Eosinophilic Esophagitis in Children from Western Saudi Arabia: Relative Frequency, Clinical, Pathological, Endoscopic, and Immunological Study

Background and Purpose. Eosinophilic esophagitis (EE) is an evolving allergic disease with an accelerated incidence. The purpose of this study was to delineate the relative frequency and clinicopathological characteristics of EE in children from western Saudi Arabia. Methods. Children with EE were studied retrospectively between October 2002 and December 2011 at King Abdulaziz University Hospital and International Medical Center. Results. The relative frequency of EE was 0.85% of 2127 upper gastrointestinal endoscopies performed during the study period. Eighteen patients were identified with EE. The median age was 8.6 years (range, 1.5–18 years). Thirteen (72.2%) were males. Dysphagia and vomiting were the most common symptoms. Ten (55.6%) children had history of atopy. Testing for food allergy by skin prick test was positive in 11 (61.1%). The most common endoscopic abnormalities were mucosal longitudinal furrow and loss of vascular pattern followed by patchy specks and strictures. The histopathological findings included increased intraepithelial eosinophils, eosinophilic degranulation, lamina propria fibrosis, and eosinophilic microabscesses. Treatment was initiated by swallowed topical corticosteroids in 12 (66.7%) and oral prednisolone in 6 (33%) patients, followed by low dose of topical corticosteroids and dietary elimination. Conclusions. Eosinophilic esophagitis is an uncommon but evolving problem. A high index of suspicion is required for early identifications and intervention to avoid possible complications.