Evaluation of Long-term Course in Children with Eosinophilic Esophagitis Reveals Distinct Histologic Patterns and Clinical Characteristics.

Abstract

BACKGROUND\nEosinophilic esophagitis (EoE) is a chronic, increasingly prevalent antigen driven disease. There is a paucity of information on long-term course in children.\n\n\nOBJECTIVE\nTo understand the longitudinal trajectory of pediatric EoE during routine clinical care.\n\n\nMETHODS\nWe prospectively enrolled children into an EoE database and reviewed their medical and pathology records over 13 years.\n\n\nRESULTS\nFrom 2011 to 2015, 146 EoE children seen for their first visit at our center had ≥2 years of follow up and ≥3 endoscopies over an average follow up time of 5.13 years (range 2-13). Longitudinal eosinophilic inflammation during treatment demonstrated 3 patterns over time. Children with <15 eosinophils per high power field (hpf) for >75% of their follow up time were termed continuous responders (CR). Children with waxing and waning inflammation of <15 eosinophils per hpf for <75% but ≥25% of follow up time were termed intermittent responders (IR). Non- responders (NR) were defined as <15 eosinophils per hpf for <25% of their follow up. 59 of 146 (40%) patients were CR; 65 of 146 (45%) were IR; 22 of 146 (15%) were NR. CR patients differed from IR and NR patients on the parameters of male to female ratio (1:1 in CR, 4:1 in IR, 6:1 in NR) (p<.001) and in their initial response to any therapy, including PPI (p<.001). Endoscopic severity correlated with esophageal eosinophilia (r=0.73, p<.001). On multivariate analysis, female sex and initial therapeutic response to medications or elimination diet associated with long-term control of esophageal eosinophilia.\n\n\nCONCLUSIONS\nLong-term pediatric EoE followed 3 different longitudinal trajectories of inflammation. The long-term histologic groups differed significantly in biological sex and initial therapeutic response.