Understanding of Eosinophilic Esophagitis in Children - A Comprehensive Study on Epidemiology, Clinical Manifestations, Diagnosis and Innovative Treatment Modalities
DOI:
https://doi.org/10.12775/JEHS.2024.55.009Keywords
eosinophilic esophagitis EoE, pediatric patients, clinical manifestations, diagnostic methods, treatment methods, biological therapyAbstract
Introduction:
In the late 1960s, probable cases of eosinophilic esophagitis (EoE) emerged, initially linked to esophageal rings and congenital causes or gastroesophageal reflux disease (GERD). Doubts about the GERD association arose due to poor responses to antisecretory therapy. EoE is now a significant pediatric health concern, impacting 1 to 7 cases per 10,000 children.
Purpose of the Study:
This study aims to comprehensively explore EoE's epidemiology, etiology, subtypes, clinical manifestations, diagnostic methods, and treatment modalities.
Materials and Methods:
The study employs a cross-sectional analysis of pediatric EoE patients, utilizing endoscopic evaluation and histological assessment. Three distinct EoE subtypes are identified based on pathogenic characteristics. Clinical manifestations, diagnostic methods, and treatments, including endoscopy, are examined.
Results:
Clinical manifestations span a broad spectrum in the pediatric population. Diagnostic methods include endoscopy, esophageal manometry, impedance-pH monitoring, capsule endoscopy, and string tests. Three distinct EoE subtypes are identified with unique characteristics. Treatment modalities involve dietary management, proton pump inhibitors, topical corticosteroids, biologic therapies, allergen immunotherapy, and endoscopic interventions.
Conclusion:
Formerly associated with GERD, EoE is now a significant pediatric health concern. The study underscores the importance of comprehensive diagnostic approaches and diverse treatment modalities, including promising biologic therapies and allergen immunotherapy. Understanding these aspects is crucial for effective management and improved outcomes in patients.
References
Liacouras CA, Furuta GT, Hirano I, et al. Eosinophilic esophagitis: Updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128(1):3-20.e6.
Dellon ES, Jensen ET, Martin CF, Shaheen NJ, Kappelman MD. Prevalence of eosinophilic esophagitis in the United States. Clin Gastroenterol Hepatol. 2014;12(4):589-596.
Sleiman PM, Wang ML, Cianferoni A, et al. GWAS identifies four novel eosinophilic esophagitis loci. Nat Commun. 2014;5:5593.
Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133(4):1342-1363.
Markowitz JE, Spergel JM, Ruchelli E, Liacouras CA. Elemental diet is an effective treatment for eosinophilic esophagitis in children and adolescents. Am J Gastroenterol. 2003;98(4):777-782.
Straumann A, Spichtin HP, Bernoulli R, Loosli J, Vögtlin J. [Idiopathic eosinophilic esophagitis: a frequently overlooked disease with typical clinical aspects and discrete endoscopic findings]. Schweiz Med Wochenschr. 1994;124(35):1419-1429.
Liacouras CA, Wenner WJ, Brown K, Ruchelli E. Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr. 1998;26(4):380-385.
Hirano I, Furuta GT. Approaches and Challenges to Management of Pediatric and Adult Patients With Eosinophilic Esophagitis. Gastroenterology 2020; 158:840.
Singendonk MMJ, et al. Esophageal manometry in eosinophilic esophagitis: Ready for prime time? United European Gastroenterol J. 2021;9(5):563-569.
Ravi K, Geno DM, Katzka DA. Esophageal Impedance-pH Monitoring in Clinical Practice. J Neurogastroenterol Motil. 2018;24(1):19-29.
Rodrigues M, et al. Capsule Endoscopy in Pediatric Gastroenterology: A Comprehensive Review. GE Port J Gastroenterol. 2021;28(2):89-104.
Warners MJ, et al. String capsule endoscopy in children with eosinophilic esophagitis. Gastrointest Endosc. 2017;85(5):946-953.
