Sun Ravi W, Bonilla-Velez Juliana, Pesek Robert D, Johnson Adam B, Cleves Mario A, Richter Gresham T
Department of Otolaryngology-Head and Neck Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Arkansas Children's Hospital, Little Rock, Arkansas, U.S.A.
Laryngoscope. 2018 Apr;128(4):798-805. doi: 10.1002/lary.26838. Epub 2017 Sep 2.
OBJECTIVES/HYPOTHESIS: To delineate clinical characteristics and treatment outcomes of eosinophilic esophagitis (EoE) in the youngest of children.
Retrospective chart review.
A 7-year retrospective chart review of children with clinicopathologic diagnosis of EoE was performed with specific analysis of patients under 5 years old. EoE was defined as the presence of symptoms of esophageal dysfunction with pathologically proven eosinophilic inflammation (≥15 eosinophils per high-power field [EOS/HPF]) unresponsive to reflux therapy. Patient parameters and clinical results were systematically reviewed.
Of 558 children diagnosed with EoE, 127 (22.8%) were younger than 5 years old (mean age 2.5 years). This subgroup presented with reflux symptoms (90.1%), vomiting (86.2%), diarrhea (55.3%), liquid dysphagia (52.0%), and constipation (50.0%), whereas food impaction (1.6%) was rare. Liquid dysphagia was present at all ages but significantly more common in younger children (P = .0101). The most common food and environmental allergens were egg whites (39.7%), cow's milk (36.5%), peanuts (34.9%), animal dander (15.1%), and weed pollen (11.1%). Patients were managed with antireflux medication (100%), elimination diet (83.5%), and steroid medication (68.5%). After treatment, 86% of parents reported symptom improvement. Mean reduction of EOS in pos-treatment biopsy was 33.5 EOS/HPF (P < .0001), and 67 patients showed histologic resolution of EoE (56.8%, P < .0001).
Approximately one-quarter of children with EoE present under 5 years of age with multiple esophageal symptoms, comorbidities, and allergen-sensitization profiles. These patients demonstrate substantial clinicohistologic improvement following therapy.
目的/假设：明确最小年龄段儿童嗜酸性粒细胞性食管炎（EoE）的临床特征及治疗效果。
回顾性病历审查。
对经临床病理诊断为EoE的儿童进行了为期7年的回顾性病历审查，并对5岁以下患者进行了专项分析。EoE定义为存在食管功能障碍症状，且经病理证实有嗜酸性粒细胞炎症（每高倍视野≥15个嗜酸性粒细胞[EOS/HPF]），对反流治疗无反应。系统回顾了患者参数及临床结果。
在558例诊断为EoE的儿童中，127例（22.8%）年龄小于5岁（平均年龄2.5岁）。该亚组患者出现反流症状（90.1%）、呕吐（86.2%）、腹泻（55.3%）、流质吞咽困难（52.0%）和便秘（50.0%），而食物嵌塞（1.6%）较为罕见。流质吞咽困难在各年龄段均有出现，但在年幼儿童中更为常见（P = 0.0101）。最常见的食物和环境过敏原为蛋清（39.7%）、牛奶（36.5%）、花生（34.9%）、动物皮屑（15.1%）和杂草花粉（11.1%）。患者接受抗反流药物治疗（100%）、排除饮食（83.5%）和类固醇药物治疗（68.5%）。治疗后，86%的家长报告症状改善。治疗后活检中EOS的平均减少量为33.5 EOS/HPF（P < 0.0001），67例患者EoE的组织学表现消退（56.8%，P < 0.0001）。
约四分之一的EoE患儿年龄在5岁以下，伴有多种食管症状、合并症及过敏原致敏情况。这些患者在治疗后临床组织学表现有显著改善。
4。《喉镜》，128:798 - 805，2018年。
