Management Guidelines of Eosinophilic Esophagitis in Childhood

Abstract

EoE is a chronic, relapsing inflammatory disease with largely unquantified long-term consequences. Investigations and treatment are tailored to the individual and must not create more morbidity for the patient and family than the disease itself. Better maintenance treatment as well as biomarkers for assessing treatment response and predicting long-term complications is urgently needed.

Eosinophilic oesophagitis: an insidious but treatable cause of sore throat

“…2 Once eosinophilic infiltration has been demonstrated, it is recommended that patients should be given a trial of highdose PPI for 4-8 weeks followed by a repeat endoscopy. 2,7 In patients with persistent symptoms and eosinophilic infiltration despite PPI therapy, EO can be formally diagnosed. 3 This step is important in distinguishing EO from GORD where eosinophilic infiltration is caused by reflux, and Proton Pump InhibitorResponsive Oesophageal Eosinophilia (PPI-REE), a primary autoimmune disorder that causes eosinophilic infiltration in the absence of reflux 3 but resolves with PPIs.…”

Eosinophilic esophagitis and esophageal atresia: coincidence or causality?

“…7,8,12 The treatment goals are complete resolution of clinical symptoms, eosinophilic inflammation, and esophageal remodeling. To this end, dietary and pharmacologic interventions are used: 1,7,10 …”

“…1,2 Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a congenital anomaly of the esophagus. The treatment of choice is surgical repair with potential late complications such as dysphagia, gastroesophageal reflux, strictures, and dysmotility.…”

“…The recommendation is to collect at least 2-4 biopsies of the upper and lower third of the esophagus because it usually shows a patchy involvement, and of the gastric antrum and duodenum to rule out eosinophilic gastroenteritis. 1,12 The histological marker of EoE is the presence of 15 or more eosinophils per hpf, with a 100% sensitivity and a 96% specificity. Eosinophil degranulation, eosinophil microabscesses, basal cell hyperplasia, and lamina propria fibrosis may also occur 7,10 ( Figure 3).…”

Proton Pump Inhibitor Therapy in Eosinophilic Esophagitis: Current Role and Future Perspectives

“…As such, a PPI trial before arriving at a diagnosis of EoE is currently mandatory in order to avoid unnecessary therapeutic interventions in PPI-REE, such as topical steroids or elimination diets. Diagnostic and therapeutic implications of PPI-REE have been also included and highlighted in the recently published third (2013) and fourth (2014) iteration of clinical guidelines [11,12]. Table 1 summarizes the rapidly evolving consideration of PPI responsiveness in patients with suspected EoE over the past 7 years.…”