Document Detail

Eosinophilic esophagitis: strictures, impactions, dysphagia.
MedLine Citation:
PMID:  12645786     Owner:  NLM     Status:  MEDLINE    
Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive esophageal symptoms (11 male), median age 5 years, and identified to have eosinophilic esophagitis with > 5 eosinophils per high-power field (eos/hpf) are reported. Of these, four had strictures, six had impactions, and two had only dysphagia. A diagnostic evaluation included esophagogastroduodenoscopy with biopsies in all and upper gastrointestinal series, IgE, radioallergosorbent tests, and skin tests for food allergies in some cases. Esophageal histology specimens were independently analyzed for eosinophil density by two authors. Four of five children with > 20 eos/hpf responded to elimination diets/steroids. The fifth child responded to a fundoplication. Seven children had 5-20 eos/hpf and three of them with no known food allergies responded to antireflux therapy alone. Three others in this group with positive food allergies responded to treatment with elimination diets and/or steroids. The seventh patient in this group was lost to follow-up. In conclusion, on the basis of response to therapy, eosinophilic esophagitis can be subdivided into two groups: those with likely gastroesophageal reflux disease if < 20 eos/hpf and no food allergies, and others with allergic eosinophilic esophagitis associated with food allergies and often with > 20 eos/hpf.
Seema Khan; Susan R Orenstein; Carlo Di Lorenzo; Samuel A Kocoshis; Philip E Putnam; Luther Sigurdsson; Theresa M Shalaby
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  48     ISSN:  0163-2116     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:  2003 Jan 
Date Detail:
Created Date:  2003-03-20     Completed Date:  2003-04-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  22-9     Citation Subset:  AIM; IM    
Division of Pediatric Gastroenterology, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, 3705 Fifth Avenue, Pittsburgh, Pennsylvania 15213-2583, USA.
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MeSH Terms
Deglutition Disorders / etiology
Eosinophilia / complications*,  therapy
Esophageal Stenosis / etiology*
Esophagitis / complications*,  therapy
Food Hypersensitivity / complications
Gastroesophageal Reflux / complications
Retrospective Studies

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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