Children with asthma may have a significantly higher prevalence of eosinophilic esophagitis (EoE) than previously recognized. EoE is a chronic, progressive inflammatory disease of the esophagus often associated with allergic conditions such as asthma. Thanks to new research outlined in the paper, “Screening for Eosinophilic Esophagitis in the Pediatric Asthma Clinic Leads to Increased Diagnosis and Identifies a High Prevalence of Disease,” a simple, symptom-based screening process in a pediatric asthma clinic could improve identification of the condition and prevent serious long-term complications. The paper was published in The Journal of Allergy and Clinical Immunology: In Practice.
EoE can be subtle or mistaken for other gastrointestinal issues and diagnosis is frequently delayed, the study’s authors noted, increasing the risk of complications including esophageal strictures and growth problems in children.
To better understand how common the disease is among pediatric asthma patients, researchers administered a modified Pediatric Eosinophilic Esophagitis Symptom Severity (PEESSv2.0) questionnaire to 189 children with asthma, ranging in age from 3 to 17 years, at a tertiary-care asthma and allergy clinic. Patients who reported symptoms considered concerning for EoE were referred for further evaluation by gastroenterology specialists.
The screening process produced striking results, the authors said. More than 80% of participants screened positive for at least one concerning symptom. Of those screened positive, nearly half were referred to a gastroenterologist, and 44 patients completed the referral process. Twenty-four children ultimately underwent an endoscopy, the diagnostic procedure used to confirm EoE. Among those examined, one-third were diagnosed with the disease.
Based on these findings, researchers estimated that approximately 8% of asthma patients in the clinic population had EoE. When accounting for eligible patients who did not participate or were lost to follow-up, the estimated prevalence increased to nearly 14%, suggesting the condition may be substantially underdiagnosed in children with asthma, investigators noted. The authors also found that vomiting was the only individual symptom significantly associated with an eventual EoE diagnosis, indicating that this symptom may warrant particular attention during clinical evaluations.
The demographic profile of children diagnosed with EoE closely reflected that of the overall study group, with 75% identifying as non-white. Researchers noted that systematic screening could help reduce racial disparities in diagnosis while enabling earlier intervention for affected children.
The study’s authors concluded that routine EoE screening in pediatric asthma clinics may be an effective strategy for identifying previously unrecognized cases of the disease. Earlier detection, they said, could prevent long-term damage to the esophagus and improve quality of life for children living with both asthma and EoE. Investigators have planned for additional research to refine screening methods and determine whether similar approaches could benefit other populations with allergic diseases.
