Eosinophilic esophagitis in esophageal atresia: Tertiary care experience of a “selective” approach for biopsy sampling

Abstract

Background: A high prevalence (9.5-30%) of eosinophilic esophagitis (EoE) in patients with esophageal atresia (EA) has been reported. The application of the EoE criteria to EA patients might be problematic. To date, only studies using a "routine" biopsy approach, even in asymptomatic patients, have been performed. The aim of the study was to establish the prevalence of EoE among symptomatic EA patients (EA/EoE group) without anastomotic stricture (AS) and to compare their characteristics with those of EoE patients from general population (EoE group).Methods: From 2005 to 2018, we reviewed charts of children with EA and EoE. "Selective" biopsy approach only in EA children without AS and/or endoscopic feature of EoE was performed. Characteristics of EA/EoE and EoE groups were compared.Results: Among 370 EA and 118 EoE, 15 EA/EoE patients were detected (4.0% of EA patients).Male predominance and a high prevalence of allergy without differences between EA/EoE and EoE groups was observed. EA/EoE children were significantly younger (p < 0.0001). PPIresponder patients were significantly more prevalent in EA/EoE group (p ¼ 0.045). Conclusion:Our data confirm that EA patients are at high risk for developing EoE. High incidence, early onset, and high prevalence of PPI-responders might suggest that esophageal motility disorders interact to increase propensity to EoE in EA patients. However, our study also suggests that overdiagnosis of EoE may occur in EA and that adapted criteria for EoE diagnosis should be developed for EA patients.

Eosinophilic Esophagitis in Esophageal Atresia: Is It Really a New Disease?

“…Many factors may explain these findings. The literature available on EoE prevalence in EA patients is contradictory: some studies identified a 20% prevalence [13][14][15], similar to the one that we report in the present study, while another recent cohort study detected a lower prevalence of less than 5% [16]. The main factor responsible for this discrepancy may be the different approaches to esophageal sampling: according to the ESPGHAN guidelines, endoscopy with biopsies is mandatory for the routine monitoring of GERD or any type of esophagitis in patients with EA; therefore, while Tambucci et al chose a "selective" approach in symptomatic children, we routinely perform esophageal biopsies during all routine endoscopies of the protocol, i.e., at 6-12 months before stopping PPI therapy and, in the case of asymptomatic patients, at 5, 10 and 15 years [3].…”

“…First, it seems that EA patients may have an earlier onset of EoE than children from the general population; as postulated before, this particular group of patients undergoes routine surveillance endoscopy with adequate biopsy mapping, which might enable the early diagnosis of EoE, even when symptoms are still mild [ 16 ].…”

“…In the literature available, the prevalence of atopic comorbidities is also reported to be high in cohorts of EA-EoE patients [ 16 , 24 ]. However, although allergies and atopy were prevalent among our EoE cohort of patients, only four children with EA-EoE presented with an allergy history.…”

Making the case for multidisciplinary pediatric aerodigestive programs

“…These include patients previously treated for esophageal atresia and tracheoesophageal fistula (Figure 3 ). Common complications among these patients include esophagitis[ 13 ], recurrent respiratory tract infection, tracheomalacia and poor growth with increased healthcare utilization[ 14 - 16 ]. Pediatric gastroenterology input can be crucial to evaluate for anatomic and mucosal esophageal abnormalities and for persistent tracheoesophageal fistula, which can be difficult to diagnosis.…”

Oral Viscous Budesonide in Children With Eosinophilic Esophagitis After Repaired Esophageal Atresia: A Clinical Trial

“…The estimated prevalence of EoE in EA ranges from 9.5% to 30% thus it is significantly higher than that observed in the general population (0.1%–0.5%) (6–11). Although, there is still an ongoing debate as to whether esophageal eosinophilia in EA patients shares the same pathophysiological mechanisms of EoE in the general population (12,13), current evidence indicates that treatments resulting in mucosal eosinophil count reduction led to a significant improvement of dysphagia and GERD symptoms and lower the occurrence of AS in EA children (8).…”