Submitted, Not Presented: Esophagus.

Abstract

Introduction: Transitioning pediatric patients diagnosed with eosinophilic esophagitis (EoE) to an adult gastroenterology practice continues to be a challenge in proper treatment and management of this disease. Furthermore, long term treatment outcomes in this patient population are not known. Our aim was to identify patients with EoE and follow their course from diagnosis into adulthood, while also describing their response to treatments.Table: Table. Symptom and Eosinophil Count/hpf Compared from First to Last VisitMethods: Records were reviewed and 26 patients with a diagnosis of EoE were identified who had been seen at our healthcare system as pediatrics and had transitioned into adulthood. Patient encounters, symptoms, atopy testing, esophagogastroduodenoscopy (EGD) reports, and treatments were pulled retrospectively from patient's chart and analyzed in detail. Results: Our main findings were: 1. Most of the patients were male (n=19, 73%), and only three patients had no other atopic diagnoses (n=3, 11%). The concomitant hypersensitivity diagnoses included environmental allergies (n=17, 65%), food allergies (n=19, 73%), inflammatory bowel disease (n=4, 15%) and asthma (n=6, 23%). 2. All patients received PPI's at one point, and a majority were placed on either targeted or 6 food diet restriction (n=22, 85%). Other interventions included topical steroids (n=12, 46%), elemental diet (n=3, 11%), H2 antagonists (n=4, 15%), reslizumab (n=2, 8%), dilatation (n=2, 8%), and oral steroids (n=1, 4%). 3. Two of the patients (8%) have transitioned to our adult GI center, but only after being lost to follow up for several years and returning due to worsening of symptoms. They were the only patients in our cohort to progress to the fibrostenotic subtype and require dilatation. 4. Overall, there was significant improvement in patient's eosinophil counts/hpf (n=18, p < 0.01) and symptom scores (n=26, p < 0.01) when comparing their counts and scores at first visit to their last visit. 5. Six of the patients (75%) who did not have symptom improvement also did not have more than one EGD performed or follow up as directed. Conclusion: In conclusion, transitioning patients from pediatric to adult GI centers continues to be a challenge. Non-compliance results in persistence of symptoms and, in two cases, led to development of the fibrostenotic subtype. A significant proportion of our patients had improvement in both histology and symptoms with treatment. Greatest response rates were seen in patients on combined PPI and diet restriction therapy.