Lincoln Olivio Diniz MPH, Presenter: Nothing to Disclose

Alex Towbin MD, Abstract Co-Author: Nothing to Disclose

Philip E. Putnam MD, Abstract Co-Author: Nothing to Disclose

Eosinophilic esophagitis (EE) is a disorder characterized by dense esophageal eosinophilia and esophageal symptoms such as dysphagia, food sticking, vomiting, and heartburn. Over the past decade, there has been an increase in both the number of cases diagnosed as well as in awareness of disease. There are few reports describing the fluoroscopic findings of EE. These reports have described esophageal strictures, rings, and dysmotility. The purpose of our study was to evaluate the frequency of fluoroscopic findings of biopsy-proven cases of EE in children.

A clinical database was used to identify all patients diagnosed with EE by esophageal biopsy at our institution between 2000 and August, 2008. The hospital PACS was then used to locate each upper GI study or esophagram performed in these patients. Each case was evaluated by two radiologists for the presence or absence of esophageal strictures, rings, mucosal irregularity, irregular contractions, or impacted food. The two radiologists met after their independent evaluations to reach a consensus on each case. The radiology report was read to ensure a contemporaneous diagnosis of gastroesophageal reflux or esophageal dysmotility.

There were 151 studies evaluated in 133 patients; 74 (49%) studies had no abnormal findings of the esophagus; 14 (9%) had strictures (6 in the mid esophagus and 8 in the distal esophagus); 8 (5%) had rings; 9 (6%) had dysmotility; 7 (4%) had mucosal irregularity; 3 (2%) had impacted food; and 22 (15%) had irregular contractions. Other findings included 29 patients with gastroesophageal reflux; 3 with paraesophageal hernia; 2 with hiatal hernia; and 1 patient each with a contained leak and distal esophageal diverticula.  

EE remains mostly a clinical and pathologic diagnosis. Although approximately 50% of patients had at least one esophageal finding at fluoroscopy, no one finding occurred with enough frequency to reliably suggest a diagnosis. While normal imaging does not exclude a diagnosis of EE, it should be included in the differential diagnosis of children with esophageal strictures, rings, dysmotility, mucosal irregularity, irregular contractions, and impacted food.

There is an increasing incidence of EE in the United States. This is the first large study evaluating the fluoroscopic findings in these patients.

Diniz, L, Towbin, A, Putnam, P, Esophageal Findings on Fluoroscopy in Children with Eosinophilic Esophagitis.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8004450.html