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Eosinophilic esophagitis in children

Alexandra Ahmet, Eric I Benchimol, Ellen B Goldbloom, Janice L Barkey
BACKGROUND: Adrenal suppression (AS), a glucocorticoid (GC) side effect associated with significant morbidity, is well described related to inhaled corticosteroid therapy for asthma. Swallowed topical glucocorticoid therapy is the main pharmacotherapy treatment for eosinophilic esophagitis (EoE) and therefore children with EoE are potentially at increased risk of AS. METHODS: In this prospective cohort study, we included children and youth <18 years diagnosed with EoE and treated with swallowed fluticasone or oral viscous budesonide for more than 1 month...
2016: Allergy, Asthma, and Clinical Immunology
E Ten Velde, B C Gonera-de Jong
In this case report we discuss two children with dysphagia. Both presented with difficulties in swallowing and oesophageal impaction of solid food. The first case involves a 16-year-old boy who suffered from dysphagia for many years. After a long diagnostic journey, during which a psychogenic cause was suspected, he was diagnosed with oesophageal achalasia. After a balloon dilatation of the lower oesophageal sphincter his complaints persisted and the treatment procedure was repeated. The second case involves a 15-year-old girl, who presented with a food impaction in the distal oesophagus...
2016: Nederlands Tijdschrift Voor Geneeskunde
Leon A Sokulsky, Adam M Collison, Scott Nightingale, Anna Le Fevre, Elizabeth Percival, Malcolm R Starkey, Philip M Hansbro, Paul S Foster, Joerg Mattes
INTRODUCTION: Food antigens are common inflammatory triggers in pediatric eosinophilic esophagitis (EoE). TNF-related apoptosis-inducing ligand (TRAIL) promotes eosinophilic inflammation through the upregulation of Midline (MID)-1 and subsequent downregulation of Protein Phosphatase 2A (PP2A) but the role of this pathway in EoE that is experimentally induced by repeated food antigen challenges has not been investigated. METHODS: Esophageal mucosal biopsies were collected from children with EoE and controls and assessed for TRAIL and MID-1 protein and mRNA transcript levels...
October 13, 2016: American Journal of Physiology. Gastrointestinal and Liver Physiology
Anna K Le Fevre, Marjorie M Walker, Amir Hadjiashrafy, Rani Bhatia, Joerg Mattes, Nicholas J Talley, Scott Nightingale
OBJECTIVES: This study compared the clinical and histopathological characteristics of children with EoE and elevated anti-transglutaminase (TTG Ab) with those with EoE and normal TTG Ab titres. METHODS: Single center chart and blinded histopathological review of patients diagnosed with EoE over a four-year period, who had esophageal and duodenal biopsies taken at time of endoscopy, and TTG Ab measured within 6 months of biopsy. Patients with histology-proven CD were excluded...
October 12, 2016: Journal of Pediatric Gastroenterology and Nutrition
E Gómez Torrijos, P Sánchez Miranda, P Donado Palencia, A Castro Jimenez, J Rodriguez Sánchez, Y Mendez Díaz, L Moreno Lozano, R García Rodríguez
BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic inflammatory emerging disease of the oesophagus with immunoallergic aetiology. Until now, few studies about this disease in children and adolescents have been published Objectives: To study the demographic, clinical, serologic, endoscopic-histological and allergologic characteristics of the patients and their atopic and digestive comorbidities. METHODOLOGY: It is an prospective observacional study in children and adolescents (<16 years) assessed in a multidisciplinary specialized eosinpophilic esopahgitis unit in a tertiary referral centre in the central region of Spain carried out between 2011-2015...
October 10, 2016: Journal of Investigational Allergology & Clinical Immunology
Ekaterini Politi, Aspasia Angelakopoulou, Dimitra Grapsa, Maria Zande, Kalliopi Stefanaki, Ioanna Panagiotou, Eleftheria Roma, Ekaterini Syrigou
OBJECTIVES: Previous data have suggested that filaggrin (FLG) and periostin (POSTN) genes may be dysregulated in eosinophilic esophagitis (EoE). We aimed to further evaluate the expression patterns of FLG and POSTN proteins in esophageal tissue samples of patients with EoE, as compared to those of patients with gastroesophageal reflux disease (GERD) and normal controls. METHODS: A total of 61 prospectively collected cases, including 40 children with EoE and 21 children with gastroesophageal reflux disease (GERD), and a control group of 14 sex and age-matched healthy children were enrolled...
