Paroma Bose, MD1, Eric Albright, MD2, Muhammad T. Idrees, MD2, Cindy L. Sawyers, CCRC1, Anthony Perkins, MS2, Sandeep Gupta, MD, FACG3, Emily Hon, MD2
1Riley Hospital for Children / Indiana University School of Medicine, Indianapolis, IN; 2Indiana University School of Medicine, Indianapolis, IN; 3University of Illinois, Zionsville, IN
Eosinophilic esophagitis (EoE) is a clinicopathologic disease that requires endoscopy for evaluation. At this time, we do not have non-invasive methods to differentiate between EoE and non-EoE causes of esophageal dysfunction. The Pediatric Eosinophilic Esophagitis Symptom Score version 2 (PEESSv2.0) is an EoE-specific validated outcome metric for use by children and parents/caregivers, but its use has not been explored outside of EoE. Our primary aim was to determine if demographics, clinical history, or PEESSv2.0 scores can differentiate between EoE and non-EoE patients in children undergoing initial esophagogastroduodenoscopy (EGD) for esophageal dysfunction.
Methods: A prospective cohort study of pediatric patients was conducted at our center after IRB approval. Children ages 1-18 undergoing initial EGD for esophageal dysfunction were enrolled. Demographics, clinical history, and child self-report and parent-proxy report PEESSv2.0 symptom scores were collected at the time of endoscopy. Esophageal biopsies were reviewed by two blinded pathologists. EoE was defined as ≥ 15 eos/hpf seen in any level of the esophagus on biopsy with symptoms of esophageal dysfunction. Non-EoE was defined as < 15 eos/hpf.
Results: 72 children were enrolled in the study from 2015 to 2018 [58% (42/72) males; mean age 9.4 years; age range 1-17 years]. 56% (40/72) had ≥ 15 eos/hpf on esophageal biopsy and met criteria for EoE. 43% (31/72) had < 15 eos/hpf and were labeled non-EoE. Children with EoE trended towards being older than non-EoE patients (mean age 10.4 vs 8.3 years, p=0.070). Children with EoE were more likely to be male than non-EoE patients (70% vs 45.2%; p=0.051). Presence of personal or family history of atopy did not differ between these groups. Non-EoE children and their parents had higher (worse) mean PEESSv2.0 total scores than those with EoE (p=0.001 for child-report and p=0.049 for parent-proxy). PEESSv2.0 dysphagia subdomain scores (child and parent-proxy) did not differ between EoE and non-EoE groups.
Discussion: Children with EoE tended to be older and of male gender than non-EoE patients. Personal or family history of atopy did not increase likelihood of diagnosing EoE. Interestingly, the total PEESSv2.0 scores were worse in non-EoE group compared to EoE group. We plan to explore this unexpected finding by analyzing PEESSv2.0 subdomains and compare PEESSv2.0 with other EoE outcome metrics. These data may help stratify likelihood of EoE prior to subjecting a child to initial endoscopy.
Citation: Paroma Bose, MD; Eric Albright, MD; Muhammad T. Idrees, MD; Cindy L. Sawyers, CCRC; Anthony Perkins, MS; Sandeep Gupta, MD, FACG; Emily Hon, MD. P1683 - ARE THERE PREDICTORS OF EOSINOPHILIC ESOPHAGITIS IN CHILDREN UNDERGOING INITIAL ENDOSCOPY FOR ESOPHAGEAL DYSFUNCTION?. Program No. P1683. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.