Medical Professional Publications

"Classic" Symptoms Not Enough to Diagnose EE

Using an imaging technique known as fluoroscopy to search for ring-like narrowing of the esophagus is not enough to diagnose children with a common gastrointestinal disorder, suggests research conducted at Nationwide Children’s Hospital.

Eosinophilic esophagitis is an inflammatory condition in which the wall of the esophagus becomes filled with large numbers of coarse white blood cells.  Eosinophilic esophagitis is more common than other well-known gastrointestinal disorders. Children with this condition commonly have difficulty swallowing, can get food lodged in their esophagus and can experience other upper gastrointestinal symptoms. Radiologic signs of eosinophilic esophagitis in adults have been reported, but little data is available regarding these findings in children.

In a study appearing in Pediatric Radiology, faculty from the Departments of Radiology, Gastroenterology and Pathology at Nationwide Children’s Hospital retrospectively reviewed the clinical, endoscopic and histologic findings of all children diagnosed with eosinophilic esophagitis at Nationwide Children’s during an eight-year period.  Of the 108 children identified, 17 had a fluoroscopic upper GI examination needed for this study.

Findings showed that radiologic abnormalities were demonstrated in a minority of the children. In 12 of the children, the upper GI was normal. Multiple, closely-spaced, ring-like narrowings of the esophagus suggested to be specific for eosinophilic esophagitis were found in only two of the 17 patients.

“As has been previously reported in other conditions, the symptoms of dysphagia and dysmotility are often out of proportion to the radiologic findings and such seems to be the case with eosinophilic esophagitis,” said Carlo Di Lorenzo, MD, chief of the Division of Pediatric Gastroenterology at the Nationwide Children’s and one of the study authors.  “Of particular interest is the lack of abnormal fluoroscopic findings in the four children who presented acutely with food impaction.”

Dr. Di Lorenzo says that if fluoroscopic upper GI examination is used as the benchmark for diagnosing eosinophilic esophagitis, it seems the condition may likely be missed in a number of patients. “The presence of esophageal narrowing or mucosal irregularity should raise suspicion for eosinophilic esophagitis and biopsy evaluation is needed to clarify the underlying cause and to help direct therapy,” he said.

Binkovitz LA, Lorenz EA, Di Lorenzo C, Kahwash S. Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation. Pediatr Radiol. 2009 Dec 18. [Epub ahead of print]

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