Extent of eosinophilic esophagitis predicts response to treatment

Ghoz, Hassan; Stancampiano, Fernando; Valery, Jose; Nordelo, Katie; Malviya, Balkishan; Lacy, Brian E.; Francis, Dawn L.; DeVault, Kenneth R.; Bouras, Ernest P.; Krishna, Murli; Palmer, William C.

doi:10.1055/a-1492-2650

Cited by 5 publications

(4 citation statements)

References 22 publications

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“…Many studies have observed a weak correlation between clinical and histological improvement in children and adults [17,23,29]. In our analysis, clinical remission was observed more often than endoscopic or histological remission, as in other studies.…”

Section: Discussionsupporting

confidence: 81%

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Treatment effectiveness in paediatric patients with eosinophilic oesophagitis

Zdanowicz¹,

Kucharska²,

Lebensztejn³

et al. 2022

polp

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Introduction: An increase in the incidence of eosinophilic oesophagitis (EoE) in children is being observed worldwide. The diagnosis is confirmed by the morphological examination of the mucosa biopsies. The aim of our study was to evaluate the clinical course of EoE in the first year of diagnosis, and the effectiveness of the first-line treatment of EoE in children. Material and methods:This single-centre retrospective study included children with EoE newly diagnosed between January 2015 and December 2020. Patients were monitored after initial treatment and 12 months after diagnosis. The study assessed clinical, endoscopic, and histological responses to various therapeutic strategies. Results: Of the 27 children diagnosed with EoE, 19 were enrolled in the study. The median age of children with EoE was 9 years (range 2-17 years) and the majority were male (84.2%). The most frequent initial treatments were proton pump inhibitors (PPIs) (47.4%), also in combination with an elimination diet (36.8%). Clinical improvement was noted in 73.7% of cases after initial therapy and in 84.2% of patients after 12-month follow-up. However, endoscopic and histological improvement was observed less frequently, in 52.6% and 47.4% of patients, respectively. Forty-two per cent of children with EoE obtained clinical, endoscopic, and histological improvement, and the majority of them received PPIs in mono-or combination therapy with an elimination diet. Conclusions: Choosing an effective treatment that provides clinical, endoscopic, and histological improvement in patients with EoE is a challenge for clinicians. According to our observations, clinical improvement should not be a single indicator of treatment success; therefore, it is necessary to repeat upper endoscopy and oesophageal biopsy.

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Section: Discussionsupporting

confidence: 81%

“…In our study, only 57.9% of patients complied with the time of follow-up endoscopy. Loss of follow-up endoscopy has also been reported in other studies [17,19,29,31].…”

Section: Discussionsupporting

confidence: 63%

Treatment effectiveness in paediatric patients with eosinophilic oesophagitis

Zdanowicz¹,

Kucharska²,

Lebensztejn³

et al. 2022

polp

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“…Of note, such favorable outcome was not seen in localized distal disease. Lately, Ghoz and colleagues suggested higher therapeutic response with limited distal disease compared to diffuse disease in a single-center study [27]. However, most of the patients included in that study were actually treated with PPI (87 and 83%).…”

Section: Discussionmentioning

confidence: 99%

Histological Phenotyping in Eosinophilic Esophagitis: Localized Proximal Disease Is Infrequent but Associated with Less Severe Disease and Better Disease Outcome

Heil,

Kuehlewindt,

Godat

et al. 2023

Int Arch Allergy Immunol

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Introduction: It is still unknown whether eosinophilic esophagitis (EoE) patients with localized disease are different from those with extended disease. Methods: We evaluated prospectively included patients in the Swiss EoE cohort. Data on all patients with active disease at baseline, no concomitant gastroesophageal reflux disease, no strictures at baseline, and at least one follow-up visit were analyzed. We compared patients with histologically localized proximal versus distal versus extended (=proximal and distal) disease with regard to patient, disease characteristics, disease presentation, and development of complications. Results: We included 124 patients with a median of 2.5 years of follow-up (73.4% males, median age 35.0 years). Ten patients had proximal (8.1%), 46 patients had distal (37.1%), and 68 patients had extended disease (54.8%). Patients with proximal disease were significantly more often females (80%) compared with patients with distal (26.1%, p = 0.002) or extended disease (19.1%, p < 0.001) and reported less severe symptoms (VAS 0 vs. VAS 1, p = 0.001). Endoscopic and histological disease was less pronounced in the proximal esophagus of proximal EoE compared to extended disease (EREFS 1.0 vs. 3.0, p = 0.001; 27.0 eos/hpf vs. 52.5 eos/hpf, p = 0.008). Patients with proximal disease were less likely to undergo dilation compared to patients with distal disease in the follow-up (3.3% vs. 23.3%, p = 0.010). In a multivariate Cox regression model, proximal eosinophilia was less likely to be associated with treatment failure compared to distal eosinophilia. Conclusion: Although isolated proximal EoE is infrequent, it is associated with less severe disease and better disease outcome. Proximal disease appears to present a unique EoE phenotype.

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“…Em alguns casos, observam-se manchas brancas ou placas (exsudatos), estenoses ou fragilidade da mucosa (esôfago de papel crepom) (ABE Y, et al As diretrizes atuais recomendam que pelo menos seis biópsias esofágicas sejam obtidas de dois locais diferentes no esôfago, mais tipicamente nas metades distal e proximal. À medida que o número de biópsias chega a seis ou mais, a sensibilidade diagnóstica para EEo (GHOZ H, et al, 2021).…”

Section: Manifestações Clínicas E Diagnósticounclassified

Uma abordagem das principais características da esofagite eosinofílica

Bracci

Flora²,

Cury³

et al. 2023

Acervo Saúde

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Objetivo: Analisar as características da Esofagite Eosinofílica (EEo). Revisão bibliográfica: A EEo é uma doença inflamatória crônica, imunomediada, caracterizada por disfunção esofágica e infiltração transmural do esôfago por eosinófilos. A EEo é considerada o distúrbio gastrointestinal eosinofílico mais freqüente com incidência de aproximadamente 5 a 10 casos por 100.000 por ano e prevalência de aproximadamente 0,5 a 1 caso por 1.000. Sua etiologia exata é desconhecida, mas acredita-se que seja resultado das interações de ambiente, genética e sistema imunológicos do hospedeiro. Na EEo a inflamação causada por eosinófilos está confinada ao esôfago. O aumento da prevalência resulta da conscientização sobre a doença, melhor acesso à endoscopia, bem como aumento da incidência de alergias. Considerações finais: A EEo é uma doença inflamatória imunológica crônica, mediada por antígeno Th2, cuja incidência é crescente, principalmente nos países ocidentais. Seu diagnóstico é feito a partir da suspeição clínica (impactação alimentar, disfagia e história de atopia) confirmado com endoscopia digestiva alta com no mínimo 6 biópsias. O tratamento da EEo é feito primariamente com dieta e, posteriormente, com opções terapêuticas como os inibidores de bombas de prótons e corticóides tópicos deglutidos.

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Extent of eosinophilic esophagitis predicts response to treatment

Cited by 5 publications

References 22 publications

Treatment effectiveness in paediatric patients with eosinophilic oesophagitis

Treatment effectiveness in paediatric patients with eosinophilic oesophagitis

Histological Phenotyping in Eosinophilic Esophagitis: Localized Proximal Disease Is Infrequent but Associated with Less Severe Disease and Better Disease Outcome

Uma abordagem das principais características da esofagite eosinofílica

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