Feeding Tube Response in Esophagitis

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Eosinophilic esophagitis (EoE) in young children can be associated with poor feeding as well as associated failure to thrive/failure to gain weight. Thus, use of nasogastric (NG) tube feeds as well as surgical gastrostomy tube (G-tube) feeds may be recommended to improve caloric intake as well as to provide elemental nutrition in this age group with EoE. There is minimal long-term data available regarding which pediatric patients with EoE would benefit most from NG/G-tube feeds.  

This retrospective study occurred at a tertiary children’s hospital in the United States. All pediatric patients with EoE and with a history of enteral tube feeds used as treatment for EoE from 2002 to 2021 were included. Basic patient demographics were obtained on all patients, and all patients were evaluated for both endoscopic and histologic response to enteral feeds. A total of 457 pediatric patients with EoE were identified, of which 39 pediatric patients with EoE required enteral tube feeds. The mean age of initial diagnosis of EoE for patients requiring enteral tube feeds was 6.3 ± 7.6 years, and the mean age for patients requiring enteral tube placement was 6.3 ± 9.3 years. The most common symptoms in this patient group were emesis and dysphagia. When compared to children with EoE who did not require enteral tube feeds, the patients with EoE and enteral tube feeds were significantly younger, had a significantly lower body mass index (BMI), and had a significantly lower initial Eosinophilic Esophagitis Endoscopic Reference Score (used to determine treatment response to EoE) and Endoscopic Severity Score.  

Most patients had enteral tube placement for failure to gain weight, and 19 patients (49%) required a transition from NG tube feeds to G-tube feeds. The vast amount of enteral nutrition provided to this patient group consisted of elemental formula (87%). Other therapeutics provided for this group included proton pump inhibitors, system steroids, and dupilumab. Enteral tubes remained in place for a mean of 6.8 ± 6.2 years. Most patients (92%) had enteral tube complications which were relatively mild, including tube displacement or granulation tissue formation. Most patients (71%) with enteral support achieved histologic EoE response. There was a significant increase in BMI-for-age z-scores in those patients with EoE requiring enteral feeds. Patients requiring enteral feeds prior to a diagnosis of EoE were significantly more likely to have autism or developmental delay, be non-white, and have no food allergies compared to patients with enteral feeding starting after a diagnosis of EoE. However, there was no difference in patient age, sex, or year in which EoE was diagnosed. Patients requiring initial enteral feeds due to a feeding problem had a delay of 2.2 ± 0.6 years prior to EoE eventually being diagnosed.

Although this is a small retrospective study, it does provide some interesting information to pursue further. For example, the finding that pediatric patients with EoE requiring enteral tube feeds having lower associated Eosinophilic Esophagitis Endoscopic Reference Scores and Endoscopic Severity Scores need further study as such patients may require more intensive feeding therapy and perhaps medical therapy. The delay in EoE diagnosis in patients with enteral feedings already in place suggests that a heightened awareness of the possibility of EoE is needed when evaluating children with feeding problems.

Borinsky S, Cameron B, Xue Z, LaFata S, Kiran A, Ocampo A, McCallen J, Lee C, Redd W, Cotton C, Eluri S, Reed C, Dellon E. Feeding Tube Placement, Complications, and Treatment Responses in a Large Eosinophilic Esophagitis.  J Pediatr Gastroenterol Nutr 2023; 77: 753-759.

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