Longterm outcome of vertical lines in the (DISTAL) esophageal mucosa (VLEM) and eosinophilic esophagitis: A prospective study

Introduction: Last year we reported a previously unpublished endoscopic finding in children with eosinophilic/peptic esophagitis, viz VLEM (Gastrointest Endoscopy 1995;41:338). Aim: We now present data from a prospective study of this possible association and report on it's response to therapy. Methods: Endoscopists recorded the findings for each esophagogastroduodenoscopy (EGD) (n322) performed between 6/1/95-11/30/95 on a standard form. Histological assessments of esophageal mucosal biopsies were recorded. Results: VLEM were observed in 22 patients (pts) (ages 3mo-17 yrs) (12 new pts) who underwent 27 EGDs during the study period. Esophageal mucosal biopsies were obtained for histological study during each of these EGDs. VLEM were observed on 25 EGDs. 23/25 (92%; specificity 0.96, sensitivity 0.54) cases had eosinophilic esophagitis. 20/23 (87%) were subjectively graded moderate or severe by the pathologists. 14/22 pts underwent ≥1 EGDs. VLEM and histological findings were unchanged in 10/14 pts on follow up (f/u) (mean 6.7mo, range 2-19 mo) and improved/resolved in 3/14 on f/u (mean 12.3mo, range 5-27 mo). In one pt, VLEM appeared on repeat EGD (2 mo later) while the histology improved. All pts had received similar therapy (promotility agent and aggressive acid-suppression) and 11/14 reported symptomatic improvement. Conclusions: In this prospective study, we have confirmed our earlier retrospective observation of the positive correlation between VLEM and histological eosinophilic/peptic esophagitis. Additionally, the data suggests that VLEM and the associated histological abnormalities are generally slow to respond to therapy inspite of symptomatic improvement. Thus, prolonged therapy with endoscopie monitoring may be indicated. The long term implication(s) of these observations awaits further study.