Eosinophilic gastrointestinal disorders in children and adolescents: A single-center experience

Votto, Martina; Raffaele, Alessandro; Filippo, Maria De; Caimmi, Silvia; Brunero, Marco; Riccipetitoni, Giovanna; Marseglia, Gian Luigi

doi:10.1016/j.dld.2021.06.027

Cited by 15 publications

(22 citation statements)

References 37 publications

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“…There were a significant number of patients who did not have an endoscopy at the 1-year timepoint, though nearly 20% were diagnosed within 1 year of data collection and almost half within 3 years; these patients may not have had time to have a repeat endoscopy at the time of chart review, which is a challenge in real-world studies. Although follow-up endoscopy rates were low, they were somewhat similar to those in other published cohorts; Votto et al also showed limited follow-up with just 58% of their 52 EoE patients returning for clinical follow-up and 40% having repeat endoscopic evaluation at 1 year (22). Our analysis of clinical remission was limited both in absolute numbers of those with follow-up data, and it was based on patient/parent report rather than a validated scoring system.…”

Section: Discussionsupporting

confidence: 80%

Subtyping of Eosinophilic Esophagitis Based on Disease Presentation in a pediatric Cohort

Sessions

Purington

McGhee

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objective: Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory disease characterized by eosinophilic infiltration of esophageal tissue. Subtyping of EoE patients could be useful in predicting therapeutic response. We propose clinical subtypes, apply them to our pediatric EoE population retrospectively, and assess therapy choices and remission at one year. Methods: A retrospective chart review of pediatric patients diagnosed with EoE was conducted. Patients were grouped into proposed subtypes (severe, allergic, fibrostenotic, inflammatory, unclassified) based on presenting characteristics. The primary outcome was histologic remission, which was defined <15 eosinophils/high-powered-field (hpf) at the closest visit 1 year postdiagnosis. Results: Subtyping was possible in 242 of 256 patients and follow-up histological data were available in 75 subjects. The majority had an overlap in phenotype with 17% severe, 77% allergic, 15% fibrostenotic, 60% inflammatory, and 5% unclassified, whereas 45% of the cohort were assigned to a unique subtype. At 1 year, 43/75 (57%) of patients achieved histologic remission, with an overall average decrease of 33 (IQR −47, −12) eosinophils/hpf across the entire cohort. There was no difference in remission rates among subtypes. First-line therapy review revealed higher rates of proton pump inhibitor (PPI) ± topical steroids utilization in severe patients, while topical steroids were prescribed preferentially over dietary therapy in the fibrostenotic subtype. Conclusion: There were no observed differences in remission rates at 1 year among clinically defined subtypes of EoE, although this could be attributed to overlapping subtypes. Most patients responded well to medical therapy. Larger scale prospective studies designed to subtype patients and protocolize treatment may help personalize the approach to EoE management.

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Section: Discussionsupporting

confidence: 80%

Subtyping of Eosinophilic Esophagitis Based on Disease Presentation in a pediatric Cohort

Sessions

Purington

McGhee

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Supportive histologic findings include: eosinophils in clusters in the superficial lamina propria, eosinophils in the muscular propria, glandular destruction, the presence of intraepithelial eosinophils and eosinophilic cryptitis or crypt abscess (14,20). Endoscopic findings in EoG may vary from normal appearance (most patients) to nodularity, erythema, erosions, and ulcerative lesions (10,21). About 70% of EGID patients present with peripheral eosinophilia (>500 cells/mL), and in two-thirds of eosinophilic duodenitis/enteritis patients, total serum IgE was reported to be !100IU/mL (22,23).…”

Section: Eosinophilic Gastritismentioning

confidence: 99%

Helicobacter pylori‐negative Chronic Gastritis in Children

Assa

Borrelli

Broekaert

et al. 2022

J. pediatr. gastroenterol. nutr.

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Objectives:To systematically review the current evidence on Helicobacter pylori-negative chronic gastritis including natural history, available therapies and outcomes.Methods:Articles providing data on the prevalence, treatment or outcomes of Helicobacter pylori-negative gastritis were identified through a systematic search in the MEDLINE and EMBASE databases. All original research articles from human studies until October 31, 2021, were included.Results:A total of 54 studies were included consisted of eosinophilic gastritis (n = 9), autoimmune gastritis (n = 11), collagenous gastritis (n = 16), focally enhanced gastritis (n = 6), lymphocytic gastritis (n = 5) and other causes including idiopathic gastritis and chronic renal failure related (n = 7). Most of the included studies were either cross-sectional or longitudinal cohorts except for collagenous gastritis, which mainly included case reports and case series. The prevalence of paediatric eosinophilic gastritis ranges between 5 and 7/100,000 and patients have generally favourable outcome with 50% to 70% clinical and histological response to either corticosteroids or elimination diets. Autoimmune gastritis and collagenous gastritis are extremely rare entities, commonly present with refractory iron deficiency anaemia, while lymphocytic gastritis is relatively common (10%–45%) in children with coeliac disease. Data on treatments and outcomes of autoimmune, collagenous, and focally enhanced gastritis are lacking with limited data implying poor response to therapy in the former 2 diagnoses.Conclusions:Helicobacter pylori-negative gastritis is uncommonly reported, mainly in small cohorts, mixed adult-paediatric cohorts or as sporadic case reports. As common symptoms are not specific, thus not always result in an endoscopic evaluation, the true prevalence of these distinct disorders may be underestimated, and thus under reported.

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“…However, toddlers and young children may present growth failure and feeding issues that are not a contraindication for an elimination diet after a comprehensive assessment of the nutritional status (32). As reported in different pediatric studies, a significant proportion of children with EoE has other coexisting allergic diseases, including multiple IgEmediated food allergies (33)(34)(35). These patients generally are not the best candidates for FEDs, as the extensive food restrictions may compromise patient's compliance and negatively impact on QoL (14).…”

Section: Diet Therapy What Clinicians Should Know Before Prescribing a Diet Therapymentioning

confidence: 99%

Diet Therapy in Eosinophilic Esophagitis. Focus on a Personalized Approach

et al. 2022

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Eosinophilic esophagitis (EoE) is a chronic allergic disease defined by a marked eosinophilic inflammation and symptoms of esophageal dysfunction. EoE is a heterogeneous disease and severely impacts the quality of life of affected patients. The current therapeutic management of EoE is based on two cornerstones: medication and diet therapy, both effective but limited by several critical issues. The choice of one or the other therapy might depend on the different disease phenotypes (allergic vs. non-allergic, inflammatory vs. fibro-stenotic), patient's age (adult vs. childhood-onset), food habits, patient/family preference, and familiar financial resource. Diet therapy is a successful treatment but limited by low patient adherence, the need for several endoscopies, food restrictions, psychosocial impact, and potential nutritional deficiencies. All these limitations could be effectively overcome with multidisciplinary and personalized management. This review summarizes the most recent evidence on the dietary elimination approaches and will provide a practical guide to clinicians in managing and implementing dietary therapy for patients with EoE.

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Eosinophilic gastrointestinal disorders in children and adolescents: A single-center experience

Cited by 15 publications

References 37 publications

Subtyping of Eosinophilic Esophagitis Based on Disease Presentation in a pediatric Cohort

Subtyping of Eosinophilic Esophagitis Based on Disease Presentation in a pediatric Cohort

Helicobacter pylori‐negative Chronic Gastritis in Children

Diet Therapy in Eosinophilic Esophagitis. Focus on a Personalized Approach

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