P0492 GASTROESOPHAGEAL REFLUX SYMPTOMS AND QUALITY OF LIFE DO NOT CORRELATE WITH ESOPHAGEAL HISTOPATHOLOGY IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS

Introduction: Eosinophilic Esophagitis (EE) is an allergic disorder, which can usually be treated by eliminating offending foods from the diet. Identifying allergenic foods can be difficult since blood and skin tests are often not helpful. This study examined the relationship between gastroesophageal reflux (GER) symptoms and health related quality of life (HRQOL) during remissions and relapses in patients with EE as foods were removed and reintroduced. Methods: Nine patients with EE were studied longitudinally. Each underwent at least three upper endoscopies, which showed that the esophageal eosinophila (initially >18/HPF) did not resolve with PPI therapy, but did with elimination of foods from the diet. To assess HRQOL, we administered the CHQ-PF50 (for parents of children 5–17 years) and CHQ-CF87 (for children 10–17 years). Depending on the age of the child, questionnaires to assess symptoms of GER were also completed by parents (IGER-SF, GER3–9P, GER10–17P) and patients (GER10–17C). All questionnaires were completed on the day of the corresponding endoscopy. Histologic specimens were graded by a pathologist blinded to the questionnaire results. Demographic and medical information were obtained from reviewing the medical record and interviewing the parents. Results: Patients had a mean age of 6.4 years (range 1–17 years) and 6/9 were male. A history of atopy was found in 7/9 patients including: eczema (2), asthma (2), allergic rhinitis (1), environmental allergy (5) and known food allergy (4). Of the 8 patients who had a CBC, none were anemic, 3 had thrombocytosis and 5 had eosinophilia. Other abnormal lab tests included: elevated antigliadin IgG (5/5), elevated antigliadin IgA (2/5) and elevated IgE (2/3). Of the four patients old enough to have HRQOL data, the summary scores during remission, as compared to active disease (initial diagnosis/relapse) were not significantly different for the Psycho-Social (p=.93 ) or Physical-Health (p=.14) summary scores. Interestingly, psychosocial scores in 3/4 patients fell after initiation of EE treatment. Similarly, there was no difference (p=.30) in the presence or absence of GER symptoms when the patients had active disease, as compared to when they were in remission. In addition, no GER symptoms were recorded at the time that 5 biopsy specimens (in 4 patients) showed active EE. Conclusion: Overall HRQOL and GER symptoms were independent of the presence or absence of esophageal eosinophilia in patients with EE. These findings underscore the importance of obtaining endoscopic specimens in the evaluation of treatment outcomes in patients with EE, regardless of symptoms.