[1987] Childhood Esophagitis – A Practice Audit

Michael C Lynch, Karmaine A Millington, Haresh Mani. Penn State Hershey Medical Center, Hershey, PA

Background: Consensus recommendations for diagnosis and treatment of eosinophilic esophagitis were published in 2007. We performed a clinicopathologic analysis and practice audit of childhood esophagitis to evaluate implementation of recommendations in a tertiary care academic center.
Design: All esophageal biopsies performed in children in a one-year period were reviewed and cases with esophagitis selected for study. Pathology slides were semiquantitatively graded for esophagitis as recommended (based on basal cell hyperplasia, papillary elongation and spongiosis) and evaluated for recommended elements (inflammation, eosinophil numbers and fibrosis). Medical charts were reviewed for all available clinical and laboratory information.
Results: Of 780 esophageal biopsies performed in the one-year-period, 208 (26.7%) had esophagitis. Mean patient age was 9.18 y (range 11d to 18y), with a male dominance. Epithelial eosinophilia and submucosal fibrosis correlated with increasing esophagitis grades. All grades showed mild lymphocytosis. Submucosal inflammation, when present, was predominantly lymphocytic, with eosinophil dominance in 8/108 (7.4%) cases. Lymphoid aggregates were seen in all grades. These pathologic parameters were rarely included in the original pathology reports.

Pathologic Features
Grade (n)Eosinophils/hpfEosinophil MicroabscessLymphocytes/hpfLymphoid AggregatesSubmucosal Fibrosis
Minimal (32)3.70/3294/81/8
Mild (75)138/75178/319/31
Moderate (64)3933/641814/3424/34
Severe (37)8834/37186/2517/25

Clinical details were available in 172 (82%) cases. 103/172 (60%) cases had esophageal dysfunction (pain or dysphagia). Dysphagia was comparable between grades, while pain decreased with increasing esophagitis. Heartburn was more frequent in minimal esophagitis, probably reflecting reflux esophagitis. Endoscopic findings were available for 151 (73%) cases, and was abnormal in 84/151 (56%) cases. Blood eosinophilia was uncommon. Allergen details were not available for any case.

Clinical Features
Grade (n)Mean ageGender (M:F)PainDysphagiaHeartburnAbnormal EGDBlood Eosinophilia
Minimal (32)9.2620:1214/254/2520/2511/201/15
Mild (75)9.1647:2833/609/6027/6022/542/32
Moderate (64)9.8145:1920/5310/5324/5329/461/27
Severe (37)8.3726:119/344/3419/3422/311/20

Conclusions: Consensus recommendations are not uniformly followed at either the clinical or pathology levels, thus diluting the utility of published guidelines. Wider awareness of guidelines and synoptic reporting will allow uniform assessment of pediatric esophageal biopsies and may help close gaps in disease knowledge.
Category: Quality Assurance

Tuesday, March 5, 2013 9:30 AM

Poster Session III # 297, Tuesday Morning


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