Sun RW, et al. – This report highlighted the clinical characteristics and treatment outcomes of eosinophilic esophagitis (EoE) in children under the age of 5 years. Accumulated data represented that approximately one–quarter of children with EoE had multiple esophageal symptoms, comorbidities, and allergen–sensitization profiles. However, these patients showed substantial clinicohistologic improvement following therapy.

Methods

• This study included patients under 5 years old.
• EoE was defined as the presence of symptoms of esophageal dysfunction with pathologically proven eosinophilic inflammation (≥15 eosinophils per high–power field [EOS/HPF]) unresponsive to reflux therapy.
• Patient parameters and clinical results were systematically reviewed.

Results

• Out of 558 children diagnosed with EoE, 127 (22.8%) were younger than 5 years old (mean age 2.5 years).
• This subgroup presented with reflux symptoms (90.1%), vomiting (86.2%), diarrhea (55.3%), liquid dysphagia (52.0%), and constipation (50.0%), whereas food impaction (1.6%) was rare.
• Liquid dysphagia was present at all ages but significantly more common in younger children (P = .0101).
• The most common food and environmental allergens were egg whites (39.7%), cow's milk (36.5%), peanuts (34.9%), animal dander (15.1%), and weed pollen (11.1%).
• Patients were managed with antireflux medication (100%), elimination diet (83.5%), and steroid medication (68.5%).
• After treatment, 86% of parents reported symptom improvement.
• Mean reduction of EOS in pos–treatment biopsy was 33.5 EOS/HPF (P < .0001).
• 67 patients showed histologic resolution of EoE (56.8%, P < .0001).