Molina-Infante J, Arias Á, Alcedo J, et al. Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: The 2-4-6 study. J Allergy Clin Immunol. 2018;141(4):1365-1372.
Spergel JM, Rothenberg ME, Collins MH, et al. Reslizumab in children and adolescents with eosinophilic esophagitis: results of a double-blind, randomized, placebo-controlled trial. J Allergy Clin Immunol. 2012;129(2):456-463, 463.e1-3.
Shoda T, Wen T, Aceves SS, et al. Eosinophilic oesophagitis endotype classification by molecular, clinical, and histopathological analyses: a cross-sectional study. Lancet Gastroenterol Hepatol 2018; 3:477.
Kelley ML Jr, Frazer JP. Symptomatic mid-esophageal webs. JAMA 1966; 197:143.
Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology 1978; 74:1298.
Shiflett DW, Gilliam JH, Wu WC, et al. Multiple esophageal webs. Gastroenterology 1979; 77:556.
Bousvaros A, Antonioli DA, Winter HS. Ringed esophagus: an association with esophagitis. Am J Gastroenterol 1992; 87:1187.
McKinley MJ, Eisner TD, Fisher ML, et al. Multiple rings of the esophagus associated with gastroesophageal reflux [case report]. Am J Gastroenterol 1996; 91:574.
Langdon DE. Corrugated ringed and too small esophagi. Am J Gastroenterol 1999; 94:542.
Langdon DE. Corrugated ringed esophagus. Am J Gastroenterol 1993; 88:1461.
Katzka DA, Levine MS, Ginsberg GG, et al. Congenital esophageal stenosis in adults. Am J Gastroenterol 2000; 95:32.
Morrow JB, Vargo JJ, Goldblum JR, Richter JE. The ringed esophagus: histological features of GERD. Am J Gastroenterol 2001; 96:984.
Gluck M, Schembre D, Jiranek G. Multiple esophageal rings: Histology, EUS, and manometric findings (abstract). Am J Gastroenterol 2001; 96:S14.
Fox VL, Nurko S, Furuta GT. Eosinophilic esophagitis: it's not just kid's stuff. Gastrointest Endosc 2002; 56:260.
Prasad GA, Alexander JA, Schleck CD, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol 2009; 7:1055.
Wang FY, Gupta SK, Fitzgerald JF. Is there a seasonal variation in the incidence or intensity of allergic eosinophilic esophagitis in newly diagnosed children? J Clin Gastroenterol 2007; 41:451.
Almansa C, Krishna M, Buchner AM, et al. Seasonal distribution in newly diagnosed cases of eosinophilic esophagitis in adults. Am J Gastroenterol 2009; 104:828.
Furuta GT, Katzka DA. Eosinophilic Esophagitis. N Engl J Med 2015; 373:1640.
Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology 2018; 155:1022.
Collins MH. Histopathologic features of eosinophilic esophagitis. Gastrointest Endosc Clin N Am 2008; 18:59.
Roy-Ghanta S, Larosa DF, Katzka DA. Atopic characteristics of adult patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 2008; 6:531.
Erwin EA, James HR, Gutekunst HM, et al. Serum IgE measurement and detection of food allergy in pediatric patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2010; 104:496.
Alexander JA, Katzka DA. Therapeutic options for eosinophilic esophagitis. Gastroenterol Hepatol (N Y) 2011; 7:59.
Alexander JA. Topical steroid therapy for eosinophilic esophagitis. Gastroenterol Hepatol (N Y) 2014; 10:327.
Erin Phillips Syverson, MDcorresponding author and Eitan Rubinstein, MD. Real World Experience With Dupilumab in Eosinophilic Esophagitis in Children and Young Adults at a Tertiary Care Pediatric Medical Center 2022 May; 3(2): e180.
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Copyright (c) 2024 Marta Zarzycka, Marcelina Sikora, Ines Plewniok, Monika Maj-Dziedzic, Jeremiasz Dubiel, Anna Brzozowska, Adrian Maj, Greta Śmietana, Martyna Warno, Wiktor Kozik
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