Long-term Outcomes in Pediatric-Onset Esophageal Eosinophilia

Abstract

There are limited data reporting the natural history of pediatric eosinophilic esophagitis (EoE). Specifically, data describing quality of life in children with EoE as they progress into adulthood are incomplete. This study attempted to characterize long-term clinical outcomes in patients with pediatric EoE.The cohort consisted of 3817 pediatric patients who underwent an esophageal biopsy at a large pediatric children’s hospital between 1982 and 1999. An age-matched control group was recruited from a local university.A nested case-control study of patients retrospectively identified histologic EoE (≥15 eosinophils/high-power field) and chronic esophagitis (<15 eosinophils/high-power field). Once cohorts were identified, they were sent an introductory letter, consent form, and study questionnaires. The 4 study questionnaires included the validated 12-item Short-Form Health Survey, Mayo Dysphagia Questionnaire, Reflux Disease Questionnaire, and general medical questionnaire developed by the study’s authors.A total of 666 subjects of the original cohort of 3817 were identified as having reflux esophagitis. One hundred ninety-eight (30%) fit criteria of EoE (rEoE) and 468 (70%) were classified as having chronic esophagitis (CE). Forty-two of the 198 in the rEoE group and 67 of the 468 in the CE group completed the study and were included in the analysis. Quality of life was significantly decreased in both the rEoE group and the CE group compared to controls (P < .001). Rates of dysphagia and food impaction were significantly increased in the rEoE group compared to the controls. Increased esophageal eosinophil counts during childhood were predictive of dysphagia during early adulthood (odds ratio, 1.6; 95% confidence interval [CI], 1.1–2.5; P < .05). Food allergy (odds ratio 2.7; 95% CI, 1.2–6.0; P < .01), allergic rhinitis (odds ratio, 3.5; 95% CI, 1.8–6.8; P < .001), and asthma (odds ratio, 2.1; 95% CI, 1.02–4.3; P = .04) were associated with dysphagia. Food impaction was more common among patients with reported food allergy (odds ratio, 3.1; 95% CI, 1.2–7.8: P = .02).EoE is associated with reduced quality of life and persistent symptoms 15 years after presentation. Increased esophageal eosinophil counts, food allergy, and atopy in childhood increase the rate of dysphagia in early adulthood.Limited data are available on the long-term outcome of untreated EoE. This study highlights the need to identify and appropriately manage pediatric patients with EoE to prevent long-term sequelae.