Systemic steroids have a role in treating esophageal strictures in pediatric eosinophilic esophagitis

Hoofien, Assaf; Rea, Francesca; Espinheira, Maria do Céu; Dias, Jorge Amil; Romano, Claudio; Oliva, Salvatore; Auth, Marcus K.H.; Zangen, Tsili; Kalach, Nicolas; Domínguez-Ortega, Gloria; Angelis, Paola De; Zevit, Noam

doi:10.1016/j.dld.2020.11.025

Cited by 18 publications

(25 citation statements)

References 14 publications

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“…Apparently, this finding contrasts with the evidence in adults in which untreated EoE has been associated with progressive formation of esophageal strictures (32). Despite our findings in children and adolescents that confirmed the presentation of pediatric EoE with an inflammatory-predominant phenotype, which has been reported as less likely to evolve with significant remodeling even if untreated for several years (33,34), we cannot conclude that remodeling is not present in this cohort. Further evidence that pediatric EoE is an inflammatory rather than a fibrostenotic disease is the very rapid clinical and endoscopic response of pediatric EoE-associated strictures reported in patients treated with systemic steroids (33).…”

Section: Discussioncontrasting

confidence: 99%

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

Oliva

Dias

Rea

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Few pediatric data on phenotypic aspects of eosinophilic esophagitis (EoE) are available. The pEEr registry was developed to prospectively characterize children with EoE from Europe and Israel. Methods: pEEr is an ongoing prospective registry enrolling children with esophageal eosinophilia (≥15 eos/HPF). Anonymized data were collected from 19 pediatric centers. Data regarding demographics, clinical manifestations, endoscopy, histology, and therapies were collected. Results: A total of 582 subjects (61% male) were analyzed. The median age at diagnosis was 10.5 years [interquartile range (IQR): 5.7-17.7], whereas the age at symptom onset was 9.2 years (IQR: 4.3-16.4), resulting in a median diagnostic delay of 1.2 years (IQR: 0.7-2.3). The diagnostic delay was longer below age <6 years. Shorter diagnostic delays were associated with the presence of food allergy or a family history for EoE. Symptoms varied by age with dysphagia and food impaction more common in adolescents, while vomiting and failure to thrive more common in younger children (P < 0.001). Among endoscopic findings, esophageal rings were more common in adolescents, whereas exudates were more frequent in younger children(P < 0.001). Patients who responded to proton pump inhibitors (PPIs) were more likely to be older, males, and less often presented severe endoscopic findings. Patients unresponsive to PPIs received topical steroids (40%), elimination diet (41%), or a combined therapy (19%). Conclusions: EoE findings vary according to age in pediatric EoE. Young children are commonly characterized by non-specific symptoms, atopic dermatitis, food allergy, and inflammatory endoscopic lesions. Adolescents usually have dysphagia or food impaction, fibrostenotic lesions, and a better PPI response.

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Section: Discussioncontrasting

confidence: 99%

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

Oliva

Dias

Rea

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…After systemic steroid treatment, at follow-up endoscopy 95% showed resolution of the strictures and 67% had normal eosinophils/hpf counts. While all patients improved clinically, 75% (15/20) 171 In paediatric patients with EoE, moderate-to-severe oesophageal strictures may respond safely and rapidly to short courses of systemic steroids bridged to standard EoE treatments.…”

Section: Grade Of Evidence: Moderatementioning

confidence: 94%

“…Three patients, who had only partially responded to systemic steroids, underwent oesophageal dilation. 171 There are no data on the use of systemic steroids for the management of EoE in adults.…”

Section: Systemic Steroids Are Not Recommended In Eoementioning

confidence: 99%

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British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Dhar

Haboubi

Attwood

et al. 2022

Gut

121

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BackgroundEosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.MethodsThe Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.ResultsFifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.ConclusionsThese comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.

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“…Despite being effective in inducing remission, it is not recommended to use systemic corticosteroids due to their possible serious adverse systemic effects [ 1 , 10 ]. The only potential use for systemic corticosteroids is as an alternative to surgical dilation for the treatment of esophageal strictures or in a patient with severe symptoms in whom prompt induction of remission is desirable; even then, their use should be restricted to a short course [ 11 ].…”

Section: General Treatment Recommendations For Eoementioning

confidence: 99%

Formulations of Topical Steroids in Eosinophilic Esophagitis—Current Treatment and Emerging Possibilities

Główczewski

Krogulska

2022

JCM

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Eosinophilic esophagitis (EoE) is a chronic immune-mediated disorder characterised by eosinophilic inflammation and esophageal dysfunction symptoms. The recommended first-line treatment options are proton pump inhibitors and swallowed topical steroids (STS). However, current recommendations regarding STS are based on relatively few studies employing various doses and formulations. Our aim was to review the STS formulations currently used in the treatment of eosinophilic esophagitis, to demonstrate in a practical way the variety of exiting application methods, and to present emerging options for STS delivery to the esophagus. After the literature review, we established that the three most commonly used STS formulations include mist from an inhaler, viscous suspensions compounded with vehicles for oral use, and a recently introduced proprietary medication in the form of orodispersible tablets. Several drug delivery technologies with potential use in EoE are under investigation. To ensure optimal adherence, the choice of formulation should be based on efficacy, patient preferences and experience of the clinician, as well as current recommendations. Further studies are needed to compare the efficacy and acceptability of existing STS types, and to develop new, well-tolerated and effective drug formulations.

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Systemic steroids have a role in treating esophageal strictures in pediatric eosinophilic esophagitis

Cited by 18 publications

References 14 publications

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

Characterization of Eosinophilic Esophagitis From the European Pediatric Eosinophilic Esophagitis Registry (pEEr) of ESPGHAN

British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults

Formulations of Topical Steroids in Eosinophilic Esophagitis—Current Treatment and Emerging Possibilities

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