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.
|Grade (n)||Eosinophils/hpf||Eosinophil Microabscess||Lymphocytes/hpf||Lymphoid Aggregates||Submucosal Fibrosis|
|Grade (n)||Mean age||Gender (M:F)||Pain||Dysphagia||Heartburn||Abnormal EGD||Blood Eosinophilia|