September 24, 2016: Journal of Pediatric Gastroenterology and Nutrition
Mikhail Lisovsky, Maria Westerhoff, Xuchen Zhang
The clinical significance of lymphocytic esophagitis (LyE), which is characterized by the prominence of peripapillary intraepithelial lymphocytes (IELs) without significant granulocytosis, remains poorly understood. During the last few years, plausible clinical correlates and novel approaches for stratification of LyE have started to emerge. Association with Crohn's disease has been established in children, but is not observed in adults. In adults, the form of LyE showing CD4(+) -predominant IELs has been recently found to be associated with non-achalasia primary motility abnormalities...
September 16, 2016: Annals of the New York Academy of Sciences
Thirumazhisai Gunasekaran, Gautham Prabhakar, Alan Schwartz, Kiranmai Gorla, Sandeep Gupta, James Berman
Aim. Compare EoE-AP with EoE-D for clinical, endoscopy (EGD), histology and outcomes and also with FAP-N. Method. Symptoms, physical findings, EGD, histology, symptom scores, and treatments were recorded for the three groups. Cluster analysis was done. Results. Dysphagia and abdominal pain were different in numbers but not statistically significant between EoE-AP and EoE-D. EGD, linear furrows, white exudates were more in the EoE-D and both combined were significant (p < 0.05). EoE-D, peak and mean eosinophils (p  0...
2016: Canadian Journal of Gastroenterology & Hepatology
Carina Venter, David M Fleischer
No abstract text is available yet for this article.
August 31, 2016: Annals of Allergy, Asthma & Immunology
Mirna Chehade
No abstract text is available yet for this article.
August 6, 2016: Revista Paulista de Pediatria: Orgão Oficial da Sociedade de Pediatria de São Paulo
Usha Krishnan, Hayat Mousa, Luigi Dall'Oglio, Nusrat Homaira, Rachel Rosen, Christophe Faure, Frédéric Gottrand
BACKGROUND: Esophageal atresia (EA) is one of the most common congenital digestive anomalies. With improvements in surgical techniques and intensive care treatments, the focus of care of these patients has shifted from mortality to morbidity and quality-of-life issues. These children face gastrointestinal (GI) problems not only in early childhood but also through adolescence and adulthood. There is, however, currently a lack of a systematic approach to the care of these patients. The GI working group of International Network on Esophageal Atresia comprises members from ESPGHAN/NASPGHAN and was charged with the task of developing uniform evidence-based guidelines for the management of GI complications in children with EA...
November 2016: Journal of Pediatric Gastroenterology and Nutrition
Yiang Hui, Sonja Chen, Kara A Lombardo, Murray B Resnick, Shamlal Mangray, Andres Matoso
Histologically, esophageal biopsies should have {greater than or equal to}15 intraepithelial eosinophils (IEEs) per high power field (HPF) to support a clinicopathologic diagnosis of eosinophilic esophagitis (EoE). Children with clinically apparent EoE may show pauci-eosinophilic biopsies due to patchy involvement. Immunostaining (IHC) for arachidonate-15 lipooxygenase (ALOX15) has been demonstrated to be a sensitive marker for EoE. We retrospectively assessed the expression of ALOX15 in 48 biopsies from 21 patients with established diagnosis of EoE and with tissue fragments below the threshold of 15 IEEs/HPF...
August 30, 2016: Pediatric and Developmental Pathology
Samiullah, Hadi Bhurgri, Umair Sohail
Eosinophilic gastrointestinal disorders represent a spectrum of disorders demonstrating gastrointestinal eosinophilia without any known cause for eosinophilia. Pathogenesis is not clearly established, but immune responses to dietary antigens are implicated. These disorders affect children and adults and are seen in association with allergic disorders. Eosinophilic esophagitis is diagnosed in the setting of mucosal eosinophilia on endoscopic biopsy and symptoms of esophageal dysfunction. Eosinophilic gastroenteritis is also diagnosed with endoscopic biopsies...
September 2016: Primary Care
Anjum Saeed, Asaad Assiri, Zafar Zaidi, Abdulmalik Alsheikh
Esophagitis in children is not uncommon, mostly due to gastro-esophageal reflux. Other conditions like eosinophilic and infective esophagitis need to be elucidated in differential diagnoses. Fungal orCandida esophagitisusually occurs in high risk children who are immune-compromised, malnourished, on steroid therapy or have uncontrolled diabetes mellitus. An eleven-year girl presented with uncontrolled type I diabetes mellitus and recurrent epigastric pain with vomiting. Her oral intake was satisfactory. There was no dysphagia and odynophagia...
