Researchers identify a distinct subtype of eosinophilic esophagitis in children

Researchers from Ann & Robert H. Lurie Children's Hospital of Chicago identified a distinct subtype of eosinophilic esophagitis (EoE) – a chronic allergic inflammatory disorder in which the esophagus narrows, interfering with food going down properly. They found that about 25% of children with EoE have hypermobile joints, meaning their joints can bend beyond the normal range of motion. These patients also tend to experience autonomic symptoms, most commonly chronic light-headedness upon standing up. This combination of symptoms leads to a significantly worse quality of life, according to the study published in the Journal of Allergy and Clinical Immunology.

With recognition of this disease subtype, clinicians need to routinely screen children with EoE for hypermobility and chronic light-headedness because we have simple treatments for these symptoms that can make a huge difference in these children's quality of life."

Joshua Wechsler, MD, MS, Senior Author, Medical Director of Eosinophilic Gastrointestinal Diseases Program at Lurie Children's and Assistant Professor of Pediatrics and Medicine, Northwestern University Feinberg School of Medicine

"Patients often don't mention light-headedness on their own, since they might not pay much attention to brief episodes. But they might mention headache that commonly appears afterwards," he added. "So if chronic headache comes up, clinicians need to specifically ask if light-headedness precipitated it. Importantly, patients with EoE are advised to talk about these non-GI symptoms with their doctor."

Treatment for chronic light-headedness includes increased fluids, salt and exercise. Hypermobility requires aggressive physical therapy, since muscles around the joints need to be strong to prevent frequent injuries and dislocations.

In the study, 80 EoE patients, aged 2 to 21 years, completed validated surveys about their symptoms and quality of life. Both active EoE and hypermobility were associated with autonomic symptoms. Light-headedness upon standing up was more common in girls with EoE.

"The associations we found between EoE, hypermobility and autonomic dysfunction hopefully will spur more research and potentially offer new clues as to how EoE develops," said Dr. Wechsler. "We still don't know if these associations occur just with EoE or with other inflammatory diseases as well. Our findings open the door to exciting research directions."

Dr. Wechsler is the CURED (Campaign Urging Research for Eosinophilic Disease) Foundation Research Scholar at Lurie Children's. He heads the Wechsler and CURED Laboratory at Stanley Manne Children's Research Institute at Lurie Children's.

The primary funding for this study was provided by Dysautonomia International.