The spectrum of eosinophilic oesophagitis in a district general hospital in the UK

Abstract

Eosinophilic oesophagitis (EE) is increasingly seen in children with gastro-oesophageal reflux disease (GORD) symptoms. There are reports of rare association in syndromes such as Rubenstein–Taybi syndrome. Although there is no clear association, EE has been seen in neurodisability children. Aim To study the epidemiology, clinical presentation, investigations and response to treatment. Methods The case notes of children diagnosed with EE were reviewed for clinical symptoms, investigations, and response to treatment. Results From 2004–2009, 31 patients were diagnosed with EE in our GI clinic based on standard endoscopic and histologic criteria. The youngest was a male 16 month old, and the oldest was 15 years. The gender ratio was 24 males to 7 females. 21 patients had other associated disorders. One patient has Asperger9s syndrome and celiac disease confirmed on endoscopy. Another patient has attention deficit hyperactive disorder, and two patients have global developmental delay with chromosomal abnormalities. One patient had arthrogryposis multiplex. Five patients had asthma, and three patients with multiple food allergies. One patient with mastocytosis was shown on biopsy of a small skin lesion removed surgically from his anterior chest wall. Another patient had eosinophilic colitis as well as EE. 21 patients have high IgE levels, of which 19 had specific radioallergosorbent test positivity. In 10 patients, the eosinophil count was mildly elevated in the peripheral blood. 24 of 31 patients improved clinically following treatment with swallowed fluticasone and montelukast. However, only 14 of 31 demonstrated endoscopic improvement, of which 10 had an eosinophil count of less than 20/hpf. Discussion EE should be considered in patients with atopy, and food aversion or intolerance. Children with learning difficulties, chromosomal abnormalities, autism, and Asperger9s syndrome should also be investigated for EE even if the symptoms are attributed to GORD. Although most patients with EE respond clinically to medical treatment, endoscopic response should be sought, as it may be necessary to retreat, or to consider monoclonal anti-IL-5 antibody. Conclusions Symptomatic children with allergy and a strong family history of atopy, and children with neurodisability should be investigated for EE. High IgE is a useful surrogate marker for EE in the presence of GI manifestations.