Food allergy, anaphylaxis, dermatology, and drug allergyEsophageal remodeling in pediatric eosinophilic esophagitis
Section snippets
Patient selection
An EE database was compiled at Children's Hospital San Diego of all patients meeting criteria for EE and an equal number of patients with gastroesophageal reflux disease (GERD).3 The biopsy used in this study was the first biopsy that demonstrated EE in the patient. EE was defined histologically as greater than 20 eosinophils per hpf on ×400 light microscopy. Patients with GERD were children who underwent diagnostic endoscopic esophageal biopsy for complaints of vomiting and pain consistent
Patient characteristics
The mean age of patients with EE (n = 7), patients with GERD (n = 7), and patients with a normal esophagus (n = 7) was 10.5, 8.4, and 11.2 years, respectively (Table I). All children with EE were male, whereas 57% of children with GERD and 86% of normal children were male. All of the patients with EE complained of dysphagia, whereas none of the patients with GERD or normal patients complained of dysphagia. Five of 7 patients with EE were known to be atopic (71%), 2 of 7 patients with GERD were
Discussion
In this study we have demonstrated the novel finding that several structural features associated with allergen-induced airway remodeling in patients with asthma are also occurring in the esophagus of pediatric patients with EE, especially in the subset of patients who have esophageal strictures. However, even nonstrictured patients with EE had increased fibrosis and vascularity compared with patients with GERD and normal patients, suggesting that the remodeling process is occurring even in the
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Supported by the American Academy of Allergy, Asthma & Immunology Education and Research Trust (ERT) Clinical Research Grant (S.S.A.), National Institutes of Health T32 Training award AI 007469 (S.S.A.), and National Institutes of Health grant AI 38425 (D.H.B.).
Disclosure of potential conflict of interest: S. S. Aceves has received grant support from the American Academy of Allergy, Asthma and Immunology Clinical ERT. D. H. Broide has received grant support from the National Institutes of Health. The other authors have declared that they have no conflict of interest.