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Eosinophilic esophagitis in children

Javier Molina-Infante, Carolina Gutierrez-Junquera, Edoardo Savarino, Roberto Penagini, Ines Modolell, Ottavia Bartolo, Alicia Prieto-García, Aurelio Mauro, Javier Alcedo, Antonia Perelló, Carlos Guarner-Argente, Noelia Alcaide, Ana M Vegas, Patricia Barros-García, Marianette Murzi-Pulgar, Monica Perona, Javier P Gisbert, Alfredo J Lucendo
OBJECTIVES: Rising trends in eosinophilic esophagitis (EoE) have been repeatedly linked to declining Helicobacter pylori (H. pylori) infection, mostly in retrospective studies. We aimed to prospectively evaluate this inverse association. METHODS: Prospective case-control study conducted in 23 centers. Children and adults naïve to eradication therapy for H. pylori were included. Cases were EoE patients, whereas controls were defined by esophageal symptoms and <5 eos/HPF on esophageal biopsies...
March 15, 2018: American Journal of Gastroenterology
Mary Allyson Lowry, Michael F Vaezi, Hernan Correa, Tina Higginbotham, James C Slaughter, Sari Acra
BACKGROUND & AIMS: Eosinophilic esophagitis (EoE) is a chronic disorder in children that requires continued assessment of disease activity, involving repeated sedation, endoscopy, and biopsy analysis. We investigated whether mucosal impedance measurements can be used to monitor disease activity in pediatric patients with EoE. METHODS: We measured mucosal impedance at 3 locations in the esophagus in pediatric patients (1-18 years old; 32 with active EoE, 10 with inactive EoE, 32 with non-erosive reflux disease [NERD]) and 53 children with symptoms but normal findings from histologic analyses (controls) undergoing routine esophagogastroduodenoscopy at the Vanderbilt Pediatric Gastroenterology Clinic...
March 14, 2018: Journal of Pediatric Gastroenterology and Nutrition
Javier Molina-Infante, Alfredo J Lucendo
Eosinophilic esophagitis (EoE) is a chronic, immune-mediated, esophageal disease triggered predominantly, but not excusively, by food antigens. Presently, available food allergy tests are suboptimal to predict food triggers for EoE, especially in adults. Elemental diet (exclusive feeding with aminoacid-based formulas) and empiric six-food elimination diet (6-FED; withdrawing milk, wheat, egg, soy, nuts and fish/seafood for 6 weeks), have consistently shown the best efficacy rates. However, their high level of restriction and need for multiple endoscopies have hampered their implementation in clinical practice...
March 6, 2018: Journal of Allergy and Clinical Immunology
Lisa M Fahey, Prasanna M Chandramouleeswaran, Shaobo Guan, Alain J Benitez, Glenn T Furuta, Seema S Aceves, Mei-Lun Wang, Chris A Liacouras, Amanda B Muir, Patrick Ma Sleiman, Hakon Hakonarson, Jonathan M Spergel, Antonella Cianferoni
OBJECTIVES: TSLP has been shown to be associated with eosinophilic esophagitis (EoE). Specifically, children with EoE often have the nucleotides AA or AG instead of GG at the single nucleotide polymorphism position RS3806932. Presently, the phenotypic characteristics in EoE children with the TSLP EoE risk allele are unknown. METHODS: A retrospective analysis was performed of all children with EoE who had TSLP genotyping at The Children's Hospital of Philadelphia from 2008-2014...
March 6, 2018: Clinical and Translational Gastroenterology
Carolina Gutiérrez-Junquera, Sonia Fernández-Fernández, M Luz Cilleruelo, Ana Rayo, Luis Echeverría, Belén Borrell, Enriqueta Román
OBJECTIVES: Proton pump inhibitor (PPI)-responsive eosinophilic esophagitis (EoE) is frequently observed in children, but data on long-term treatment are scarce. The objective of this study is to evaluate the long-term efficacy and safety of PPIs in children with EoE. METHODS: This prospective study enrolled children with EoE and histological remission to an 8-week esomeprazole trial (1 mg/kg/dose, twice daily). Esomeprazole was maintained at 1 mg/kg/day for 1 year...
March 5, 2018: Journal of Pediatric Gastroenterology and Nutrition
S M Bolton, A F Kagalwalla, J B Wechsler
PURPOSE OF REVIEW: The goal of this review is to present and summarize studies on endoscopic findings in eosinophilic esophagitis (EoE), at diagnosis and in response to treatment, utilizing rigorous peer-reviewed literature in children wherever possible and to introduce a recently proposed standardized endoscopic evaluation system. RECENT FINDINGS: Gold standard of diagnosis and assessment of response to therapy in EoE requires multiple endoscopies with biopsies for histology, which allows for observation of the esophageal mucosa...
