Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults (original) (raw)
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Primary Eosinophilic Esophagitis in Children and Adults: New Aspects for Diagnosis
2013
Eosinophilic esophagitis (EoE) is a chronic, Th2-type immune-mediated disorder. During the past decade, the increasing prevalence of EoE has been recognized in pediatric and adult populations all over the world. EoE diagnosis can be frequent challenging. Three criteria must be met to diagnose EoE: clinical symptoms of esophageal dysfunction, an esophageal biopsy with a peak eosinophil count of at least 15 eosinophils per high-power microscopy field and exclusion of other possible causes of esophageal eosinophilia. Although eosinophils mediate the EoE pathogenesis, proin-flammatory cytokines are also critically involved. In the past years biologic therapeutics have revolutionized treatment of EoE.
EOSINOPHILIC ESOPHAGITIS: A LITERATURE REVIEW (Atena Editora)
EOSINOPHILIC ESOPHAGITIS: A LITERATURE REVIEW (Atena Editora), 2024
A esophagitis eosinofílica (EoE) is a chronic esophageal condition with an immunological and allergic etiology, characterized by symptoms related to esophageal dysfunction and histological findings of inflammation predominantly involving eosinophils. The aim of this study was to analyze recent research on aspects related to EoE. Methodology involved a search of scientific articles indexed in PubMed and EBSCO databases between 2018 and 2023, yielding 161 articles. Inclusion criteria included articles published within the last 5 years, with full-text availability. Paid articles and those published more than 5 years ago were excluded, resulting in the selection of 25 articles. Results and Discussion: EoE is a globally distributed disease with increasing incidence. Its primary immunological mechanism involves Th2 cells. External factors stimulate Th2 cells to produce interleukins (IL) such as IL-4, IL-5, and IL-13, with the contribution of an IgE-mediated pathway and other mediators like eotaxin-3. Symptoms vary with age and can resemble those of GERD. In children up to preschool age, symptoms include food refusal or intolerance and poor weight gain, while school-aged children commonly experience vomiting, epigastric pain, heartburn, and regurgitation. Treatment of EoE aims to mitigate esophageal inflammation to alleviate symptoms, prevent complications such as esophageal remodeling and fibrosis, and improve patient quality of life. Therapeutic approaches include medications like Proton Pump Inhibitors (PPIs), swallowed topical corticosteroids (fluticasone and budesonide), dietary interventions, mechanical dilation, and biologic medications. Dupilumab 300 mg weekly is the first selective systemic immunomodulatory biologic therapy approved for EoE in patients aged 12 and older, showing clinically significant benefits with a favorable safety profile compared to non-selective systemic immunosuppressants. Conclusion: Diagnosis of EoE is based on clinical and pathological evidence, including symptoms of esophageal dysfunction, mucosal changes, eosinophilic infiltration, and inflammation observed during endoscopy and biopsy. Treatment focuses on reducing esophageal inflammation to alleviate symptoms, prevent complications, and improve patient quality of life.
2021
INTRODUCTION AND OBJECTIVE Eosinophilic esophagitis (EoE) is an inflammatory immune-mediated oesophageal disease of growing prevalence. The aim of this study is to characterise the clinical symptoms, endoscopic features and histological findings, as well as their possible correlations, in newly-diagnosed EoE paediatric patients. MATERIAL AND METHODS Between 2009-2018, the clinical records of patients diagnosed with EoE at the Paediatric Hospital in Warsaw, Poland, were retrospectively reviewed. Inclusion criteria were upper gastrointestinal tract symptoms in association with oesophageal mucosal biopsy specimens containing not less than 15 intraepithelial eosinophils per hpf. The prevalence and the possible correlations between symptoms, endoscopic features and the density of eosinophilic infiltration were analysed; the medical history of the comorbidities were also assessed. RESULTS The study included 47 children (median age 9.5 years). The most common clinical symptoms were abdomin...
Eosinophilic esophagitis-Where are we today?
Jornal de pediatria, 2018
The objective of this review is to provide an overview of the practical diagnostic and therapeutic approaches to eosinophilic esophagitis and to increase the visibility of the disease among pediatricians. A search of the MEDLINE, Embase, and CINAHL databases and recent consensus statements and guidelines were performed. The definition of eosinophilic esophagitis is based on symptoms and histology. It is important to rule out other diseases associated with esophageal eosinophil-predominant inflammation. It is not yet clear whether the increased prevalence is due to a real increase in incidence or a result of increased awareness of the disease. Various options for management have been used in pediatric patients, including proton pump inhibitors, dietary restriction therapies, swallowed topical steroids, and endoscopic dilations. More recently, proton pump inhibitor-responsive esophageal eosinophilia and eosinophilic esophagitis have been contemplated on the same spectrum, and proton p...
