Original Investigation |

Prevalence of Eosinophilic Esophagitis in Children With Refractory Aerodigestive Symptoms

Courtney A. Hill, MD1; Jyoti Ramakrishna, MBBS, MD2; M. Shannon Fracchia, MD3; Daniel Sternberg, BS4; Shilpa Ojha, MBChB4; Scott Infusino, BA4; Christopher J. Hartnick, MD, MS4
[+] Author Affiliations
1Section of Otolaryngology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
2Pediatric Gastroenterology and Nutrition, Massachusetts General Hospital, Boston
3Pediatric Pulmonology, Massachusetts General Hospital, Boston
4Division of Pediatric Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston
JAMA Otolaryngol Head Neck Surg. 2013;139(9):903-906. doi:10.1001/jamaoto.2013.4171.
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Importance  Eosinophilic esophagitis (EoE) is an increasingly important diagnosis for children; it has a remarkable impact on their quality of life and can present with aerodigestive symptoms commonly evaluated by otolaryngologists.

Objectives  To evaluate the prevalence of EoE in children presenting to a pediatric aerodigestive clinic, to describe their presentation, and to review the role of subsequent food allergy evaluation and treatment.

Design  Review of a prospective database.

Setting  Tertiary pediatric multispecialty aerodigestive center.

Patients  Children with aerodigestive symptoms refractory to medical treatment who underwent direct laryngoscopy with rigid or flexible bronchoscopy and esophagoscopy with or without pH probe study.

Main Outcomes and Measures  Diagnosis of EoE.

Results  Between 2003 and 2012, 376 of 1540 children seen in the center (mean [range] age, 4.54 [0-18.6] years; male to female ratio, 1.72:1) remained symptomatic despite medical therapy and thus underwent triple endoscopic evaluation. Of the 376 children, 14 (3.7%) were eventually diagnosed as having EoE, as defined by 15 or more eosinophils per high-power field on esophageal biopsy and either a negative pH study result or nonresponse to a trial of high-dose proton pump inhibitors. The subpopulation with EoE presented with airway symptoms and diagnoses, most commonly cough (n = 6; 42.9%). Inflammatory subglottic stenosis due to EoE was identified in 1 patient. Of the 14 children with EoE, 6 presented with gastrointestinal symptomatology, most commonly choking or gagging. Subsequent treatment including food allergy challenge and elimination diet resulted in a clinical improvement in half of the cases identified.

Conclusions and Relevance  This represents the largest multispecialty clinic epidemiologic study evaluating the prevalence of EoE in children presenting not strictly with gastrointestinal symptoms but rather with aerodigestive symptoms that are frequently evaluated by pediatric otolaryngologists. Although the prevalence is low, EoE should be considered for children with appropriate symptoms in whom other medical therapies fail.

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