Childhood esophagitis: then and now

Area of Science:

• Pediatric Gastroenterology
• Histopathology
• Immunology

Background:

• Childhood esophagitis, marked by intraepithelial eosinophils, is a growing concern.
• The temporal trends in pediatric esophagitis prevalence are not well-established.
• Eosinophilic esophagitis (EoE) is a distinct condition with unique characteristics.

Purpose of the Study:

• To compare the prevalence of intraepithelial eosinophils in pediatric esophageal biopsies between two distinct time periods: 1980-1988 and 2001-2002.
• To investigate potential changes in the histological hallmark of esophageal inflammation over time.
• To assess if the prevalence of eosinophilic esophagitis has changed in children.

Main Methods:

• A retrospective review of 1058 esophageal biopsies from 510 pediatric subjects was conducted.
• Biopsies were obtained from two periods: 1980-1988 and 2001-2002.
• Histological findings, specifically eosinophil counts per high-power field, were quantified.

Main Results:

• A statistically significant increase in the overall prevalence of esophageal inflammatory disease was observed between the two periods.
• Despite the rise in general esophageal inflammation, no increase in the prevalence of eosinophilic esophagitis was detected, regardless of the diagnostic threshold used (25, 20, 15, or 10 eosinophils/hpf).
• The density of eosinophilic infiltrates in esophageal biopsies remained unchanged over the 22-year study duration.

Conclusions:

• There is no evidence of a change in the density of eosinophilic infiltrates in pediatric esophageal biopsies over a 22-year period.
• The study highlights a significant increase in the overall prevalence of esophageal inflammatory disease in children during the same timeframe.
• Findings suggest that while general esophageal inflammation is increasing, the specific condition of eosinophilic esophagitis may not be, based on histological eosinophil counts.