Psychological Functioning of Children and Adolescents With Eosinophil-Associated Gastrointestinal Disorders

Cortina, Sandra; McGraw, Kelly; deAlarcón, Alessandro; Ahrens, Annette; Rothenberg, Marc E.; Drotar, Dennis

doi:10.1080/02739615.2010.515927

Cited by 25 publications

(37 citation statements)

References 26 publications

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“…17, 18 Our study focused solely on patients with EoE, a subset of EGIDs that may not carry as much clinical morbidity because of the less extensive involvement of the GI tract. In this regard, patients with other EGIDs may have additional symptoms such as bleeding and diarrhea and may need to be on chronic systemic steroid treatments or require more extensive testing including colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

“…17 Using the generic core scales of the PedsQL, Cortina and colleagues found that pediatric patients with Eosinophilic Gastrointestinal Diseases (EGIDs) had significantly poorer HRQoL than healthy controls. 18 This negative impact could be explained by patients experiencing persistent symptoms, following daily medical and/or dietary treatments, coping with the burden of elimination diets, and uncertainty about their future given the chronic nature of this disease.…”

Section: Introductionmentioning

confidence: 99%

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Health‐Related Quality of Life Over Time in Children With Eosinophilic Esophagitis and Their Families

Klinnert

Silveira

Harris

et al. 2014

J. pediatr. gastroenterol. nutr.

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Objectives Existing treatments for pediatric EoE effectively reduce inflammation. However, impact of treatment on health-related quality of life (HRQoL) over time for pediatric patients with EoE and their families has not been systematically assessed. We hypothesized that individualized multidisciplinary treatment would improve both child and family HRQoL over time, with improvements associated with decreased symptom severity. Methods Children with EoE treated in 4 tertiary care centers were enrolled. Baseline assessments occurred at the time of patients’ first evaluation; follow-up assessments occurred at 2 and 6 months after baseline. Presence and severity of 8 EoE symptoms were measured. HRQoL was measured with the PedsQL parent proxy-report (PR), child self-report (CR), and Family Impact Module (FIM). Statistical analyses used mixed-effects modeling to test changes over time for child and family HRQoL. Results Ninety-seven children were enrolled (ages 2–18 years; mean age, 7.7 yrs +/− 4.8 y; 78% male; 80% Caucasian). Baseline mean symptom number was 3.5 (SD, 2.3) and symptom severity was 5.5 (SD, 4.5). HRQoL scores were significantly related to symptom scores (P < 0.001). EoE symptom severity decreased during the study (P=0.03). PR PedsQL Total and FIM Total scores improved from baseline to 6 months (respectively, adjusted means 78.4 vs 81.0, P=0.0006; 68.9 vs 70.1, P=0.03). Interactions with baseline symptom severity revealed that subjects with lowest symptom severity showed the most improved HRQoL scores (P=0.0013). Conclusions HRQoL improved during the course of evaluation and treatment, with positive changes being strongest for patients with less symptom severity at baseline.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Health‐Related Quality of Life Over Time in Children With Eosinophilic Esophagitis and Their Families

Klinnert

Silveira

Harris

et al. 2014

J. pediatr. gastroenterol. nutr.

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“…Disease control is important for patient quality of life as well as for decreasing complications (12, 13). Adult studies show that increasing use of esophageal topical corticosteroids (TCS) over a 5 year time period associates with fewer episodes of food impactions (11).…”

Section: Introductionmentioning

confidence: 99%

Long-term assessment of esophageal remodeling in patients with pediatric eosinophilic esophagitis treated with topical corticosteroids

