Differences in Adult vs. Pediatric Onset Eosinophilic Esophagitis

Abstract

Purpose: Originally described in children, there are increasing reports of eosinophilic esophagitis (EoE) in adults. It is unclear if adult onset EoE differs from pediatric onset EoE or if both are the manifestations of the same pathophysiologic process. Few studies have investigated possible differences in clinical features of EoE between these two age groups. Aims: To examine the differences in clinical EoE manifestations based on age of onset and duration of symptoms. Methods: Retrospective chart analysis was performed on all EoE patients at our institution within the last 24 months. Patients completed a validated allergy, reflux, dysphagia score and symptom duration questionnaires. Endoscopy with 2 sets of four quadrant biopsies were performed (along with dilatation if significant strictures were present (lumen <15 mm)). Peripheral eosinophil count and IgE levels were also obtained. EoE was defined as >20 eosinophils per HPF on endoscopic biopsy plus symptoms of chest pain, dysphagia or food impaction. Chronic dysphagia was defined as symptom duration greater than 10 yrs. We defined pediatric onset EoE as symptom onset prior to age 18 yrs. Comparisons were made between pediatric and adult onset EoE for allergy history, IgE levels, peripheral eosinophila, and endoscopic findings, significant strictures, and symptom duration. Results: 59 patients were identified with EoE. Average age was 40 yrs (std. dev. 13.7 yr). 13/59 had (25.4%) pediatric onset EoE. Mean duration of symptoms was 9 years (range 2 months-50 yrs). 16/59 patients (27.1%) had significant strictures. There was no significant difference in allergy history, IgE levels, peripheral eosinophilia and endoscopic findings between adult and pediatric onset EoE. Patients with either chronic symptoms or pediatric EoE had a greater probability of a significant stricture (P < 0.004 respectively). Conclusion: We found no differences in adult onset vs. pediatric onset EoE with regards to allergy, IgE levels, peripheral eosinophilia and endoscopic findings. Eosinophilic esophagitis appears to be the same disease affecting persons at different ages. Adult patients with long duration of symptoms and/or pediatric onset EoE were more likely to have significant strictures. Early diagnosis and treatment of EoE is important and may potentially prevent stricturing disease.Figure