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J Pediatr Gastroenterol Nutr 1998 Apr;26(4):380-5

Primary eosinophilic esophagitis in children: successful treatment with oral

corticosteroids.

Liacouras CA, Wenner WJ, Brown K, Ruchelli E

Division of Gastroenterology and Nutrition, The University of Pennsylvania

School of

Medicine, The Children's Hospital of Philadelphia 19104, USA.

BACKGROUND: The histologic appearance of esophageal eosinophils has been

correlated

with esophagitis and gastroesophageal reflux disease in children. Esophageal

eosinophilia that persists despite traditional antireflux therapy may not

represent

treatment failure, but instead may portray early eosinophilic gastroenteritis or

allergic esophagitis. In this study, a series of pediatric patients with severe

esophageal eosinophilia who were unresponsive to aggressive antireflux therapy

were

examined and their clinical and histologic response to oral corticosteroid

therapy

assessed. METHODS: Of 1809 patients evaluated prospectively over 2.5 years for

symptoms of gastroesophageal reflux, 20 had persistent symptoms and esophageal

eosinophilia, despite aggressive therapy with omeprazole and cisapride. These

patients were treated with 1.5 mg/kg oral methylprednisolone per day, divided

into

twice-daily doses for 4 weeks. All patients underwent clinical, laboratory, and

histologic evaluation before and after treatment. RESULTS: Histologic findings

in

examination of specimens obtained in pretreatment esophageal biopsies in

children

with primary eosinophilic esophagitis indicated significantly greater

eosinophilia

(34.2+/-9.6 eosinophils/high-power field [HPF]) compared with that in children

with

gastroesophageal reflux disease who responded to medical therapy (2.26+/-1.16

eosinophils/HPF; p < 0.001). After corticosteroid therapy, all but one patient

with

primary eosinophilic esophagitis had dramatic clinical improvement, supported by

histologic examination (1.5 +/-0.9 eosinophils/HPF, p < 0.0001). CONCLUSIONS:

Pediatric patients in a series with marked esophageal eosinophilia and chronic

symptoms of gastroesophageal reflux disease unresponsive to aggressive medical

antire-flux therapy had both clinical and histologic improvement after oral

corticosteroid therapy.

Comments:

Comment in: J Pediatr Gastroenterol Nutr 1998 Apr;26(4):468-71

PMID: 9552132, UI: 98211860

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