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Esophageal eosinophilia in children with dysphagia
Ka Ming Cheung1, Mark R Oliver, Donald J S Cameron
1Department of Gastroenterology and Clinical Nutrition, Royal Children's Hospital, Melbourne.
Insights
Children with dysphagia and esophageal eosinophilia often have allergies and food impaction, not acid reflux. This finding helps differentiate causes of swallowing difficulties in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Allergy and Immunology
- Esophageal Disorders
Background:
- Dysphagia in children can occur without a clear cause.
- Esophageal eosinophilia is sometimes observed but its significance is debated.
- It may indicate primary eosinophilic esophagitis rather than reflux esophagitis.
Purpose of the Study:
- To evaluate esophagitis, acid reflux, and esophageal eosinophilia in children with dysphagia.
- To determine the relationship between esophageal eosinophilia and gastroesophageal reflux in pediatric patients.
- To differentiate causes of dysphagia in children presenting with esophageal eosinophilia.
Main Methods:
- Retrospective study of 42 children investigated for dysphagia.
- Comparison of clinical, endoscopic, manometric, and pH parameters between children with and without esophageal eosinophilia.
- Analysis of esophageal mucosal biopsies for eosinophil counts.
Main Results:
- Children with esophageal eosinophilia were more frequently male and had a history of allergies and food bolus obstruction.
- Endoscopic findings included wrinkled and thickened esophageal mucosa with basal cell proliferation.
- Esophageal pH monitoring and motility studies were similar and normal in both groups.
Conclusions:
- Esophageal eosinophilia in children with dysphagia is not associated with pathologic gastroesophageal reflux.
- This suggests eosinophilic esophagitis as a distinct entity in pediatric dysphagia.
- Findings aid in distinguishing reflux from other causes of dysphagia in children.
Objectives:
Children occasionally have dysphagia in the absence of an apparent primary cause. Esophageal eosinophilia is sometimes seen in these patients at the time of upper endoscopy but its significance is not clear. Although eosinophilia is regarded by some as a histologic hallmark of childhood reflux esophagitis, it may in fact signal a primary eosinophilic esophagitis in children with dysphagia. Our aim was to evaluate esophagitis, acid reflux determined by pH probe, and esophageal eosinophilia in children with the primary complaint of dysphagia.
Methods:
A retrospective study was performed in 42 children, admitted for investigation of dysphagia, in whom no primary cause could be found. Twenty-one children (mean age +/- SD, 10.1 +/- 4.0 years) had esophageal eosinophilia and 21 children (8.3 +/- 4.7 years) did not. Clinical, endoscopic, manometric and esophageal pH parameters in these two groups were compared.
Results:
Patients with esophageal eosinophilia were more often male (p<0.01) with a history of allergy (p<0.001) and food bolus obstruction (p<0.05) requiring endoscopic removal. Their esophageal mucosa appeared wrinkled and thickened at endoscopy with basal cell proliferation, and large numbers of eosinophils in esophageal mucosal biopsies. Continuous esophageal pH records and motility studies, when obtained, were similar in both groups and were within normal values.
Conclusion:
Children with dysphagia who have esophageal eosinophilia are unlikely to have pathologic gastroesophageal reflux.
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