Frequency of Esophageal Eosinophilia in a Pediatric Population from Central Brazil

Daniel Strozzi,Marilia Adriano Mekdessi,Lysa Bernardes Minasi,Luciana Ximenes Salustiano,Pedro H De Paula Silva,Marco Aurélio Silveira Botacin,Aparecido Divino Da Cruz,Gesmar Rodrigues Silva Segundo

doi:10.1038/s41598-018-23178-9

Daniel Strozzi, Marilia Adriano Mekdessi + Show 6 more

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https://doi.org/10.1038/s41598-018-23178-9

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Here we report a retrospective cross-sectional study on Esophageal eosinophilia (EsEo) frequency in Brazil, for 2, 425 pediatric patients with symptoms associated with gastroesophageal diseases in 2012. EsEo is defined by ≥15 eosinophils per high power field (400x) and confirmed through histological analyses of esophageal biopsies. Overall, 126 patients had EsEo equating to a frequency of 5.2%. There was a significant difference between the endoscopic features of patients with EsEo, where 10.7% had erosive esophagitis, 3.0% had non-erosive esophagitis and 1% showed normal esophageal mucosa. According to the interaction of the variables in the Classification and Regression Tree Analysis, most patients diagnosed with EsEo were older males with erosive esophagitis. On the other hand, the lowest frequency of EsEo was found among younger females with non-erosive esophagitis/normal mucosa. Environmental conditions, including climate variation and changes, were observed in association with EsEo, supporting a potential role for environmental factors in its pathogenesis. There was an inverse correlation between the number of EsEo, rainfall and humidity. EsEo is a relatively frequent finding in the pediatric population of Brazil with symptoms of gastroesophageal diseases. Both clinical and histological examinations of patients are important for a reliable diagnostic of EsEo cases and to patient care.

Highlights

Esophageal eosinophilia (EsEo) is a chronic inflammation characterized by the increase of eosinophil infiltration limited to the eophageal epithelium[1]
From the cohort of 2,425 patients, 126 patients were diagnosed with EsEo, which equates to an overall frequency of 5.2%
Nine patients were excluded from the initial cohort because their histological reports indicated ≥15 eosinophils per high-powered field (HPF) in the duodenal biopsies, which may characterize a systemic eosinophilic disease instead[18]

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Introduction

Esophageal eosinophilia (EsEo) is a chronic inflammation characterized by the increase of eosinophil infiltration limited to the eophageal epithelium[1]. EsEo has become more frequently diagnosed in patients undergoing upper digestive endoscopy (UDE) for symptoms associated with gastroesophageal diseases[2]. The estimated frequency of EoE varies between 2 and 10% for the pediatric patients undergoing gastroesophageal endoscopy www.nature.com/scientificreports/. Here we report on the first retrospective cross-sectional study on the frequency of EsEo in central Brazil, within a large population of pediatric patients with symptoms associated to gastroesophageal diseases. The histological features of esophagus biopsies were analyzed to determine the number of eosinophils per high power field (HPF). The variables sex, age, and endoscopic results of patients were compared with the frequency of cases diagnosed with EsEo. the annual fluctuation of rainfall, relative humidity, and temperature were correlated with the number of cases diagnosed to determine the influence of relevant environmental variations on the frequency and pathogenesis of EsEo

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