Pediatric Eosinophilic Esophagitis Presents Differently Depending on BMI

Children with eosinophilic esophagitis (EoE) with obese body mass index (BMI) are diagnosed at a later age and more often present with abdominal pain than other children with EoE, according to study findings published in Annals of Allergy, Asthma & Immunology.

Study authors aimed to characterize EoE presentations among pediatric patients of varying weight classes.

Investigators conducted an observational study of children less than 19 years of age newly diagnosed with EoE at an academic medical center in the US from January 2015 to December 2018. The study included 341 patients (31% girls; 81% White, 12% Black, 2% Asian). Based on Centers for Disease Control and Prevention definitions, 19% had obesity (≥95^th percentile), 14% overweight (85^th-94^th percentile), 63% normal weight (5^th-84^th percentile), and 5% underweight (<5^th percentile). Symptoms at presentation included vomiting, nausea, food refusal, gastroesophageal reflux disease, chest pain, choking, and abdominal pain.

Investigators found children with obese body mass index (BMI) were more likely to complain of abdominal pain than children in the other weight groups (obese 40% vs 18% underweight, 21% normal weight, 19% overweight). Moreover, children in the group with obesity were more likely to be diagnosed at an older age (mean [SD] age in years: obese 11.6 [4.1] vs underweight 7.9 [6.1], normal weight 8.8 [4.9], overweight 9.3 [5.3]; P =.0005). No other presenting symptoms showed significant differences among weight groups.

Children with obesity and overweight vs those with underweight and normal weight were less likely to be tested for inhalant allergies (obese, 8%; overweight, 12%; underweight, 29%; normal weight, 23%) and food allergies (obese, 13%; overweight, 26%; underweight, 41%; normal weight, 30%).

Investigators found no significant between-group differences on endoscopy concerning the presence of linear furrows, tracheal rings, erythema, white specks, or edema/loss of vascularity. They noted no significant differences between children in the obese/overweight groups and children in the normal weight group concerning eosinophil counts in esophageal biopsies.

Investigators noted no significant differences concerning sex, race, asthma, atopic dermatitis, allergic rhinitis, or type of insurance relative to EoE diagnosis and weight group.

Study limitations include family and parental recall bias and the possible inclusion of children who had proton-pump-inhibitor-responsive esophageal eosinophilia rather than EoE.

“[C]hildren with obese and overweight status had a chief complaint of abdominal pain more commonly, and were diagnosed at later ages, than children of normal and underweight status. Clinical suspicion must remain high for EoE in children of all BMI subclasses as they may present differently,” investigators concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.