Original Contribution
The American Journal of Gastroenterology (2000) 95, 1422–1430; doi:10.1111/j.1572-0241.2000.02073.x
The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children
Published in part in abstract form and presented at the annual meeting of the American Gastroenterological Association, New Orleans, May 20, 1998: Orenstein SR, et al. The spectrum of eosinophilic esophagitis in children. Gastroenterology 1998;114:A248.
Susan R Orenstein MD1, Theresa M Shalaby RN1, Carlo Di Lorenzo MD1, Philip E Putnam MD1, Luther Sigurdsson MD1 and Samuel A Kocoshis MD1
1Division of Pediatric Gastroenterology, University of Pittsburgh School of Medicine, and Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
Correspondence: Susan R Orenstein, MD, Director, Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, PA 15213
Received 2 November 1999; Revised 0000; Accepted 2 March 2000.
Abstract
OBJECTIVES:
Eosinophilic esophagitis, previously confused with esophageal inflammation due to gastroesophageal reflux, has recently begun to be distinguished from it. We undertook this analysis of our large series of children with the condition to clarify its spectrum: its presenting symptoms; its relation to allergy, respiratory disease, and reflux; its endoscopic and histological findings; and its diagnosis and therapy.
METHODS:
We analyzed the details of our clinical series of 30 children with eosinophilic esophagitis, defining it as 
5 eosinophils per high power field in the distal esophageal epithelium. Retrospective chart review was supplemented by prospective, blinded, duplicate quantitative evaluation of histology specimens, and by telephone contact with some families to clarify subsequent course. Presentation and analysis of the series as a whole is preceded by a case illustrating a typical presentation with dysphagia and recurrent esophageal food impactions.
RESULTS:
Presenting symptoms encompass vomiting, pain, and dysphagia (some with impactions or strictures). Allergy, particularly food allergy, is an associated finding in most patients, and many have concomitant asthma or other chronic respiratory disease. A subtle granularity with furrows or rings is newly identified as the endoscopic herald of histological eosinophilic esophagitis. Histological characteristics include peripapillary or juxtaluminal eosinophil clustering in certain cases. Association with eosinophilic gastroenteritis occurs, but is not common. Differentiation from gastroesophageal reflux disease is approached by analyzing eosinophil density and response to therapeutic trials. Therapy encompasses dietary elimination and anti-inflammatory pharmacotherapy.
CONCLUSION:
Awareness of the spectrum of eosinophilic esophagitis should promote optimal diagnosis and treatment of this elusive entity, both in children and in adults.
