LAUSR

OBJECTIVES To determine demographic and clinical characteristics of infants and toddlers < 2 years with eosinophilic esophagitis (EoE) and to assess treatment response in this rarely studied pediatric age group. METHODS Retrospective study of children < 2 years diagnosed with EoE at a single center from 2016-2018. EoE was defined by ≥15 eosinophils per high power field (eos/hpf) on at least one esophageal biopsy. Demographics, symptoms, and endoscopic findings were collected via chart review. EoE treatment (PPI, swallowed steroids, dietary restriction, or a combination) and treatment responses on all follow-up endoscopies were reviewed, with remission defined as < 15 eos/hpf. RESULTS Forty-two children ages 1.3 ± 0.4 years underwent 3.8±2.3 endoscopies over 3.6±1.7 years of follow-up. Thirty-six children (86%) were male, and comorbidities included atopy (86%), reflux (74%), and a history of cow's milk protein allergy (40%). Common symptoms were feeding difficulties in 67% of patients (with gagging or coughing with feeding in 60% and difficulty with progression to pureed or solid foods in 43%), vomiting (57%), and coughing/wheezing (52%). Of the 37 patients with follow-up endoscopies, 25 (68%) had histologic remission. There was an effect of therapy type on histologic response (P = 0.004) with the best responses seen on combinations of diet/steroids or diet/proton pump inhibitor (PPI) and the worst response seen on PPIs alone. All patients showed improvement in ≥ 1 symptom at the time of first follow-up endoscopy. CONCLUSIONS EoE should be considered in young children with feeding difficulties, vomiting, or respiratory symptoms. All patients improved clinically with standard medical or dietary interventions, however there is dissociation between clinical and histologic response with only 2/3 of patients achieving histologic remission.