Treatment outcomes for eosinophilic esophagitis in children with esophageal atresia

Abstract

Eosinophilic esophagitis (EoE) has been reported to be more prevalent in patients with esophageal atresia/tracheoesophageal fistula (EA-TEF). To date, there is limited data on the management of EoE in this group of patients. The aim of this study is to evaluate the treatment outcomes of EoE in children with EA-TEF. A retrospective chart review was performed on all EA-TEF children who were diagnosed with and treated for EoE between January 2000 and September 2013 at the Sydney Children's Hospital. Data collected included details of the patient's treatment, post-treatment endoscopy, symptoms and nutrition. Twenty patients were included in the study. Median age at diagnosis was 26 months (8-103 months), and median time from diagnosis to last follow-up was 23 months (2-132 months). Patients were treated with budesonide slurry, swallowed fluticasone, elimination diet alone or in combination. All patients were on proton pump inhibitors at time of diagnosis of EoE which was continued. Six out of seven patients who had furrowing/exudate in endoscopy at diagnosis had complete resolution at a median follow-up period of 26 months (P = 0.031). Median peak intraepithelial eosinophil count reduced significantly from 30/high-powered field (HPF) (19-80/HPF) to 8/HPF (0-85/HPF) (median time for improvement = 24 months) (P = 0.015). There was a significant reduction in symptoms of dysphagia and reflux post-treatment (P < 0.001). Prevalence of strictures significantly decreased (P = 0.016), as did need for dilatations (P = 0.004). In four out of six patients with gastrostomies at baseline, the feeding improved on treatment of EoE and the gastrostomy could be closed. There was also a nonsignificant trend towards improvement in weight and height 'z scores' of the patients. Treatment of EoE in children with EA-TEF was found to significantly reduce intraepithelial eosinophil count, symptoms, strictures and need for dilatations.

Disease associations in eosinophilic oesophagitis and oesophageal eosinophilia

“…A high proportion of these patients exhibit evidence of food and/aeroallergen sensitisation and peripheral eosinophilia [102][103][104]. Chronic dysphagia that persists after oesophageal dilation and despite having achieved a normal calibre for the oesophageal lumen was found to be common among these patients [103], who also presented endoscopic features characteristic of EoE [102].…”

“…Several case reports and short case series published in the last decade have suggested that EoE is a frequent concomitant problem in patients with a history of congenital oesophageal deformities, specifically oesophageal atresia [100][101][102][103][104]. Oesophageal atresia, with or without an associated tracheo-oesophageal fistula, is a relatively common congenital malformation, with a live-birth prevalence of 1.8 per 10,000 births [105].…”

Eosinophilic esophagitis and esophageal atresia: coincidence or causality?

“…Results demonstrated that treatment improved dysphagia and reflux symptoms, and reduced eosinophil count, strictures, and the number of dilations required. 25 For the management of EoE and EA, the ESPGHAN and the NASPGHAN recommend to consider the consensus established for EoE treatment in the general population. 1,19 In sum, several authors consider it is important to study dysphagia, recurrent strictures, difficulty eating, and PPI-refractory reflux symptoms in patients with EA, not only with a contrast study but also with an EGD and multiple biopsies before performing an esophageal dilation and anti-reflux surgery.…”

Esofagitis eosinofílica y atresia esofágica: ¿casualidad o causalidad?

“…Los resultados demostraron que el tratamiento mejoraba los síntomas de disfagia y reflujo, disminuía el recuento de eosinófilos, estenosis y el número de dilataciones requeridas. 25 Para el manejo de EEo en AE, la ESPGHAN y NASPGHAN recomiendan tener en cuenta el consenso para tratamiento de EEo en la población general. 1,19 En resumen, diversos autores consideran importante investigar la disfagia, las estenosis recurrentes, las dificultades en la alimentación y los síntomas de reflujo refractarios a IBP en pacientes con AE, no solo con estudio contrastado, sino también con VEDA y múltiples biopsias antes de realizar una dilatación esofágica y cirugía antirreflujo.…”

“…La dilatación endoscópica se reserva para estenosis refractarias a pesar del tratamiento adecuado de su EEo y/o ERGE o si clínicamente está indicada (Figura 6). 6,18,19,25 n…”