Eosinophilic Esophagitis in Esophageal Atresia

Krishnan, Usha

doi:10.3389/fped.2019.00497

Cited by 26 publications

(16 citation statements)

References 62 publications

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“…When a diagnosis of EoE is made in preschool-age children with EA, the most representative symptoms of the disease in the EA-EoE cohort seem to be vomiting and food intolerance [ 23 ], while older children from the general population with only EoE manifest the usual symptoms of EoE, such as dysphagia, food impaction and chest pain.…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Esophagitis in Esophageal Atresia: Is It Really a New Disease?

et al. 2022

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Eosinophilic esophagitis (EoE) is a chronic, immune-mediated esophageal disease. Symptoms are related to mucosal eosinophilic-predominant inflammation that leads to esophageal dysfunction. Recent data suggest that esophageal atresia (EA) patients may have an increased incidence of EoE compared to the general population. As EoE symptoms may be confused with EA-related symptoms, they may significantly worsen morbidity in this specific group of patients. We investigated specific characteristics of patients with AE and EoE compared to those with EoE only. We conducted an observational retrospective monocentric study including all patients diagnosed with EoE from 1 January 2010 to 31 December 2021. For each patient, demographic, clinical and histopathological data were collected and then compared between the two cohorts (EA-EoE vs. EoE only). During the study period, 62 patients were included: 17 children were in the follow-up because of EA (18.1% of 94 EA patients screened in that period), while the other 45 presented EoE only. The demographic and clinical features of EA-EoE patients demonstrate a lower prevalence of allergic subjects (23.5% vs. 80%, p < 0.05), a lower age of presentation (3.1 vs. 12.2 years, p < 0.05), non-specific symptoms and a higher resolution rate with PPI therapy (64.7% vs. 17.8%, p < 0.05) compared to EoE-only patients. Our data confirm that EA patients are at high risk for developing EoE. As symptoms may overlap with the EA spectrum, early recognition of EoE may prevent patients from receiving unnecessary invasive therapeutic interventions and from developing complications from untreated EoE.

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Section: Discussionmentioning

confidence: 99%

Eosinophilic Esophagitis in Esophageal Atresia: Is It Really a New Disease?

et al. 2022

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“…In EA patients, EoE is reported as 17% [ 4 , 7 ] and attributed to a possible genetic association and barrier defect in the esophageal mucosa caused by acid reflux or prolonged exposure to PPI therapy [ 3 ]. In this cohort of patients, symptoms of EoE are often misdiagnosed as GERD.…”

Section: Discussionmentioning

confidence: 99%

“…Patients who presented allergic symptoms or EoE symptoms underwent full allergic skin tests. The diagnosis of EoE was made according to the updated criteria of the AGREE Conference [ 7 , 14 ]. We diagnosed EoE in patients who had clinical symptoms and presented esophageal samples with >15 eosinophils/High Power Field (HPF), in the absence of other possible causes.…”

Section: Methodsmentioning

confidence: 99%

“…Modern discussion in the scientific community focuses on the long-term follow-up of the EA population. Most EA patients suffer from gastrointestinal (GI) conditions during their lifetime: 22 to 45% of EA patients have gastroesophageal reflux disease (GERD), up to 17% have eosinophilic esophagitis (EoE), and 9 to 41% have physical growth impairment, mainly in the first years of life [ 2 , 3 , 4 , 5 , 6 , 7 ]. It is thus well known that patients born with EA require a lifetime follow-up comprising endoscopic examinations from childhood [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic Surveillance of Esophageal Atresia Population according to ESPGHAN-NASPGHAN 2016 Guidelines: Incidence of Eosinophilic Esophagitis and New Histological Findings

et al. 2022

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Follow-up of children born with esophageal atresia (EA) is mandatory due to high incidence of comorbidities. We evaluated endoscopic findings at follow-up of EA patients performed at our Centre according to ESPGHAN-NASPGHAN 2016 guidelines. A retrospective observational study was performed using data from January 2016 to January 2021. We included EA patients (age range: 1–18 years) who were offered a program of endoscopic and histological high gastrointestinal (GI) tract examinations as per ESPGHAN-NASPGHAN 2016 guidelines. Clinical, surgical, auxological, endoscopic, and histological data were reviewed; variables as polyhydramnios, EA type, surgical type, enteral feeding introduction age, growth data, and symptoms were correlated to endoscopic and histological findings. The population included 75 patients (47 males), with mean age of 5 ± 4 years. In 40/75 (53.3%) patients, we recorded oral feeding problems, and upper gastrointestinal or respiratory symptoms suspicious of gastroesophageal reflux. Eosinophilic esophagitis (EoE) incidence was 9/75 (12%), significantly higher than in general population (p < 0.0001), and 10/75 (13.3%) presented non-specific duodenal mucosal lesions. EoE represents a frequent comorbidity of EA, as previously known. EA is also burdened by high, never-described incidence of non-specific duodenal mucosal lesions. Embedding high GI tract biopsies in EA endoscopic follow-up should be mandatory from pediatric age.

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“…An increasing amount of evidence showed that children with esophageal atresia (EA) (30-32) or with diaphragmatic hernia (34) are at higher risk to develop EoE (33, 34, 79). Several risk factors have been associated with the development of EoE in children with EA, such as early life factors, early exposure to acid suppressants and antibiotics, GERD, esophageal dysmotility, and epithelial injury (79). Interestingly, Krishnan et al demonstrated that children with EoE + EA share the same dysregulated genes (that encode for proteins involved in epithelial barrier functions and Th2 inflammation) compared to patients with EoE and without EA (33).…”

Section: Diseases Of Modern Life and Phenotypes Of Eoementioning

confidence: 99%

Early Life Risk Factors in Pediatric EoE: Could We Prevent This Modern Disease?

et al. 2020

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Eosinophilic esophagitis (EoE) is a chronic antigen-mediated inflammatory disease that affects the esophagus. In the last 20 years, a large number of epidemiological studies showed a significant increase in the incidence and prevalence of EoE, especially in developed countries. This phenomenon might correlate to the overall increase in pediatric allergic diseases or might be a result of improved medical awareness and knowledge through modern diagnostic instruments. Since 1993, when EoE was first recognized as a distinct clinical entity, several signs of progress in the pathophysiology of EoE were achieved. However, a few studies reported data on early risk factors for pediatric EoE and how these factors may interfere with genes. Currently, the most defined risk factors for EoE are male sex, Caucasian race, and atopic comorbidities. Other putative risk factors may include alterations in epithelial barrier function and fibrous remodeling, esophageal dysbiosis, variation in the nature and timing of oral antigen exposure, and early prescription of proton pump inhibitors and antibiotics. Notably, the timing and nature of food antigen exposure may be fundamental in inducing or reversing immune tolerance, but no studies are reported. This review summarized the current evidence on the risk factors that might contribute to the increasing development of EoE, focusing on the possible preventive role of early interventions.

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Eosinophilic Esophagitis in Esophageal Atresia

Cited by 26 publications

References 62 publications

Eosinophilic Esophagitis in Esophageal Atresia: Is It Really a New Disease?

Eosinophilic Esophagitis in Esophageal Atresia: Is It Really a New Disease?

Endoscopic Surveillance of Esophageal Atresia Population according to ESPGHAN-NASPGHAN 2016 Guidelines: Incidence of Eosinophilic Esophagitis and New Histological Findings

Early Life Risk Factors in Pediatric EoE: Could We Prevent This Modern Disease?

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