To the Editor: Ms Hu and colleagues1 sought to identify the genetic map for pediatric
gastroesophageal reflux (GER). However, the authors do not report diagnostic
criteria for GER, and therefore we are concerned about the uniformity of their
Children with chronic vomiting, spitting up, dysphagia, and food refusal
are commonly diagnosed with GER and are treated with acid suppression. Alternatively,
these symptoms may have other causes such as anatomical malformations, food
allergies, functional bowel diseases, or metabolic disorders. Clinical criteria
used to make an initial diagnosis of GER can be subjective, but when symptoms
are refractory to medical management, patients will often undergo evaluation
including esophagogastroduodenoscopy with biopsy. One emerging cause of such
refractory symptoms is eosinophilic esophagitis (EE), which has been reported
in at least 81 children in 4 different academic institutions.2- 5
The affected squamous epithelium contains a large number of intraepithelial
eosinophils, despite at least 2 months of acid suppression.2
Treatment with fundoplication is not therapeutic, but corticosteroids or an
elemental diet provide effective symptom control and improvement of esophageal
histology.3,4 To date, the
incidence, etiology, and long-term consequences of EE are not well defined.
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