Age-based Differences in the Diagnosis and Management of Esophageal Eosinophilia

作者：Ras**ach Whitney; Rubenstein Joel H; Elkins Matthew; DeMatos Vera; Greenson Joel K; Greenhawt Matthew^*

来源：Journal of Allergy and Clinical Immunology-In Practice, 2015, 3(1): 81-+.

DOI：10.1016/j.jaip.2014.06.019

• Eosinophilic esophagitis
• Eosinophil
• Health disparities
• Care pathways
• Swallowed steroid therapy
• Esophagogastroduodenoscopy
• Allergy
• TIGER
• GERD
• Dysphagia
• Age
• Children
• Adults
• Biopsy
• Dilation
• Dietary therapy
• Esophageal biopsy

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.

• 出版日期2015-2