Does Helicobacter pylori protect against eosinophilic esophagitis in children?

BACKGROUND: Helicobacter pylori infection and eosinophilic esophagitis (EoE) in children seem to have a reversed association with socioeconomic status (hygienic condition) and allergy conditions. While Hp infection (Hp) is highly associated with poor hygiene and/or poor socioeconomic status, but not with allergic conditions (asthma, rhinitis, etc.), EoE has the opposite epidemiological relationship (high association with allergy but low with low hygienic conditions). AIM: To investigate the association between Hp infection and EoE in children. METHODS: A retrospective chart review of all children who undergo the first upper endoscopy procedure in the gastroenterology clinic, between 2007 and 2012, was performed. Demographic, endoscopic and histological data were collected. The data was divided into 4 diagnostic groups: Hp infection, EoE, reflux esophagitis, and children who had normal histology. The relationship between Hp positive children and the other groups was performed. RESULTS: A total of 966 charts were available for review. Esophagitis, idiopathic gastritis, EoE, and Hp infection were detected in 268 (28%), 480 (49%), 62 (6%), and 31 (3%) children, respectively. The mean age of the EoE group was significantly lower compared to all reference groups (p < .002), but no significant different was detected among the reference groups (gastritis, GERD, and Hp infection; p = 1.00). Simple logistic regression analysis using Hp infection as a predictor for EoE did not find a significant relationship between these two variables (p-value = .471, OR = 0.478, 95% CI 0.06-3.56). However, multivariable logistic regression analysis between EoE and the reference groups indicated a significant negative relationship between Hp infection and EoE (p-value = .023, adjusted OR = 0.096, 95%CI 0.013-0.72). Neither gastritis nor GER showed significant relationship with EoE (p-values are 1.000 and .992, respectively). CONCLUSION: A reversed association between Hp and EoE was found in a cohort of West Virginia children. The possible explanations for these findings are discussed.

Etiology and management of esophageal impaction in children: A review of 11 years.

INTRODUCTION: Esophageal impaction in children is a medical emergency that needs an immediate medical attention. In the last years multiple objects have been detected and were removed endoscopically. In the last decade, Eosinophilic Esophagitis (EoE) has been associated with esophageal stenosis, leading to esophageal impaction with various objects including toys, food, coins and other. AIM: To determine the various objects and symptoms associated with impactions and to develop algorithm that guides Emergency Department Physicians and Primary care Providers when facing such problem in pediatric patient. MATERIAL AND METHODS: A retrospective chart review of all children referred to the pediatric gastroenterology service at Marshall University for FB impaction between 2000 and 2010 was performed. Foreign bodies treated by other specialties were excluded from this review. Clinical and demographic data were retrieved. RESULTS: A total of 291 charts with the diagnosis of foreign body reviewed of which only 126 met the inclusion criteria and considered for final calculation. Male/Female ratio and mean age were 1.17:1.0, and 3.65 ± 0.75 years, respectively. Time of impaction before ER evaluation was: < 24hrs in 75 patients, >24hrs in 17 and in 34 the time of ingestion was not known. Radiology was performed in 118 patients, of whom 1 had pneumo-mediastinum and 1 had pneumothorax. Endoscopic localization of the objects showed: 81- proximal, 23- middle esophagus, and 22- in the distal esophagus. The esophageal mucosa showed non-specific changes in 37 patients, 5 with EoE features, 1 patient with hiatal hernia, 1 patient with candidiasis, and in 5 pts had no mucosal description. CONCLUSION: Children with foreign body in the esophagus are commonly seen in our Hospital ER. Those children may harbor undiagnosed medical conditions that will need future therapy. Careful endoscopic assessment with mucosal biopsies is needed to diagnose those conditions earlier. Referral to a GI specialist may be warranted.