February 28, 2018: Current Gastroenterology Reports
Sandy R Durrani, Vincent A Mukkada, Theresa W Guilbert
Eosinophilic esophagitis and asthma are frequently found as comorbid conditions in children and adults along with other manifestations of atopic diathesis. These two conditions have similar T helper 2 responses-driven pathophysiology and share common management strategies such as using systemic corticosteroids and targeted anti-cytokine biologic therapies. Review of the literature finds that asthma is often a comorbid condition in eosinophilic esophagitis in both children and adults; however, the EoE-asthma relationship remains poorly characterized mechanistically and clinically...
February 18, 2018: Clinical Reviews in Allergy & Immunology
Eyal Zifman, Hagar Banai, Raanan Shamir, Tamar Ringel-Kulka, Noam Zevit
OBJECTIVES: Eosinophilic esophagitis (EoE) guidelines call for similar practices in adults and children with EoE. We compared the diagnostic and management practices of gastroenterologists treating adult and pediatric patients suspected of having, or diagnosed with, EoE. METHODS: A 19 question multiple choice questionnaire was given to gastroenterologists treating either adults or children. Questions explored four areas of interest: Physician demographics, diagnosis and tissue sampling practices, management, and the need for societal publications on EoE...
February 1, 2018: Journal of Pediatric Gastroenterology and Nutrition
Yu Ting He, Paul J Christos, William R Reisacher
BACKGROUND: The pathogenesis of eosinophilic esophagitis (EoE) is currently unknown, but evidence suggests that allergic sensitization to food and airborne allergens may play a key role. This retrospective study examines the rate of sensitization to both food and airborne allergens in EoE patients, and compares their sensitivity patterns to control groups. METHODS: We identified 103 patients with a diagnosis of EoE via esophageal eosinophilia (≥15 eosinophils/high-power field [hpf]), who had undergone comprehensive food and/or airborne allergen testing through either skin or in vitro methods...
January 30, 2018: International Forum of Allergy & Rhinology
Emily Ko, Mirna Chehade
Eosinophilic esophagitis (EoE) is an immune-mediated, chronic esophageal disease characterized by esophageal symptoms and esophageal eosinophilia. It is triggered by foods and possibly by environmental allergens. Currently, there are no FDA-approved therapies for EoE. Commonly used treatments include dietary restrictions and topical corticosteroids. Many of these therapies are suboptimal in their efficacy, have side effects, or diminish patients' quality of life. Biologic therapies for EoE have therefore been sought as an alternative...
January 25, 2018: Clinical Reviews in Allergy & Immunology
Jason D Eckmann, Karthik Ravi, David A Katzka, Dawn R Davis, Jacalyn A See, Debra R Geno, Lori A Kryzer, Jeffrey A Alexander
BACKGROUND: Atopy patch testing (APT) has shown potential for predicting dietary food triggers in studies of children and adolescents with eosinophilic esophagitis (EoE). AIMS: To assess the efficacy of APT in adults with EoE. METHODS: We conducted a prospective open-label pilot study of patients ≥ 18 years old with diagnosis of EoE at Mayo Clinic in Rochester, Minnesota, from November 2014 to January 2016. All patients underwent patch testing using intact food products, followed by a six food elimination diet and stepwise food reintroduction...
January 18, 2018: Digestive Diseases and Sciences
Antonella Cianferoni, Melanie A Ruffner, Ryan Guzek, Shaobo Guan, Terri Brown-Whitehorn, Amanda Muir, Jonathan M Spergel
BACKGROUND: Eosinophilic esophagitis (EoE) is an allergic inflammatory disease that is triggered by food allergens and characterized by progressive esophageal dysfunction. Esophageal biopsy specimens are characterized by eosinophilia and expression of TH 2 cytokines. OBJECTIVE: To ascertain whether TH 2 cells can exist in the peripheral blood in patients with milk-induced EoE. METHODS: Peripheral blood mononuclear cells from 20 children with milk-induced EoE were collected during active EoE (EoE-A) while consuming milk and inactive EoE (EoE-I) while not consuming milk, and 8 healthy patients without EoE were used as controls...
February 2018: Annals of Allergy, Asthma & Immunology
J B Wechsler, S Bolton, K Amsden, B K Wershil, I Hirano, A F Kagalwalla
BACKGROUND & AIMS: The endoscopic reference score (EREFS) is used to determine severity of 5 endoscopic findings: edema, rings, exudates, furrows, and strictures. Little is known about the relationship between EREFSs and histologic markers of disease activity in children with eosinophilic esophagitis (EoE). We aimed to determine whether the EREFS can be used to identify children with EoE and how it changes with treatment. METHODS: We performed a prospective study of consecutive children (ages 2-17 years) undergoing diagnostic or post-treatment endoscopy scored real-time with EREFS from December 2012 through 2016...
