Clinical Implications of Pediatric Colonic Eosinophilia

Mark, Jacob; Fernando, Shahan D.; Masterson, Joanne C.; Pan, Zhaoxing; Capocelli, Kelley E.; Furuta, Glenn T.; Zoeten, Edwin F. de

doi:10.1097/mpg.0000000000001784

Cited by 21 publications

(22 citation statements)

References 22 publications

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“…The reasons why eosinophils seem to be more active in younger patients and also during remission are not known and, as yet, have been largely uninvestigated. It has been reported that colonic eosinophilia is more prevalent in younger than in older children diagnosed with IBD or other colonic diseases [45,46]. Furthermore, tissue eosinophilia seems to be a dominant feature of subclinical histological inflammation for patients with IBD in remission [47], which might be more prevalent in young patients with IBD.…”

Section: Discussionmentioning

confidence: 99%

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Fecal Eosinophil Cationic Protein Is a Diagnostic and Predictive Biomarker in Young Adults with Inflammatory Bowel Disease

Abedin

Seemann

Kleinfeld

et al. 2019

JCM

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Background and Aims: Fecal biomarkers are important non-invasive markers monitoring disease activity in inflammatory bowel disease (IBD). We compared the significance of fecal eosinophil cationic protein (fECP) and fecal calprotectin (fCal). Methods: fECP and fCal were measured in patients with Crohn’s disease (CD, n = 97), ulcerative colitis (UC, n = 53), Clostridioides difficile infection (CDI, n = 9), primary food allergy (PFA, n = 11), pollen-associated food allergy (n = 25) and non-inflammatory controls (n = 78). Results were correlated with clinical and endoscopic IBD activity scores. Results: fECP was significantly elevated in CD, UC, CDI and PFA compared to controls. fCal was significantly increased in CD, UC and CDI. fECP had lower diagnostic accuracy than fCal (area under the curve (AUC) = 0.88) in differentiating between endoscopically active and inactive patients with IBD (AUC = 0.77, ROC analysis). In contrast to fCal, fECP correlated negatively with age and levels were also elevated in clinically and endoscopically inactive patients with IBD <45 years (endoscopically inactive IBD vs controls; AUC for fECP = 0.86; AUC for fCal = 0.62). However, in those patients with low inflammatory activity (fCal <250 mg/kg), high fECP indicated the need for treatment modification or surgery (fECP <200 µg/kg = 22%; 200–600 µg/kg = 44%; >600 µg/kg = 82%) at month 48 of follow-up. Conclusions: fECP is a diagnostic and prognostic marker in young patients with IBD in remission.

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Section: Discussionmentioning

confidence: 99%

“…Clinical follow-up data was available for 202/212 visits (95.3%) of patients with IBD. The median (IQR) follow-up time was 48 (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54) months. The total event rate was 94/202 (46.5%).…”

Section: Fecp Is a Prognostic Biomarker In Young Patients With Ibdmentioning

confidence: 99%

Fecal Eosinophil Cationic Protein Is a Diagnostic and Predictive Biomarker in Young Adults with Inflammatory Bowel Disease

Abedin

Seemann

Kleinfeld

et al. 2019

JCM

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“…8 Some studies have demonstrated a male predominance of certain nonesophageal EGIDs such as EC, but in general there appears to be a lack of male predominance in these disorders. [32][33] When evaluating the initial management of these disorders, wide variability existed amongst participating centers, which may speak to differences in provider preference/experience, the lack of high level evidence to support any given therapy, as well as to the heterogeneity of the presentation of these disorders. PPIs were the most commonly used medication, even in patients with colonic disease.…”

Section: Discussionmentioning

confidence: 99%

Increasing Rates of Diagnosis, Substantial Co-Occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis, and Colitis Based on 10-Year Data Across a Multicenter Consortium

et al. 2019

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Objective: The literature related to eosinophilic gastritis (EG), gastroenteritis (EGE) and colitis (EC) is limited. We aimed to characterize rates of diagnosis, clinical features, and initial treatments of patients with EG, EGE, and EC. Methods: In this retrospective study, data were collected from six centers in the Consortium of Eosinophilic Gastrointestinal Researchers (CEGIR) from 2005-2016. We analyzed demographics, time trends in diagnosis, medical history, presenting symptoms, disease overlap, and initial treatment patterns/responses. Results: Of 373 subjects (317 children and 56 adults), 38% had EG, 33% EGE, and 29% EC. Rates of diagnosis for all diseases increased over time. There was no male predominance, and the majority of subjects had atopy. Presenting symptoms were similar between diseases with nausea/ vomiting and abdominal pain the most common. 154 subjects (41%) had eosinophilic inflammation outside of their primary disease location with the esophagus the most common second GI segment involved. Multi-site inflammation was more common in children than adults (68% vs 37%; p<0.001). Initial treatment patterns varied highly between centers. 109 subjects (29%) had follow-up within 6 months and the majority had clinical, endoscopic and histologic improvement.