August 2016: Journal of the College of Physicians and Surgeons—Pakistan: JCPSP
Wael N Sayej, Antoine Ménoret, Anu S Maharjan, Marina Fernandez, Zhu Wang, Fabiola Balarezo, Jeffrey S Hyams, Francisco A Sylvester, Anthony T Vella
Eosinophilic esophagitis (EoE) is an emerging allergic, IgE- and non-IgE (Th2 cell)-mediated disease. There are major gaps in the understanding of the basic mechanisms that drive the persistence of EoE. We investigated whether esophageal biopsies from children with EoE demonstrate an inflammatory response that is distinct from normal controls. We prospectively enrolled 84 patients, of whom 77 were included in our analysis, aged 4-17 years (12.8±3.8 years; 81% males). Five esophageal biopsies were collected from each patient at the time of endoscopy...
July 2016: Clinical & Translational Immunology
Steve B Min, Cade M Nylund, Thomas P Baker, Mazer Ally, Brian Reinhardt, Yen-Ju Chen, Luz Nazareno, Fouad J Moawad
BACKGROUND: The diagnosis and management of eosinophilic esophagitis (EoE) often requires multiple endoscopies. Serum biomarkers can be elevated in EoE patients, but their clinical utility in diagnosis and assessing response to treatment is not well established. GOALS: To evaluate serum biomarkers in EoE subjects compared with controls and assess longitudinally in response to treatment. STUDY: We conducted a prospective cohort study of children and adults undergoing esophagogastroduodenoscopy for suspected EoE...
July 29, 2016: Journal of Clinical Gastroenterology
B J Pelz, J B Wechsler, K Amsden, K Johnson, A M Singh, B K Wershil, A F Kagalwalla, P J Bryce
BACKGROUND: Links between food allergens and eosinophilic esophagitis (EoE) have been established, but the interplay between EoE- and IgE-associated immediate hypersensitivity to foods remains unclear. OBJECTIVE: We sought to determine the prevalence of IgE-associated food allergy at the time of diagnosis of EoE in children and to determine whether differences existed in presentation and disease compared to subjects with EoE alone. METHODS: Eosinophilic esophagitis patients were stratified based on the diagnosis of IgE-associated immediate hypersensitivity (EoE + IH vs...
July 8, 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
R Orel, S Murch, J Amil Dias, Y Vandenplas, M Homan
Therapy with proton-pump inhibitors (PPIs) results in remission in at least one third of patients with esophageal eosinophilia, presumably because of both their acid-related and anti-inflammatory mechanisms of action. However, eosinophilic esophagitis (EoE) may also develop during therapy with PPIs. We present a case series of four children who were initially diagnosed with infectious esophagitis, gastroesophageal reflux disease or gastric ulcer, who had no eosinophilic infiltration of the esophagus, but subsequently developed symptoms, endoscopic features and histological picture of typical EoE...
April 2016: Acta Gastro-enterologica Belgica
Hanan M Fouad, Nour A Abdulla, Suzan El Naghy, Ehsan H Hassan, Amal Abd El-Hamid
Upper gastrointestinal tract (GIT) symptoms are not disease specific and of limited value in the differentiation of GIT disorders. The present study aimed to determine the etiology of chronic unspecific symptoms in children and to test the need for upper endoscopy in diagnosis. This is a prospective study for 30 Egyptian children presented with chronic upper GIT symptoms for at least 2 months. History regarding severity and frequency of GIT symptoms were asked for. Children with known disorder that explains presenting symptoms were excluded...
April 2016: Journal of the Egyptian Society of Parasitology
Doerthe A Andreae, Matthew G Hanna, Margret S Magid, Stefano Malerba, Michael H Andreae, Emilia Bagiella, Mirna Chehade
OBJECTIVES: Although effective in the treatment of eosinophilic esophagitis (EoE) in children, limited data exist on long-term safety and efficacy of swallowed topical corticosteroids. We investigated whether long-term use of swallowed fluticasone in children with EoE leads to sustained reduction in esophageal eosinophils, and endoscopic and clinical improvement. METHODS: In an open-label, prospective, single-center study, we offered pediatric patients with active EoE fluticasone 2 puffs to swallow twice a day (strengths in μg/puff: 2-4 years: 44, 5-11 years: 110, ≥12 years: 220)...
August 2016: American Journal of Gastroenterology
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