Whitney Rassbach1, Joel H Rubenstein2, Matthew Elkins3, Vera DeMatos4, Joel K Greenson5, Matthew Greenhawt6. 1. Division of Allergy and Clinical Immunology, The Ichan School of Medicine at Mount Sinai, New York, NY; Department of Medicine and Pediatrics, The University of Michigan Health System, Ann Arbor, Mich. 2. Division of Gastroenterology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Mich. 3. Department of Pathology, SUNY Upstate Medical University, Syracuse, NY; Department of Pathology, The University of Michigan Medical School, Ann Arbor, Mich. 4. Division of Gastroenterology, Department of Pediatrics, The University of Michigan Medical School, Ann Arbor, Mich. 5. Department of Pathology, The University of Michigan Medical School, Ann Arbor, Mich. 6. The University of Michigan Food Allergy Center; Ann Arbor, Mich; Division of Allergy and Clinical Immunology, Department of Internal Medicine, The University of Michigan Medical School, Ann Arbor, Mich; Department of Pediatrics, Child Health Evaluation and Research Unit, The University of Michigan Medical School, Ann Arbor, Mich. Electronic address: mgreenha@med.umich.edu.
Abstract
BACKGROUND: Eosinophilic esophagitis (EoE) is hallmarked by esophageal eosinophilia, >15 eosinophils(eos)/high-powered field (hpf), unresponsive to acid inhibition, and varied symptomatology. EoE consensus guidelines do not discriminate based on age for initiating treatment. OBJECTIVE: To evaluate if age-related differences exist in managing esophageal eosinophilia and EoE within a university population. METHODS: In a retrospective cohort study from a referral center, the medical records of 426 pediatric and adult patients with at least 1 presenting symptom of esophagitis, reflux, or upper gastrointestinal dysfunction, who underwent esophageal biopsy between 2009 and 2011 were analyzed for age-based differences in care in diagnosing and managing esophageal eosinophilia. RESULTS: For these patients, 79.6% (336/426) had ≥15 eos/hpf in biopsy specimens, which was not associated with age. Significantly fewer adults than children with ≥15 eos/hpf were diagnosed with EoE (P < .001), referred for allergy evaluation (P < .001), started on swallowed steroid therapy (P < .001), or underwent repeated biopsy (P < .001). Increasing age, atopy, and increasing biopsy peak eos count moderated these effects, but the adjusted predicted probabilities for these outcomes were significantly lower among adults. Restriction for an 8-week prebiopsy proton-pump inhibitor trial did not alter the age-based relationships for an allergy referral or repeated biopsy. CONCLUSIONS: Numerous age-based differences in the management of symptomatic patients with esophageal eosinophilia existed in this cohort. Adults were significantly less likely than children to receive a clinical diagnosis of EoE, allergy referral, or steroid treatment, or to have a repeated biopsy. Even when stratified for an 8-week prebiopsy proton-pump inhibitor trial, advancing age was associated with lower odds of referral or repeated biopsy. Further study is necessary to better understand why discrepancies exist and their potential ramifications.
BACKGROUND:Eosinophilic esophagitis (EoE) is hallmarked by esophageal eosinophilia, >15 eosinophils(eos)/high-powered field (hpf), unresponsive to acid inhibition, and varied symptomatology. EoE consensus guidelines do not discriminate based on age for initiating treatment. OBJECTIVE: To evaluate if age-related differences exist in managing esophageal eosinophilia and EoE within a university population. METHODS: In a retrospective cohort study from a referral center, the medical records of 426 pediatric and adult patients with at least 1 presenting symptom of esophagitis, reflux, or upper gastrointestinal dysfunction, who underwent esophageal biopsy between 2009 and 2011 were analyzed for age-based differences in care in diagnosing and managing esophageal eosinophilia. RESULTS: For these patients, 79.6% (336/426) had ≥15 eos/hpf in biopsy specimens, which was not associated with age. Significantly fewer adults than children with ≥15 eos/hpf were diagnosed with EoE (P < .001), referred for allergy evaluation (P < .001), started on swallowed steroid therapy (P < .001), or underwent repeated biopsy (P < .001). Increasing age, atopy, and increasing biopsy peak eos count moderated these effects, but the adjusted predicted probabilities for these outcomes were significantly lower among adults. Restriction for an 8-week prebiopsy proton-pump inhibitor trial did not alter the age-based relationships for an allergy referral or repeated biopsy. CONCLUSIONS: Numerous age-based differences in the management of symptomatic patients with esophageal eosinophilia existed in this cohort. Adults were significantly less likely than children to receive a clinical diagnosis of EoE, allergy referral, or steroid treatment, or to have a repeated biopsy. Even when stratified for an 8-week prebiopsy proton-pump inhibitor trial, advancing age was associated with lower odds of referral or repeated biopsy. Further study is necessary to better understand why discrepancies exist and their potential ramifications.
Authors: Martina Votto; Matteo Naso; Andrea Martina Clemente; Maria De Filippo; Ginevra Gargiulo; Veronica Granone; Giulia Siri; Gian Luigi Marseglia; Amelia Licari Journal: Acta Biomed Date: 2022-06-06