Significance of feeding dysfunction in eosinophilic esophagitis

Table 1 Summary of clinical data

	Age	Symptom duration at presentation	Presenting symptoms	Diagnostic endoscopy1	Treatment	Histologic resolution	Feeding therapy
1	20 mo	9 mo	Vomiting, feeding refusal	Edema and exudate; up to 70 eos/hpf	OVB 0.5 mg BID; ADED	Normal; no eos/hpf	Weekly individual sessions
2	4 yr	2 yr	Vomiting, abdominal pain, feeding refusal	Furrows and exudate; up to 60 eos/hpf	Fluticasone 44 ug 2 puffs BID swallowed	Normal; no eos/hpf	Individual sessions followed by group sessions
3	15 yr	9 yr	Solid food dysphagia	Ringed esophagus; up to 46 eos/hpf	Fluticasone 220 ug 2 puffs BID swallowed, ADED	Furrows; up to 4 eos/hpf	Bimonthly individual sessions

¹Gross and histologic appearance. All diagnostic endoscopies were performed after 8 wk of age appropriate high dose proton pump inhibitor treatment to effectively exclude gastroesophageal acid reflux disease. eos/hpf: Eosinophils per high power field; OVB: Oral viscous budesonide; ADED: Allergen directed elimination diet, as identified by immunocap and skin prick testing.

Table 2 Common feeding dysfunction and clinical gastrointestinal presentation seen in eosinophilic esophagitis by age

	Infant/toddler	School age	Older child/adolescent
Feeding presentation	Liquid and food refusal, delayed oral feeding skills, low volume of intake, grazing behaviors	Food refusal, poor acceptance of new foods, preference for liquid and soft diet, low variety in diet, slow pace of eating, need for prodding to eat	Preference for liquid and soft diet, low variety in diet, fear and anxiety at mealtimes
Gastrointestinal presentation	Vomiting, irritability, pain	Abdominal pain, vomiting	Dysphagia, heartburn