Rajan

Newbury

Anilkumar

et al. 2016

Journal of Allergy and Clinical Immunology

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Background Eosinophilic esophagitis (EoE) is a chronic Th2 inflammatory disease characterized by tissue remodeling that leads to esophageal strictures and food impactions. Effects of therapy on long term remodeling in pediatric eosinophil-associated diseases has not been previously described. Objective To understand the long term control of esophageal remodeling in EoE Methods We assessed endoscopic and histologic remodeling and TGFβ1 expression in esophageal biopsies from children (n=32) with EoE treated with topical corticosteroids (TCS) over 10 years (mean=4.5). We utilized standardized EoE scoring tools to gauge endoscopic and symptom features. Results 738 biopsies from 246 endoscopic procedures were evaluated over 10 years. 486 biopsies had adequate lamina propria (LP) for evaluation of subepithelial remodeling. The severity of epithelial esophageal eosinophilia correlated with epithelial remodeling (basal zone hyperplasia, desquamation, and dilated intercellular spaces) (p<0.0001), LP eosinophilia (p<0.0001), and fibrosis (p<0.0001). Sixteen subjects were initial responders (<15 eosinophils per hpf) to TCS. Responders and non-responders spent 54% and 97% of their total disease duration with active EoE (p<0.001) and 23% and 53% (p<0.02) with maximal fibrosis scores, respectively. Responders had lower endoscopy scores during their disease duration (p=0.013). Having <15 eosinophils per hpf at any time correlated with lower fibrosis and endoscopic severity. TGFβ1 positive cells decreased in responders at the first biopsy but this was not sustained. Symptoms did not correlate with other disease features. Conclusions Children with EoE have substantial esophageal remodeling which associates with inflammation and that can improve in a sustainable manner with TCS. Although endoscopic features correspond to histologic features, symptoms did not correlate with inflammation or fibrosis.

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“…16,17 This is particularly concerning given that poor HRQOL is related to increased school/work absenteeism, lower standardized achievement and intelligence testing scores, and work productivity loss. 18-21 Without HRQOL screening, a subgroup of patients may be overlooked and not receive the necessary resources or referrals for additional services (e.g., psychological, education specialists, social services). Taken together, these findings support the need for screening youth HRQOL during clinic visits in order to identify those at risk for further psychosocial difficulties and poor disease outcomes.…”

mentioning

confidence: 99%

The Clinical Utility of Health-Related Quality of Life Screening in a Pediatric Inflammatory Bowel Disease Clinic

Ryan

Mellon

Junger

et al. 2013

Inflammatory Bowel Diseases

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Background Adjusting to symptom flares, treatment regimens, and side effects places youth with inflammatory bowel disease (IBD) at increased risk for emotional and behavioral problems and adverse disease outcomes. Implementation of psychosocial screening into clinical practice remains a challenge. This study examines the clinical utility of health-related quality of life (HRQOL) screening in predicting disease outcome and healthcare utilization. Methods One-hundred twelve youth 7-18 years diagnosed with IBD and their parents. Youth completed standardized measures of HRQOL and depression. Parents completed a proxy-report of HRQOL. Pediatric gastroenterologists provided the Physician Global Assessment. Families were recruited from a pediatric gastroenterology clinic. Retrospective chart reviews examined disease outcome and healthcare utilization 12-months following baseline measurement. Results Linear regressions, controlling for demographic and disease parameters, revealed that baseline measurement of youth and parent proxy-reported HRQOL predicted the number of IBD-related hospital admissions, gastroenterology clinic visits, Emergency Department visits, psychology clinic visits, telephone contacts, and pain management referrals over the next 12 months. Disease outcome was not significant. Conclusions Lower HRQOL was predictive of increased healthcare utilization among youth with IBD. Regular HRQOL screening may be the impetus to providing better case management and allocating resources based on ongoing care needs and costs. Proactive interventions focused on patients with poor HRQOL may be an efficient approach to saving on healthcare costs and resource utilization.

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Psychological Functioning of Children and Adolescents With Eosinophil-Associated Gastrointestinal Disorders

Cited by 25 publications

References 26 publications

Health‐Related Quality of Life Over Time in Children With Eosinophilic Esophagitis and Their Families

Health‐Related Quality of Life Over Time in Children With Eosinophilic Esophagitis and Their Families

Long-term assessment of esophageal remodeling in patients with pediatric eosinophilic esophagitis treated with topical corticosteroids

The Clinical Utility of Health-Related Quality of Life Screening in a Pediatric Inflammatory Bowel Disease Clinic

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