Incidence of Pediatric Eosinophilic Esophagitis and Characterization of the Stricturing Phenotype in Alberta, Canada

JPGN Reports · 3 authors, 2 centres

AI SUMMARY

FIDELITY 94%

POPULATIONChildren <16 years old newly diagnosed with EoE at Stollery Children's Hospital, Edmonton, Alberta, Canada (2015-2018)

INTERVENTIONDiagnostic endoscopy and treatment (PPI, dietary elimination, topical steroids); mechanical dilation for strictures

COMPARISONPatients with vs. without esophageal narrowing (strictures, subtle narrowing, no narrowing)

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AGENT 01 · STRUCTURED SUMMARY

TRACE TO SOURCE

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TL;DR

This study found that pediatric eosinophilic esophagitis (EoE) incidence in Edmonton, Alberta is 11.1 per 100,000 person-years, one of the highest reported. Among 185 new cases, 4% had focal esophageal strictures and 6% had subtle narrowing, with mechanical dilation being safe. The findings highlight the need for awareness of stricturing phenotypes in pediatric EoE.

Full summary

3,212 CHARS

**Background:** Eosinophilic esophagitis (EoE) is an increasingly recognized cause of esophageal dysfunction in children, with reported incidences ranging from 0.7 to 10 cases per 100,000 person-years. The most severe manifestation is esophageal stricture, which is common in adults (up to 70%) but less frequent in pediatrics (around 8%). However, rates vary widely (0.2%–28%). This study aimed to report the first Canadian pediatric EoE incidence using 2018 AGREE diagnostic criteria, characterize the stricturing phenotype, and assess endoscopy safety, including dilation.

**Methods:** A retrospective chart review was conducted at Stollery Children’s Hospital (Edmonton, Alberta) for all new EoE cases from 2015 to 2018. Cases were identified via esophageal biopsy reports, EoE clinic lists, and an OR database of esophageal dilatations. Diagnosis required ≥15 eosinophils per high-powered field and symptoms of esophageal dysfunction per 2018 AGREE criteria. Incidence rates were calculated using 2016 census data for patients <15 years old in Northern Alberta. Clinical, endoscopic, and pathology data were extracted from EMRs. Adverse events were captured from multiple sources, including a detailed peri-endoscopy review of 75 patients (all 19 with narrowing and 56 without). Treatment efficacy was analyzed post-hoc for PPI, dietary elimination, and topical steroids.

**Key Results:** A total of 185 new EoE cases were identified. The incidence for 0- to 14-year-olds was 11.1 per 100,000 person-years in Edmonton and 9.1 in Northern Alberta. Incidence was highest in the 10–14 age group (18.1 in Edmonton) and lower in rural (4.1) vs. urban (10.6) areas. Of the 185 patients, 8 (4.3%) had focal esophageal strictures, 4 (2.1%) required dilation, and 11 (5.9%) had subtle narrowing, for a total narrowing rate of 10.3%. Patients with strictures had higher median age at diagnosis (13.1 years vs. 9.5 years for no narrowing) and longer symptom duration (15 months vs. 12 months). Food impaction was more common in stricture patients (87.5%) vs. those without narrowing (20.5%). No perforations or significant bleeding occurred in 239 EGDs reviewed, including 28 scopes with strictures and 16 dilations. Pain was reported after 50% of scopes with strictures and 63% of dilation scopes, vs. 8% in non-narrowing scopes. No unexpected admissions or ED visits occurred within 72 hours post-EGD. In the treatment analysis, topical steroids induced histologic remission (peak eosinophils <15/HPF) in 64% of patients, dietary elimination in 44%, and PPI in 17%.

**Clinical Implications:** This study reports one of the highest pediatric EoE incidences globally, with a notable urban predominance. The 10% esophageal narrowing rate, including 4% focal strictures, underscores the importance of early diagnosis to prevent fibrotic complications. Mechanical dilation appears safe in children, though post-procedural pain is common. The lower efficacy of PPI compared to steroids and dietary elimination supports current guidelines emphasizing topical steroids as first-line therapy. The findings highlight the need for multicenter studies to better understand stricturing pathophysiology and optimize management.

PICO

PPOPULATION

Children <16 years old newly diagnosed with EoE at Stollery Children's Hospital, Edmonton, Alberta, Canada (2015-2018)

IINTERVENTION

Diagnostic endoscopy and treatment (PPI, dietary elimination, topical steroids); mechanical dilation for strictures

OOUTCOME

Incidence of EoE; proportion with strictures/narrowing; adverse events (perforation, bleeding, pain); treatment efficacy (histologic remission, endoscopic remission)

STUDY TYPE

cohort

SPECIALTY

gastroenterology

SUMMARISED BY

AI pipeline

FIDELITY CHECK

94% · A

ORIGINAL PAPER

PMC10191577

Incidence of Pediatric Eosinophilic Esophagitis and Characterization of the Stricturing Phenotype in Alberta, Canada

JPGN Reports

READ THE FULL PAPER

ABSTRACT

Introduction: Limited work has been done to characterize the stricturing pediatric eosinophilic esophagitis (EoE) phenotype. We aimed to determine, in pediatric EoE: the local incidence, the frequency of esophageal stricturing, and the safety of mechanical dilations. Methods: We retrospectively identified all new cases of EoE at our center from 2015 to 2018 using esophageal biopsy reports, EoE clinic lists, and a local OR database of esophageal dilatations. Electronic medical records (EMRs) were reviewed to confirm EoE diagnosis. Clinical data were captured from the outpatient EMR and gastroscopy/pathology reports. Scope adverse event data were captured from multiple sources. The 2016 census data were used to calculate incidence rates. Results: One hundred eighty-five new cases of EoE were diagnosed during the study period. For patients <15 years old living in Edmonton, the incidence over the 4 years was 11.1 cases per 100,000 person years. Eight of 185 (4%) patients had endoscopically confirmed esophageal strictures, 4 of which required mechanical dilation. Eleven of 185 (5.9%) patients had more subtle signs of esophageal narrowing, but no focal strictures. No perforations or episodes of significant bleeding were reported. Pain was reported after 15% of all scopes, including 50% of the 28 scopes with focal strictures. No unexpected admissions or emergency department visits occurred within 72 hours of a gastroscope with esophageal narrowing. Conclusions: Edmonton zone has one of the highest incidences of pediatric EoE reported. In this cohort, 4% had focal esophageal strictures, and 6% had more subtle narrowing. Mechanical dilation of esophageal strictures was associated with no significant adverse events.

CITATION EXPORT

David Burnett, Rabin Persad, Hien Quoc Huynh. Incidence of Pediatric Eosinophilic Esophagitis and Characterization of the Stricturing Phenotype in Alberta, Canada. JPGN Reports. (2021). https://doi.org/10.1097/PG9.0000000000000136

AUTHORS

3 · 2 CENTRES

David Burnett, Rabin Persad, Hien Quoc Huynh

From the *University of Alberta
†University of Saskatchewan.