When Kaylee Mitchell, an 11-year-old from the Milwaukee area, started having trouble swallowing, her family thought it was just part of her asthma. It turned out to be something else entirely — a condition that might have gone undiagnosed for years if her doctor had not checked for it.
New research from the Medical College of Wisconsin suggests that many children with asthma may also have eosinophilic esophagitis, or EoE — a disorder where certain white blood cells build up in the throat and make swallowing painful and difficult. The study found that screening asthma patients for EoE uncovered a much higher number of cases than doctors had expected.
Researchers, led by Dr. Robert E. Becker, examined 189 children and teenagers with asthma at a specialty clinic in Milwaukee. The patients, ranging from ages 3 to 17, or their parents, answered questions about symptoms like trouble swallowing, stomach pain, and vomiting. The results were striking: 80.4 percent screened positive for at least one EoE symptom.
Not every child who screened positive needed further testing. About half were referred to a stomach specialist, and roughly 61 percent of those completed the visit. Among the 24 children who ultimately had an endoscopy — a procedure where a tiny camera looks inside the throat — one in three was diagnosed with EoE.
Extrapolating across the entire asthma clinic population, the researchers estimated that about 8 percent of pediatric asthma patients have EoE. When accounting for families who did not participate or were lost to follow-up, that number could be as high as 13.9 percent. That is significantly higher than the 0.05 to 0.1 percent prevalence historically reported in the general population.
The only symptom that clearly pointed to an EoE diagnosis in the study was vomiting.
The findings, published in The Journal of Allergy and Clinical Immunology: In Practice, suggest that asthma clinics could be an important place to catch EoE early. Catching the condition sooner, the researchers noted, may prevent long-term complications like scarring and narrowing of the throat. It could also help reduce racial disparities in diagnosis, since EoE has historically been underdiagnosed in non-white patients.
For families like the Mitchells, earlier screening meant faster answers. "If we had not asked the question," Dr. Becker and his team wrote, "these patients would likely have remained undiagnosed."