December 14, 2017: Clinical Gastroenterology and Hepatology
Mahsa Eskian, MirHojjat Khorasanizadeh, Amal H Assa'ad, Nima Rezaei
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus affecting both children and adults, with debilitating and progressive symptoms. EoE has shown an explosive epidemiological rise in the past few decades. Many patients experience a poor level of disease control despite maximal use of available guideline-based therapies, which seriously hampers their quality of life. Diet restrictions and systemic and topical corticosteroids are the current mainstays of EoE therapy, but are associated with significant efficacy, treatment compliance, and safety issues such as oral or esophageal candidiasis, growth retardation, osteopenia, osteoporosis, glucose intolerance, and cataract formation...
December 12, 2017: Clinical Reviews in Allergy & Immunology
Jonathan E Markowitz, Laura Jobe, Michelle Miller, Carrie Frost, Zegilor Laney, Ransome Eke
BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic disease characterized by infiltration of eosinophils in the esophageal epithelium. There are limited treatment options for EoE. RATIONALE: To evaluate the long term safety and efficacy of reslizumab (RSZ) in pediatric patients who received RSZ in a randomized controlled trial (RCT) and expanded access program. METHODS: Records of patients who received RSZ in our center were reviewed. Patients received RSZ 2 mg/kg (or placebo) every 4 weeks as part of the RCT, open label extension (OLE), and compassionate use (CU)...
November 22, 2017: Journal of Pediatric Gastroenterology and Nutrition
Joan W Chen, John Y Kao
Eosinophilic esophagitis is a chronic allergen driven immune mediated disease that is increasingly recognized as a leading cause of dysphagia and foregut symptoms in children and adults. Much knowledge has been gained in recent years on the genetic and environmental risk factors for this disease, the associated inflammatory milieu, and the long term complications from esophageal remodeling. In this review we will highlight recent progress made in research into this disease, focusing on adults. We will discuss ongoing efforts to develop a minimally invasive technique that may obviate the need for repeated endoscopic assessment of disease activity...
November 13, 2017: BMJ: British Medical Journal
Lisa J Martin, Hua He, Margaret H Collins, J Pablo Abonia, Joceyln M Biagini Myers, Michael Eby, Hanna Johansson, Leah C Kottyan, Gurjit K Khurana Hershey, Marc E Rothenberg
BACKGROUND: Eosinophilic esophagitis (EoE) is an esophageal inflammatory disease associated with atopic diseases. Thymic stromal lymphopoietin (TSLP) and calpain 14 (CAPN14) genetic variations contribute to EoE, but how this relates to atopy is unclear. OBJECTIVE: The purpose of this study was to explore the relationship between EoE, atopy, and genetic risk. METHODS: EoE-atopy enrichment was tested by using 700 patients with EoE and 801 community control subjects...
November 10, 2017: Journal of Allergy and Clinical Immunology
Joel E Richter
In eosinophilic esophagitis, the main cause of solid-food dysphagia is tissue remodeling resulting in strictures and narrowed esophagus. Endoscopy and biopsies help to identify the degree of inflammation but often miss the fibrosis. Although initially considered dangerous, esophageal dilation has evolved into an extremely effective and safe treatment in fibrostenotic disease. The key is starting low with small-diameter bougies or balloons, and gradually dilating the esophagus and strictures to 16 to 18 mm. Results in more than 1000 adults and children have shown low rates of complications, especially perforations, and no deaths, but postprocedure chest pain is common...
January 2018: Gastrointestinal Endoscopy Clinics of North America
Jonathan E Markowitz, Steven B Clayton
Adults and children with eosinophilic esophagitis (EoE) have distinct clinical and endoscopic presentations. Recognition of clinical signs, along with laboratory and endoscopic findings, is critical for the identification of patients with EoE because delay in diagnosis has been associated with esophageal remodeling and stricture formation. Clinical presentation varies considerably between adults and children. This is less due to differences in the disease and more due to patient differences. This article describes the similarities and differences in clinical presentation of children and adults with EoE, including areas of epidemiology, clinical and endoscopic presentation, pathophysiology, and treatment...
January 2018: Gastrointestinal Endoscopy Clinics of North America
Ekaterina Safroneeva, Alex Straumann, Alain M Schoepfer
Patients with eosinophilic esophagitis (EoE) present with symptoms accompanied by behavioral adaptions to living with this condition. These include swallowing- and nonswallowing-associated pain in adulthood. In children, EoE symptoms vary with age and include vomiting, abdominal pain, and dysphagia. Studies using validated patient-reported outcome measures have demonstrated that symptoms in EoE are associated with severe biologic alterations and that patients on the low biologic severity spectrum have few symptoms...
January 2018: Gastrointestinal Endoscopy Clinics of North America
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