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“…In a similar study by Mansoor et al, a similar female predominance was found in both EGE and EC 8 . Some studies have demonstrated a male predominance of certain non-esophageal EGIDs such as EC, but in general there appears to be a lack of male predominance in these disorders 32-33 .…”

Section: Discussionmentioning

confidence: 99%

Increasing Rates of Diagnosis, Substantial Co-occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis and Colitis Based on 10 Year Data Across a Multi-Center Consortium

Pesek

Reed²,

Muir

et al. 2018

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Financial Support and AcknowledgementsSupport for this project was provided through a research training grant as part of the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) (U54 AI117804). CEGIR is part of the Rare Disease Clinical Research Network (RDCRN), an initiative of the Office of Rare Diseases Research (ORDR), NCATS, and is funded through collaboration between NIAID, NIDDK, and NCATS. CEGIR is also supported by patient advocacy groups including APFED CURED and EFC. This project also received support from NIH T32 DK007634 (CCR).Author DisclosersPatricia Fulkerson: Grant funding from the NIH; Consultant for Genentech, Inc; Research support from Knopp Biosciences, LLC.Gary Falk: Research support from Shire, Celgene, Adare, Regeneron. Consulting for ShireJonathan M. Spergel: Consultant for Regeneron, DBV Technology, Kaleo; Grant funding from DBV Technology, Aimmune Therapeutics, Food Allergy Research Education; Royalties from UpToDateNirmala Gonsalves: Royalties from UpToDate; Advisory board for AllakosSandeep K Gupta: Consultant for Alkalos, Abbott, QOL, Receptos; research support from ShireGlenn Furuta: Founder of EnteroTrack; Consultant for Shire; Royalties from UpToDateMarc E. Rothenberg: Consultant for Pulm One, Spoon Guru, ClostraBio, Celgene, Shire, Astra Zeneca, GlaxoSmithKline, Allakos, Adare, Regeneron and Novartis and has an equity interest in the first four listed and Immune Pharmaceuticals, and royalties from reslizumab (Teva Pharmaceuticals), PEESSv2 (Mapi Research Trust) and UpToDate. M.E.R. is an inventor of patents owned by Cincinnati Children’s.Evan Dellon: Consultant for Adare, Allakos, Alivio, Banner, Celgen/Receptos, Enumeral, GSK, Regeneron, Shire; Research funding from Adare, Celegene/Receptos, Miraca, Meritage, Nutricia, Regeneron, Shire, Educational grant from Banner, HoloclaraStudy HighlightsWhat is current knowledge?Eosinophilic gastrointestinal disorders (EGIDs) include eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC).Non-EoE EGIDs are rare with most studies limited to case reports or review of single center experiences.There are no widely established guidelines for the diagnosis of EG, EGE, or EC.What is new here?In this multicenter study, EG, EGE, and EC were all diagnosed with increasing frequency over the past decade.Presenting symptoms are non-specific and do not reliably distinguish between disorders.There was no male predominance and the majority of subjects had atopy.Co-occurrence of EG, EGE, and EC diagnoses is common, seen in 41% of patients.There is substantial variability between centers in initial treatment approaches.

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Clinical Implications of Pediatric Colonic Eosinophilia

Cited by 21 publications

References 22 publications

Fecal Eosinophil Cationic Protein Is a Diagnostic and Predictive Biomarker in Young Adults with Inflammatory Bowel Disease

Fecal Eosinophil Cationic Protein Is a Diagnostic and Predictive Biomarker in Young Adults with Inflammatory Bowel Disease

Increasing Rates of Diagnosis, Substantial Co-Occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis, and Colitis Based on 10-Year Data Across a Multicenter Consortium

Increasing Rates of Diagnosis, Substantial Co-occurrence, and Variable Treatment Patterns of Eosinophilic Gastritis, Gastroenteritis and Colitis Based on 10 Year Data Across a Multi-Center Consortium

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