Evaluation of long-term course in children with eosinophilic esophagitis reveals distinct histologic patterns and clinical characteristics

Cathleen A Collins; Jacob Palmquist; James A Proudfoot; Alex Qian; Hannah Wangberg; Emad Khosh-Hemmat; Ranjan Dohil; Seema S Aceves

doi:10.1016/j.jaci.2019.06.015

Evaluation of long-term course in children with eosinophilic esophagitis reveals distinct histologic patterns and clinical characteristics

J Allergy Clin Immunol. 2019 Oct;144(4):1050-1057.e5. doi: 10.1016/j.jaci.2019.06.015. Epub 2019 Jun 28.

Authors

Cathleen A Collins¹, Jacob Palmquist¹, James A Proudfoot², Alex Qian³, Hannah Wangberg⁴, Emad Khosh-Hemmat¹, Ranjan Dohil⁵, Seema S Aceves⁶

Affiliations

¹ Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Rady Children's Hospital, San Diego, Calif.
² Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Altman Clinical Translational Research Institute, University of California, San Diego, La Jolla, Calif; Rady Children's Hospital, San Diego, Calif.
³ Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif.
⁴ Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Department of Medicine, University of California, San Diego, La Jolla, Calif.
⁵ Division of Gastroenterology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Rady Children's Hospital, San Diego, Calif.
⁶ Division of Allergy and Immunology, University of California, San Diego, La Jolla, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Department of Medicine, University of California, San Diego, La Jolla, Calif; Rady Children's Hospital, San Diego, Calif. Electronic address: saceves@ucsd.edu.

Abstract

Background: Eosinophilic esophagitis (EoE) is a chronic and increasingly prevalent antigen-driven disease. There is a paucity of information on long-term course in children.

Objective: We sought to understand the longitudinal trajectory of pediatric EoE during routine clinical care.

Methods: We prospectively enrolled children into an EoE database and reviewed their medical and pathologic records over 13 years.

Results: From 2011 to 2015, 146 children with EoE seen for their first visit at our center had 2 or more years of follow-up and 3 or more endoscopies over an average follow-up period of 5.13 years (range, 2-13 years). Longitudinal eosinophilic inflammation during treatment demonstrated 3 patterns over time. Children with less than 15 eosinophils/high-power field (hpf) for greater than 75% of their follow-up period were termed continuous responders (CRs). Children with waxing and waning inflammation of less than 15 eosinophils/hpf for less than 75% but 25% or more of the follow-up period were termed intermittent responders (IRs). Nonresponders (NRs) were defined as having less than 15 eosinophils/hpf for less than 25% of their follow-up. Fifty-nine (40%) of 146 patients were CRs, 65 (45%) of 146 were IRs, and 22 (15%) of 146 were NRs. CRs differed from IRs and NRs on the parameter of male/female ratio (1:1 in CRs, 4:1 in IRs, and 6:1 in NRs; P < .001) and in their initial response to any therapy, including proton pump inhibitors (P < .001). Endoscopic severity correlated with esophageal eosinophilia (r = 0.73, P < .001). On multivariate analysis, female sex and initial therapeutic response to medications or elimination diet were associated with long-term control of esophageal eosinophilia.

Conclusions: Long-term pediatric EoE followed 3 different longitudinal trajectories of inflammation. The long-term histologic groups differed significantly in biological sex and initial therapeutic response.

Keywords: Therapy response; elimination diet; eosinophil; eosinophilic gastrointestinal disorder; longitudinal; pediatric; topical corticosteroid.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Child
Child, Preschool
Eosinophilic Esophagitis / pathology*
Eosinophilic Esophagitis / therapy
Female
Follow-Up Studies
Humans
Infant
Male
Time
Treatment Outcome

Abstract

Publication types

MeSH terms

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