From the Guidelines
The prevalence of eosinophilic esophagitis (EoE) in children with asthma is estimated to be around 1 in every 2000 people, although this condition is more common in individuals with atopic diseases, including asthma 1. Eosinophilic esophagitis is a chronic, rare, and food antigen-driven Th2 inflammatory condition of the esophagus that can occur in children and adults, with a higher prevalence in whites and males 1. The symptoms of EoE can be less specific in children and may include failure to thrive, feeding problems, vomiting, heartburn, and abdominal discomfort 1. Given the close interaction between EoE and other atopic diseases, such as asthma, it is essential to monitor children with asthma for symptoms of EoE, especially if they have other atopic conditions like allergic rhinitis or food allergies 1. Some key points to consider in the management of EoE include:
- The use of topical glucocorticosteroids, dietary elimination, and esophageal dilation as common management approaches 1
- The potential for proton pump inhibitors (PPIs) to be used as a treatment rather than a diagnostic test for EoE, as PPI-responsive esophageal eosinophilia is now considered part of the spectrum of EoE 1
- The importance of early diagnosis through endoscopy with biopsy to lead to appropriate management and improve quality of life for patients and their families 1.
From the Research
Prevalence of Eosinophilic Esophagitis in Children with Asthma
- The prevalence of eosinophilic esophagitis (EoE) in children with asthma is not directly stated in the provided studies, but it is known that EoE and asthma are frequently found as comorbid conditions in children and adults 2.
- A study found that 14 out of 376 children (3.7%) with aerodigestive symptoms refractory to medical treatment were diagnosed with EoE 3.
- Another study reported that the prevalence of EoE is approximately 34.4/100,000 worldwide, but it does not specifically mention the prevalence in children with asthma 4.
- EoE is frequently associated with asthma, and up to 80% of patients with EoE are atopic, similar to childhood asthma 5.
- The incidence and prevalence of EoE in children have increased significantly over the last two decades, and it is common among children with food impaction and dysphagia 6.
Comorbidities and Associations
- EoE and asthma share similar T helper 2 responses-driven pathophysiology and common management strategies 2.
- Gastroesophageal reflux disease is thought to affect asthma through microaspirations, airway hyperresponsiveness, and increased vagal tone, and the understanding of the relationship between gastroesophageal reflux and EoE is still evolving 2.
- EoE is more frequent in males, and asthma in children is also more common in boys, but this changes after puberty 5.
Diagnostic and Therapeutic Approaches
- The diagnosis of EoE requires an esophageal biopsy demonstrating at least 15 eosinophils per high-power field in the absence of other conditions associated with esophageal eosinophilia 4.
- Current therapies for EoE include proton pump inhibitors, topical steroid preparations, dietary therapy, and endoscopic dilation 4.
- Corticosteroids and allergen/food avoidance can improve symptoms in both asthma and EoE 5.