Eosinophilic Gastrointestinal Diseases in Childhood

Abstract

Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.

Efficacy of a Short-term Six-food Elimination Diet and Reintroduction Therapy in Pediatric Eosinophilic Gastroenteritis

“…The treatment of EoE typically involves PPIs and topical steroid therapies, and an SFED is administered if no response occurs with traditional therapies (3). An SFED for EoE effectively resolves symptoms in many patients, even in pediatric cases (6,16). However, no prospective randomized controlled trials have been performed for EGE; therefore, available treatments have not been empirically validated.…”

Non-IgE-Mediated Gastrointestinal Food Allergies in Children: An Update

“…Reactions in mixed IgE/non-IgE-mediated diseases, such as eosinophilic gastrointestinal diseases, are triggered by complex immunological mechanisms that only partially implicate IgE. Symptoms are dependent upon the affected organs and the extent of eosinophilic infiltration [8,9]. On the other end of the spectrum lie non-IgE-GI-FA, in which circulating food-specific IgE are typically absent.…”

“…* Soy allergy likely underrepresented by these studies. 1 From Ruffner et al [95] (n = 462), Caubet et al [26] (n = 160), Blackman et al [65] (n = 74), Maciag et al [25] (n = 441), Su et al [64] (n = 203); 2 From Ludman et al [66] (n = 54); 3 From Vazquez-Ortiz [101] (n = 81), Diaz et al [60] (n = 120), Pérez Ajami et al [104] (n = 135); 4 From Miceli Sopo et al [67] (n = 66); 5 From Mehr et al [97] (n = 35), Mehr et al [21] (n = 230); 6 From Arik Yilmaz et al [105] (n = 27); 7 From Kuitunen et al [28] (n = 54); 8 From Lake et al [84] (n = 95); 9 From Kaya et al [87] (n = 60), Arik Yilmaz et al [105] (n = 37), Erdem et al [86] (n = 77), Cetinkaya et al [85] (n = 185).…”

Nationwide Multicenter Study of Eosinophilic Esophagitis in Korean Children

“…Eosinophilic gastrointestinal diseases (EGIDs) are chronic inflammatory digestive diseases characterized by numerous eosinophils infiltrating the segments of the gastrointestinal (GI) tract [1]. EGIDs include eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC) [2].…”