The Impact of Pediatric Eosinophilic Esophagitis on Bone Metabolism

FEBRUARY 2015 AB46 Abstracts S A T U R D A Y 141 The Impact of Pediatric Eosinophilic Esophagitis on Bone Metabolism Agnes Linglart, MD, PHD, Anya Rothenbuhler, MD, PHD, Catherine Adamsbaum, MD, Diana Colson, Pascale Soulaines, Christophe Dupont, MD, PhD; Hopital de Bicetre, Le Kremlin-Bicetre, France, Nutricia Nutrition Clinique, Saint Ouen, France, Hopital Necker Enfants Malades, Paris, France. RATIONALE: Eosinophilic esophagitis (EoE) presents with a massive eosinophilic infiltration of the esophagus triggered by food antigen(s). Usually recommended treatments food elimination diet, oral steroids – or the pathophysiology of the disease itself may impact bone metabolism, a situation at risk especially in growing children. METHODS: A convenience retrospective study analysed 10 female and 4 male patients with EoE being treated according to dietary therapy recommendations, during the phase of progressive reintroduction of eliminated foods following the 6-food elimination diet period. The investigation took place in a single center using bone markers and bone tomodensitometry (TDM). RESULTS: Patients were aged 7.6 (1.4; 13.6) years [median (range)] and had been diagnosed 2.8 (0.5; 7.0) years earlier. Patients’height and body mass index z-score were in the low normal range, -1.4 (-2.3; -3.1) and -1.1 (-1.8 ; +0.6), respectively. They did not correlatewith disease duration. The mean bone density (DEXA) z-scorewas -0.6 (0.7 ;-2.5). Using quantitative TDM, the trabecular bone compartment was the most affected. 25OHvitamin D levels were below the normal range in half of the patients. The urinary calcium excretion and the urinary D-pyridinolines indicated abnormally high bone resorption, being above the normal range in most patients. CONCLUSIONS: Our study shows that children with EoE present a significant bone mineralization defect associated with high levels of turnover bone markers. For now, we recommend a preventive strategy using vitamin D supplementation and adjustments of calcium intake.