Age-based differences in the diagnosis and management of esophageal eosinophilia.

Abstract

BACKGROUND:

Eosinophilic esophagitis (EoE) is hallmarked by esophageal eosinophilia, >15 eosinophils(eos)/high-powered field (hpf), unresponsive to acid inhibition, and varied symptomatology. EoE consensus guidelines do not discriminate based on age for initiating treatment.

OBJECTIVE:

To evaluate if age-related differences exist in managing esophageal eosinophilia and EoE within a university population.

METHODS:

In a retrospective cohort study from a referral center, the medical records of 426 pediatric and adult patients with at least 1 presenting symptom of esophagitis, reflux, or upper gastrointestinal dysfunction, who underwent esophageal biopsy between 2009 and 2011 were analyzed for age-based differences in care in diagnosing and managing esophageal eosinophilia.

RESULTS:

For these patients, 79.6% (336/426) had ≥15 eos/hpf in biopsy specimens, which was not associated with age. Significantly fewer adults than children with ≥15 eos/hpf were diagnosed with EoE (P < .001), referred for allergy evaluation (P < .001), started on swallowed steroid therapy (P < .001), or underwent repeated biopsy (P < .001). Increasing age, atopy, and increasing biopsy peak eos count moderated these effects, but the adjusted predicted probabilities for these outcomes were significantly lower among adults. Restriction for an 8-week prebiopsy proton-pump inhibitor trial did not alter the age-based relationships for an allergy referral or repeated biopsy.

CONCLUSIONS:

Numerous age-based differences in the management of symptomatic patients with esophageal eosinophilia existed in this cohort. Adults were significantly less likely than children to receive a clinical diagnosis of EoE, allergy referral, or steroid treatment, or to have a repeated biopsy. Even when stratified for an 8-week prebiopsy proton-pump inhibitor trial, advancing age was associated with lower odds of referral or repeated biopsy. Further study is necessary to better understand why discrepancies exist and their potential ramifications.

• Authors: Whitney Rassbach, Joel H Rubenstein, Matthew Elkins, Vera DeMatos, Joel K Greenson, Matthew Greenhawt
• Journal: The journal of allergy and clinical immunology. In practice (J Allergy Clin Immunol Pract) 2015 Jan-Feb Vol. 3 Issue 1 Pg. 81-87.e1 ISSN: 2213-2201 [Electronic] United States
• PMID: 25577623 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Chemical References

• Adrenal Cortex Hormones
• Proton Pump Inhibitors

Topics

• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Age Factors
• Biopsy
• Cohort Studies
• Eosinophilic Esophagitis (diagnosis, pathology, therapy)
• Female
• Humans
• Male
• Proton Pump Inhibitors (therapeutic use)
• Referral and Consultation (statistics & numerical data)
• Retrospective Studies
• Young Adult