Nutritional outcomes in children with eosinophilic esophagitis

Abstract

Introduction: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. 1,2 EoE can lead to poor growth and nutrition due to both the disease process and its symptoms and through treatment with cortico-steroids and dietary elimination. The objective of this study was to assess nutrition parameters in children presenting with EoE. Methods: We performed a retrospective chart review of all patients presenting to Princess Margaret Hospital in Western Australia who were diag-nosed with EoE from May 2003 to July 2016. Data collected included demographics, endoscopic and histological findings, treatment and anthropometric measurements. Weight-for-age z scores were calculated for first recorded weight at presentation and last recorded weight at follow-up. World Health Organization growth charts were used for the 0-to 2-year age group and CDC charts for the 2-to 20-year age group. Results: One hundred patients were included. The median age at presentation was 7.9 years (range. 0.8-15.8) and 82% were male. The median follow-up period was 2.2 years (range, 0.03-13.3). Six percent of patients (median age, 5.5 years) had a weight z score of <-2 at diagnosis. Three of six (50%) had further decline in weight z score at last follow-up; one had slight improvement but with a weight z score that remained <-2; and two patients improved, with weight z scores of-0.95 and-1.25 respectively. Twelve percent of patients (median age, 4.3 years) had a weightz score between-2 and-1 at diagnosis. Three of 12 (25%) experienced further decline during the study period. Six (50%) continued to have a weight z score between-2 and-1. At follow-up, 13% of the entire cohort had a weight z score between-2 and-1. The median change in weight z score for the entire cohort between diagnosis and last follow-up was 0.01 (range,-2.25 to 1.89). A decline in an individual anthropometric z score of greater than 1 is an indication of faltering growth. Seven percent of patients in this cohort had a decline in weight z score of greater than 1. Only one of these patients had initial and follow-up weight z scores of <-2. Seventeen percent of patients in the entire cohort were undernourished, despite conven-tional treatment during the study period. Conclusions: Although malnutrition is not a major presenting feature of EoE, patients diagnosed with EoE who are already undernourished are likely to remain that way. Therefore, early identification and intensive medical therapy, supplemented with early dietitian assessment and inter-vention, is required. This underscores the need for close monitoring of growth in the management of children with EoE.L6244311942018-10-23 <br />