There are many unknowns about primary eosinophilic gastrointestinal disease (EGID) in childhood. The aim of this study is to provide data about the frequency, management, control level and prognosis of well documented primary EGID in childhood.
This study was conducted in children who underwent endoscopy and/or colonoscopy at a single center over 10-year period up to August 2018. Primary EGID was diagnosed after exclusion of secondary EGID and classified as eosinophilic gastritis (EG), eosinophilic enteritis (EE), eosinophilic gastroenteritis (EGE: eosinophilic gastritis + eosinophilic enteritis) and eosinophilic colitis (EC) according to histopathological evaluation. The pathological number of eosinophil counts were accepted as >30 hpf for gastric mucosa in 5 hpf area, ≥20/hpf for duodenal, jejunal and ileal mucosa, >50/hpf for right colonic mucosa, >35/hpf for transverse colonic mucosa and >25/hpf for left colonic mucosa. Presenting symptoms, signs, management, follow up, disease control level and remission were analyzed. Remission is defined if the patient is controlled with all clinical, endoscopic/colonoscopic and histopathologic parameters without any treatments or diet for at least a year.
During the study period 7457 biopsies were taken in 8262 endoscopy and/or colonoscopy procedures. Primary and secondary EGID frequencies were found 0.23% (n: 17 patients) and 0.1% (n: 8 patients) per procedure with biopsy in children, respectively. Endoscopy/colonoscopy procedures were not able to performed in nine patients due to short follow-up period (n:6) or patients leaving follow-up (n:3). Nine of the primary EGID patients had esophageal eosinophilia (EsE) at the time of diagnosis, five of them was previously managed as EoE. The median follow-up period of primary EGID patients excluding the ones without a control endoscopy/colonoscopy procedure was 3.35 years (min-max: 1.1-9.0 years). Proton pump inhibitors (PPI) were the most frequently used treatment alone or in combination with diet, systemic and/or topical corticosteroids. Disease control was evaluated in 8 of 17 patients and it was uncontrolled in four, partially controlled in one and controlled in three patients. Remission was achieved in two patients.
The frequency of primary EGID beyond eosinophilic esophagitis (EoE) in children is low. It may be difficult to achieve control in children with primary EGID in the long term follow-up.