Journal Article EE

[Guest guest]

Pediatr Dev Pathol 1999 Jan-Feb;2(1):15-8

Severity of esophageal eosinophilia predicts response to conventional

gastroesophageal reflux therapy.

Ruchelli E, Wenner W, Voytek T, Brown K, Liacouras C

Department of Pathology, Children's Hospital of Philadelphia, PA, USA.

Pediatric patients who present with symptoms of gastroesophageal reflux and

severe

eosinophilic esophagitis may be unresponsive to aggressive anti-reflux medical

therapy. In order to determine whether the degree of eosinophilia predicts

anti-reflux treatment response and possibly distinguishes different etiologies,

we

reviewed the initial biopsies of patients with esophageal eosinophilia and

compared

the number of eosinophils with the response to anti-reflux treatment. Over a

1-year

period, 102 patients with a biopsy demonstrating at least 1 intraepithelial

eosinophil were identified among patients undergoing initial endoscopy for

symptoms

of reflux. All patients were treated with H2 blockers and prokinetic agents.

Treatment response was classified into three categories: improvement, relapse,

and

failure. There were significant differences between the group who improved (mean

eosinophil count [MEC] 1.1 +/- 0.3 SEM) and those who failed (24.5 +/- 6.1 SEM,

P <

0.0025) or relapsed 6.4 +/- 2.4 SEM, P < 0.05). A threshold MEC value of > or =

7

provided a sensitivity of 61.3%, a specificity of 95.7%, and a predictive value

for

treatment failure of 86.1. A MEC value of < 7 provided an 85% predictive value

of

successful therapy. From these data we made the following conclusions: (1) The

number

of eosinophils has a predictive value of treatment response with > or = 7 per

high

power field offering a valuable clinical threshold for predicting outcome of

conventional therapy. (2) The variable response to conventional reflux treatment

may

reflect different etiologies. (3) Alternate medical treatment modalities may be

appropriate in the presence of severe eosinophilia, before considering surgical

intervention.

PMID: 9841701, UI: 99142267