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G74(P) Paediatric Eosinophilic Oesophagitis – A Tertiary Gastro-Allergy Experience
  1. K Fawbert1,
  2. E Minshall2,
  3. N Francis3,
  4. J Warner2,
  5. J Fell1,
  6. J Epstein1
  1. 1Paediatric Gastroenterology, Chelsea & Westminster Hospital, London, UK
  2. 2Paediatric Allergy, St. Mary’s Hospital, London, UK
  3. 3Histopathology, St. Mary’s Hospital, London, UK

Abstract

Aims Eosinophilic oesophagitis (EoO) is a chronic immune-mediated condition characterised by oesophageal dysfunction and eosinophilic infiltration. We aimed to evaluate the presenting symptoms and investigation results at presentation and to consider the role of allergy assessment within treatment.

Methods We performed a retrospective case review of 34 patients with EoO under the care of a Paediatric Gastroenterology and a Paediatric Allergy Centre focussing on presentation and management.

Results Case notes were reviewed in 34 patients with EoO. Age at diagnosis ranged from 0.83–16 yrs (mean 7.3 yrs). Of our cohort 24 were male and a minority were white British (43%). Most were referred from Hospital Paediatricians (38%). Z scores for weight ranged from –3.31 to +2.71 SD, with three patients below –2 SDS. Z scores for height ranged from –2.67 to 2.05 SD. The commonest presenting symptoms were vomiting (62%), abdominal pain (47%), dysphagia (38%), and regurgitation (21%). Twenty two patients had atopic diagnoses. At presentation, ten patients were on no treatment. Treatments included a PPI (n = 20; 63%) and montelukast (n = 18;53%). The circulating eosinophil count was elevated in 62% of patients (mean 0.74 × 109/L) and the majority had a raised total IgE (85%; median 435 kU/L). Specific IgE was determined in 71% (24/34) with positive tests to egg (71%), milk (63%), wheat (52%), and soy (50%). Skin prick tests were performed in 23 children, with 15 (65%) positive to foods, and 14 positive to aeroallergens (61%). At endoscopy, macroscopic abnormalities were seen in 59%. On histological examination, the mean eosinophil count was 26/hpf (range 15–50/hpf). After diagnosis, 26 commenced dietary restriction, 19 started PPI therapy and 14 continued on a PPI. Nine were commenced on topical or systemic steroids.

Conclusion Our cohort was predominantly male, with a high rate of atopy in concordance with previously published data. The most widely reported symptoms were vomiting, abdominal pain, dysphagia and regurgitation. Most had an eosinophilia with raised total and specific IgE. Clinical heterogeneity was reflected in the presentation and wide variety of drug and dietary treatments commenced before referral. Allergy testing was often useful in guiding treatment, although management strategies varied.

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