburn / Q000209:etiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008824:Michigan / Q000453:epidemiology; D015995:Prevalence; D012189:Retrospective Studies; D006255:Rhinitis, Allergic, Seasonal / Q000150:complications; D012621:Seasons; D014839:Vomiting / Q000209:etiology; D055815:Young Adult