Natural Histories and Disease Complications in a Cohort of 151 Children With Gastric or Duodenal Eosinophilia

Abstract

Introduction: Eosinophilic gastritis (EoG) and duodenitis (EoD) are rare conditions that are poorly understood. Our aim was to describe the natural history of children with varying degrees of gastric or duodenal eosinophilia with respect to disease complications and histologic and endoscopic longitudinal trajectories.

Methods: The electronic medical record at a tertiary children's hospital was queried to identify patients with EoG, EoD, or EoG + EoD who were cared for between January 2010 and 2022. Multiple logistic regression was performed to explore associations between baseline features and persistence/recurrence of eosinophilia or complications remote from diagnosis.

Results: We identified 151 patients: 92 with EoG, 24 with EoD, 12 with EoG + EoD, and 23 with tissue eosinophilia but did not meet histologic criteria for EoG or EoD (low grade). The average age at diagnosis was 10.6 years, and average follow-up was 5.8 years. Twenty-five percent of patients with EoG or EoD had persistence/recurrence of eosinophilia; this was associated with increases in the EoG Endoscopic Reference Score (adjusted odds ratio [aOR] 1.34, confidence interval [CI] 1.03-1.74) on diagnostic endoscopy. Eighteen percent suffered from disease complications, and development of late complications was associated with presenting with a complication (aOR 9.63, CI 1.09-85.20), severity of duodenal endoscopic abnormalities (aOR 8.74, CI 1.67-45.60), and increases in the EoG Endoscopic Reference Score (aOR 1.70, CI 1.11-2.63).

Discussion: Patients with gastric and duodenal eosinophilia should be followed closely to monitor for recurrence and complications, especially those presenting with endoscopic abnormalities or complications.

Figure 1:

A. Temporal trends in EoG/EoD diagnosis. B. Flow chart illustrating patient identification for longitudinal analysis. *chronic gastritis n=8, juvenile polyposis syndrome n=2, erosive esophagitis n=2, eosinophilic granulomatosis with polyangiitis n=1, collagenous gastritis n=1, tracheoesophagel fistula n=1, familial mediterranean fever n=1

Figure 2:

Natural History in EoG and EoD A. Proportion of EoG/EoD patients with persistence/recurrence of eosinophilia vs proportion of low-grade eosinophilia patients who later developed EoG/EoD B. Heat map illustrating patterns of histologic disease activity over repeat endoscopies

Figure 3:

Disease Complications in EoG and EoD A. Proportion of EoG/EoD patients with complications vs patients with low-grade eosinophilia B. Types of complications and timing relative to diagnosis C. Heat map illustrating type and timing of late complications