L’œsophagite à éosinophiles. Présentation, bilan allergologique et traitement : à propos de 22 cas

Abstract

Eosinophilic esophagitis (EE) is a disorder characterized by severe eosinophilic infiltration of the esophagus, with dysphagia and gastroesophageal reflux disease (GERD) symptoms unresponsive to acid blockade therapy but responsive to the removal of dietary antigens. We report information relating to children diagnosed with EE in Nice, France, over a 6-year period. We conducted a retrospective study between January 1, 2004, and July 31, 2009, evaluating all children diagnosed with EE. Clinical and demographic data, endoscopic and histological findings, allergology data, and results of treatment were collected and evaluated. A total of 22 patients, 19 males, median age 9.5 years (range: 0.8-19 years) were reviewed: 7 presented isolated dysphagia, 6 presented GERD symptoms, and 9 both dysphagia and GERD symptoms. Endoscopically, 14 had multiple esophageal white plaques, 7 had linear furrowing, 5 had circular "tracheal" rings, and 5 esophageal narrowing. The median number of esophageal eosinophils/high power field (×400) was 30 (range: 15-80). Eosinophils were localized in the distal, middle, and upper esophagus. Immunoallergy analysis findings were: high peripheral eosinophil count (74%), high total IgE level (65%), high eosinophil cationic protein (ECP) level (90%) with a median value of 69.5 μg/l and high urinary leukotriene E4 (88%). Food antigen sensitization was positive in skin-prick testing in 11 of 18 and in atopy-patch testing in 9 of 17. Dietary restriction improved clinical symptoms in 5 of 10 and local corticotherapy with viscous budesonide improved clinical symptoms in 9 out of 10. EE diagnosis must be considered in children with dysphagia or GERD who do not respond to acid blockade therapy. ECP may be used to guide diagnosis. Local corticotherapy is effective.