Ten Years in a Pediatric Center: Detecting Esophageal Pathology and Symptoms in Aerodigestive Patients

Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease (GERD) share overlapping gastrointestinal and pulmonary manifestations, often complicating timely diagnosis. Aerodigestive evaluation integrates endoscopic and bronchoscopic approaches to better characterize these patients, yet data on esophageal pathology frequency and associated symptomatology in pediatric patients remain limited.

We performed a retrospective cross-sectional chart review of pediatric patients (ages 1-18) who underwent esophagogastroduodenoscopy with biopsy and bronchoscopy with bronchoalveolar lavage (BAL) between 2013 and 2023 at a tertiary care center. Patients were classified as having EoE (≥15 eosinophils/high power field [hpf]), GERD-associated esophagitis (<15 eosinophils/hpf or reactive changes), or normal esophageal biopsies. Demographics, medication use, gastrointestinal and pulmonary symptoms, and BAL cytology were compared among groups.

Of 126 included patients, 21 (16.7%) had EoE, 31 (24.6%) had GERD-associated esophagitis, and 74 (58.7%) had normal esophageal biopsies. Gastrointestinal complaints were more frequent in patients with normal biopsies (77%) than GERD-associated esophagitis (17%, P = .05) or EoE (57%, P = .007), with abdominal pain significantly higher in normal biopsies compared to GERD-associated esophagitis (23% vs 6.5%, P < .04). Pulmonary symptoms were common across groups, with snoring more prevalent in EoE (19% vs 5.4%, P < .05). BAL revealed elevated eosinophils in EoE compared to GERD-associated esophagitis and normal esophagus (8.1% vs 1.0% and 1.6%, respectively), while GERD-associated esophagitis showed higher mean total white blood cell counts.

Gastrointestinal and pulmonary symptoms did not reliably predict esophageal pathology, with significant overlap observed across groups. The presence of histologic esophagitis despite minimal gastrointestinal complaints underscores limitations of symptom-guided evaluation alone. Aerodigestive assessment offers diagnostic value for pediatric patients with refractory respiratory symptoms and facilitates recognition of esophageal disease.