Background: Transnasal endoscopy (TNE) has been introduced in the care of pediatric patients with eosinophilic esophagitis (EoE) who require repeated esophagoscopies. TNE, as compared to conventional endoscopy, is less invasive and avoids sedation or anesthesia allowing for frequent assessments of the esophageal mucosa when making management decisions. The aim of this study is to review our early experience with TNE. Methods:We extracted data from all patients with EoE who underwent TNE at UH Rainbow Babies & Children's Hospital, Cleveland, Ohio from December 2018 to April 2021. We assessed total visit time, procedure time, success rate, and complications. Data are presented as percentages or medians with interquartile ranges (IQRs). Comparisons were made using Chi-square (and Fisher's exact) test for categorical data, Mann-Whitney test and the unpaired t-test for non-normally distributed and normally distributed data, respectively.Results: Thirty-three patients underwent 65 TNE procedures during our study period. The male-to-female ratio was 4.5:1 and median age was 13 years (IQR: 10 -15 years; range: 4 -20 years). Sixty-three (96.9%) of 65 procedures were completed. Distraction methods were used in all procedures (virtual reality goggles in 19.3% and television in 80.7%). Isolated elevated blood pressure (BP) measurements prior to the procedure were more frequent in those undergoing TNE as compared to sedated esophagogastroduodenoscopy (P = 0.04). We also calculated the heart rate (HR) for patients undergoing TNE and sedated upper endoscopy; no difference was noted (P = 0.71). Only minor adverse events occurred with TNE: nosebleed (n = 1), pre-syncope (n = 1), and pain (n = 4). None of the patients who underwent a sedated upper endoscopy developed an event. Two TNE procedures were not completed due to an inability to traverse the upper esophageal sphincter. Conclusions:We demonstrate TNE is an efficient and well-tolerated means of monitoring patients with EoE. Various straight forward distraction methods may contribute to the successful completion of the procedure. The safety as compared to conventional esophagoscopy requires large multicenter studies.

Background. Anemia is common in inflammatory bowel disease (IBD). Oral iron is widely used but efficacy can be reduced by poor compliance and insufficient absorption. Intravenous iron is safe and effective in adults but is not well studied in children. Purpose. To assess safety and efficacy of intravenous iron sucrose (IVIS) in children with IBD. Methods. We reviewed medical records of IBD patients <22 years of age who received IVIS at our institution between 2009 and 2014. Anemia was defined as hemoglobin (Hgb) level below normal for age and gender and iron-deficiency anemia as serum iron studies and red cell mean corpuscular volume below normal ranges. Each IVIS infusion was evaluated for safety. Efficacy was defined as ≥2 g/dL increase in Hgb ≤12 weeks from IVIS initiation. Results. We identified 88 patients (Crohn’s disease, n = 52; ulcerative colitis, n = 33; IBD-unclassified, n = 3) who underwent 329 IVIS infusions over 121 courses. No patient developed anaphylaxis. Six patients developed minor adverse reactions. Of the 121 IVIS courses, 80 were included in the efficacy evaluation. There was a significant rise in Hgb (mean 9.1 ±1.4 to 11.9 ± 1.8 g/dL; P < .0001, paired t test). Overall, 58.7% (47/80 courses) resulted in goal Hgb increase. Conclusions. IVIS is safe and effective in treating iron-deficiency anemia in pediatric IBD. There were only minor adverse events, and the observed rise in Hgb was clinically significant, with the majority achieving goal Hgb.

Purpose The prevalence of eosinophilic esophagitis (EoE) has been on the rise since it was first described in the 1990s. Several diseases and exogenous factors have been associated with EoE. Our aim was to investigate the epidemiology of EoE in cystic fibrosis (CF) patients. Methods We identified individuals with CF from September 2014 to September 2019 within a database (IBM Explorys Solutions, Inc.). The prevalence of EoE in patients with CF was compared to the general population. Results The database included 36,111,860 patients during the 5-year study period: 12,950 with CF (0.036%) and 28,090 with EoE (0.078%). EoE prevalence was higher in CF patients than the general population (46 in 10,000 vs. 7.8 in 10,000, p <0.001). Patients with CF and EoE were more likely to be male (50% vs. 33.5%, p <0.008), children (33.3% vs. 16.5%, p <0.001), and non-Hispanic (100% vs. 88.7%, p <0.001) than CF patients without EoE. CF with EoE patients were more likely to be children than EoE only (33.3% vs. 10.5%, p <0.001). Allergic conditions were generally more prevalent in CF with EoE than CF only (83.3% vs. 68.3%, p =0.01) and EoE only (83.3% vs. 69.3%, p =0.014). Conclusion EoE is nearly 6-times more prevalent in CF patients. Those patients had higher incidence of other atopic conditions. EoE must be considered in the differential diagnosis of patients with CF presenting with dysphagia, refractory gastroesophageal reflux, vomiting, and other esophagus-related symptoms.