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Allergic esophagitis in children: a clinicopathological entity
S V Walsh1, D A Antonioli, H Goldman
1Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
The American Journal of Surgical Pathology
|April 13, 1999
Summary
Pediatric patients with eosinophilic esophagitis may not respond to GERD treatment. Allergic esophagitis is suggested by eosinophil presence in esophageal biopsies and allergy indicators, differentiating it from acid reflux esophagitis.
Area of Science:
- Gastroenterology
- Pediatric Allergy
- Esophageal Pathology
Background:
- Eosinophilic infiltration of the esophageal epithelium is observed in reflux esophagitis and allergic gastroenteritis.
- Distinguishing between acid reflux esophagitis and non-acid, possibly allergic, esophagitis is crucial for effective treatment.
Purpose of the Study:
- To identify distinct features differentiating pediatric patients with acid reflux esophagitis from those with non-acid, potentially allergic, esophagitis.
- To investigate the role of eosinophils in esophageal biopsies post-therapy in children with gastroesophageal reflux disease (GERD).
Main Methods:
- 28 children treated for GERD were categorized into three groups based on treatment response and esophageal pH monitoring.
- Clinical, laboratory, and pathological data, including esophageal biopsy eosinophil counts, were compared between groups.
- Patients with incomplete GERD response and normal pH monitoring (Groups A & B) were compared to those with improved symptoms and abnormal pH monitoring (Group C).
Main Results:
- Groups A and B, unresponsive to GERD therapy, showed significantly higher intraepithelial eosinophil counts in esophageal biopsies compared to Group C (p=0.009).
- Peripheral eosinophilia, dysphagia, food impaction, failure to thrive, and positive allergen skin tests were present only in Groups A and B.
- Eosinophil aggregates and preferential superficial epithelial location were noted in Groups A and B, with clinical improvement upon antiallergic therapy.
Conclusions:
- A distinct group of pediatric patients with allergic esophagitis can be identified.
- These patients exhibit an allergic history, lack of response to GERD therapy, normal esophageal pH monitoring, and significant esophageal eosinophilia.
- The findings suggest allergic esophagitis as a separate entity from acid reflux esophagitis in children.