Increased Diagnosis of Eosinophilic Esophagitis in Young Children

Abstract

Eosinophilic esophagitis (EoE) is an emerging disorder of children and adults. Its natural history is largely unknown. Although the prevalence of this disorder is increasing, the number of patients diagnosed in early childhood remains low, and there is a paucity of clinical and epidemiologic data regarding young children with this disease. We have identified a cohort of 27 children diagnosed with EoE aged 6 years and younger. The mean age of onset of gastrointestinal symptoms was 10.9 months, with 46% of children reporting “symptoms since birth.” The most common symptoms included vomiting (63%), failure to thrive (41%), choking/gagging (33%), abdominal pain (30%) and feeding difficulty (22%). On average, these patients initially presented to the pediatric gastroenterologist at 25.9 months, at which time 67% were diagnosed with gastroesophageal reflux disease. Forty-seven percent had a known food allergy, and 37% had atopic dermatitis. Upper endoscopies (esophogastroduodenoscopy/EGD) and biopsies were performed on average at 38.5 months of age. Biopsy results revealed a mean eosinophil count of 36 eos/hpf in the mid-esophagus, and 55 eos/hpf distally. The mean interval between onset of symptoms and EoE diagnosis was 25 months. Thus, even though young children with EoE have early onset of symptoms, there still remains a significant delay before EGD, definitive diagnosis, and most importantly, the initiation of treatment. Pediatric gastroenterologists should have a high index of suspicion for EoE in young atopic children presenting with nonspecific upper gastrointestinal symptoms and should consider performing an EGD more promptly to assess for this disease.