Frequency of Esophageal Eosinophilia in a Pediatric Population from Central Brazil

Abstract

Here we report a retrospective cross-sectional study on Esophageal eosinophilia (EsEo) frequency in Brazil, for 2, 425 pediatric patients with symptoms associated with gastroesophageal diseases in 2012. EsEo is defined by ≥15 eosinophils per high power field (400x) and confirmed through histological analyses of esophageal biopsies. Overall, 126 patients had EsEo equating to a frequency of 5.2%. There was a significant difference between the endoscopic features of patients with EsEo, where 10.7% had erosive esophagitis, 3.0% had non-erosive esophagitis and 1% showed normal esophageal mucosa. According to the interaction of the variables in the Classification and Regression Tree Analysis, most patients diagnosed with EsEo were older males with erosive esophagitis. On the other hand, the lowest frequency of EsEo was found among younger females with non-erosive esophagitis/normal mucosa. Environmental conditions, including climate variation and changes, were observed in association with EsEo, supporting a potential role for environmental factors in its pathogenesis. There was an inverse correlation between the number of EsEo, rainfall and humidity. EsEo is a relatively frequent finding in the pediatric population of Brazil with symptoms of gastroesophageal diseases. Both clinical and histological examinations of patients are important for a reliable diagnostic of EsEo cases and to patient care.

Distribution of eosinophils in the gastrointestinal tract of children with no organic disease

“…In accordance with previous studies, the distribution of the eos in our study showed a gradual increase across the proximal segments of the GI tract, from the esophagus to the ileum, followed by a subsequent gradual decrease from the first segments of the colon to the rectum [ 3 , 4 ]. The range of eos/hpf in esophageal biopsies in our study was consistent with the findings of previous studies that reported up to 6 eos/hpf in healthy esophageal mucosa of children between 7-15 years of age [ 13 , 14 ].…”

Clinical presentation of eosinophilic esophagitis in the pediatric age

“…Interestingly enough, performing a specific genetic panel for EoE demonstrated that, at a genetic level, EoE prevalence is lower in Hispanic patients compared to Caucasians 5 . Brazil reported an EoE incidence in children similar to North America (5%), with a preference toward males of 2.5:1 6 .…”