Prevalence of Eosinophilic Esophagitis in Adolescents With Esophageal Atresia

Abstract

Background and Objective: Eosinophilic esophagitis (EoE) is an increasingly recognized childhood disease. Esophageal atresia (EA) is the most frequent congenital malformation of the esophagus. Recently, cases of EoE occurring in patients with EA have been reported, although the exact prevalence of EoE in EA remains unknown. The aim is to investigate the prevalence of EoE among EA in adolescents and to describe these patients' characteristics. Methods: Systematic upper gastrointestinal endoscopies with multistage esophageal biopsies were prospectively performed in 63 adolescents with EA. A standardized form was used to collect clinical and endoscopic data. Diagnosis of EoE was made as !15 intraepithelial eosinophils/high power field, whatever the response on proton pump inhibitors therapy. Results: Six patients (9.5%) presented an EoE (17-100 eosinophils/high power field). An atopic condition was reported more frequently in the eosinophil !15 group than in patients with no EoE (66% vs 16%; P ¼ 0.014). Except for chest pain, symptoms and endoscopic features were similar in patients with EoE and patients with no EoE. Conclusion: In our series of 63 patients born with EA, mainly distal tracheoesophageal fistula, the prevalence of EoE is increased, and therefore should be considered in adolescents with EA.

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

“…Among these, 15 The prevalence of EoE in our cohort of EA survivors (4.0%) was much greater than the 0.1-0.57% estimated in general population, 5 but lower than previously reported (9.5-30%). [11][12][13][14][15][16] Characteristics and main results of previous series are summarized in Table 3. Beside possible regional variability, the main factor accounting for this difference is the approach to esophageal biopsy sampling: "routine" versus "selective".…”

Eosinophilic Esophagitis in Esophageal Atresia

“…The 55% incidence of reactive airway disease in this study in the EA with EoE cohort was comparable with that reported in literature in EoE patients without EA (44). Atopy was also common in Oliveira (87.5%), Batres's (66%), Gorter's (50%), and Lardenoise study (6, 8, 12). The FIGERS consortium found that 67% of children with EoE had a positive skin prick testing (SPT) to at least one food (14).…”

“…In the same study by Pence et al, they did not find any symptoms which could distinguish between EA patients with EoE from EA patients without EoE or GERD patients, highlighting not only the difficulty of diagnosing EoE based on symptoms alone but also the importance of endoscopy and biopsy for diagnosis of EoE, in the EA cohort, especially in those being considered for fundoplication (42). In a prospective study on 63 adolescents with EA by Lardenois et al chest pain was the only symptom to occur significantly more in EA patients with EoE compared to EA patients without EoE (12).…”

Postoperative complications and long-term outcomes of tracheoesophageal fistula repair

“…EoE is a recognized chronic allergic/ immune condition of the esophagus, characterized by an infiltration of eosinophils in the esophageal mucosa. EoE, whose pathogenesis is unclear, has been reported in several patients following EA/TEF repair (30,70,71), with a prevalence that seems >100-fold higher than in the general population (72). The ESPGHAN-NASPGHAN guidelines recommend ruling out EoE in patients with GER symptoms and refractory to PPI, before proceeding to antireflux (72).…”

“…EoE, whose pathogenesis is unclear, has been reported in several patients following EA/TEF repair (30,70,71), with a prevalence that seems >100-fold higher than in the general population (72). The ESPGHAN-NASPGHAN guidelines recommend ruling out EoE in patients with GER symptoms and refractory to PPI, before proceeding to antireflux (72). For all of those who instead are asymptomatic, the guidelines recommended routine endoscopy throughout childhood, i.e., after stopping PPI therapy, before the age of 10 years, at transition to adulthood (25).…”