Eosinophilic esophagitis in children: doubts and future perspectives
Journal of Translational Medicine, 2019
Background: Eosinophilic esophagitis (EoE) is a chronic immune-mediated inflammatory disorder and represents the leading cause of food impaction. The pathogenesis of EoE is the result of an interplay between genetic, environmental and host immune system factors. New therapeutic approaches for EoE have been proposed. In this manuscript we review the current evidence regarding EoE management in pediatric age, with a particular focus on new findings related to the efficacy and safety of monoclonal antibodies. Main body: Conventional therapies have failed in treating some patients with EoE, which then requires aggressive procedures such as esophageal dilatation. The most effective available medical therapy for EoE is swallowed topic corticosteroids (fluticasone propionate and budesonide), which have two main drawbacks: they are related to wellknown adverse effects (especially in the paediatric population), and there are not enough long-term data to confirm that they are able to reverse the remodelling process of the esophageal mucosa, which is the major cause of EoE symptoms (including dysphagia, abdominal pain, nausea, obstruction, perforation and vomiting). The monoclonal antibodies appear to be an interesting therapeutic approach. However, the studies conducted until now have shown substantial histological improvement not coupled with significant clinical improvements and no significant relationship between a decreasing number of eosinophils and clinical symptoms, highlighting the importance in the pathogenesis of EoE of cells such as T-helper cells, mast cells, B cells, epithelial cells and natural killer cells. Conclusions: Monoclonal antibodies targeting a signal involved in the pathogenesis of EoE may not break the complex self-propagating inflammatory activation responsible for perpetuation of the inflammatory response and the development of symptoms and complications. We speculate that combined biological therapies targeting more than one molecule or cell may provide better results, with conventional therapies potentially enhancing the effects of antibodies. However, further studies should aim to find the best therapeutic approach to target the cells involved in the remodelling process and to reverse the histological changes in this complex clinical condition.
Eosinophilic Esophagitis in Children: Clinical Manifestations
Gastroenterology Clinics of North America, 2008
Eosinophilic esophagitis (EoE) is an emerging chronic immune and antigen-mediated clinicopathologic disease. During the last 2 decades, the incidence of this condition in children has increased significantly, thanks to practitioners for creating the awareness and higher use of diagnostic endoscopy. We have analysed paediatric literature on EoE focusing on the epidemiology, pathophysiology, clinical findings and diagnostic approach. EoE is pathogenically related to a Th2 inflammation characterized by a mixed IgE and non-IgEmediated reaction to food and/or environmental agents. This leads to esophageal dysfunction and remodeling accompanied by subepithelial fibrosis. EoE can be presented with several range of gastrointestinal symptoms, including regurgitation, vomiting, feeding difficulties or feeding refusal in infants and toddlers, as well as heartburn, dysphagia and food bolus impaction in older children and adults. The diagnostic suspicion is based on the presence of chronic symptoms of esophgeal dysfunction and esophageal eosinophilia characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field). In this review, we will provide an update on clinical presentation and diagnostic approach to EoE in children. We emphasized on the relevant aspects of the new clinical condition termed "PPI responsive esophageal eosinophilia", as entities distinct from EoE and the role of PPI trial in the diagnostic workup, therefore we proposed a new diagnostic algorithm.
Eosinophilic esophagitis in pediatric age, state of the art and review of the literature
2018
Eosinophilic esophagitis (EoE) is a chronic immune-mediated relapsing disease caused by eosinophilic infiltration of the esophageal mucosa which is normally lacking these cells. EoE belongs to the group of the so called Eosinophilic Gastrointestinal Disorders (EGIDs). From a rare and unusual disease, EoE has become an emerging entity and in recent years its incidence and prevalence have increased all over the world, also in children. The pathogenesis is very complex and still not completely clear. Esophageal disfunction symptoms (e.g. dysphagia and food impaction) represent the typical manifestation of EoE and this condition could be difficult to recognize, more in pediatric age than in adults. Moreover, symptoms can often overlap with those of gastro-esophageal reflux disease (GERD), leading to a delayed diagnosis. EoE is often related to atopy and an allergological evaluation is recommended. Untreated EoE could provoke complications such as strictures, esophageal rings, narrowing ...
Eosinophilic esophagitis in children: current knowledge to open new horizons
Scandinavian Journal of Gastroenterology, 2019
Eosinophilic Esophagitis (EoE) is a chronic immune/antigen-mediated condition which is also driven by genetic and environmental factors. It has been deeply investigated over the last years and its incidence is widely increasing in childhood. Although atopic diseases are closely linked with EoE, it does not recognize a classical IgE-mediate immune pathogenesis but it is rather a T helper type 2 inflammatory process. Familial clustering supports genetic predisposition in EoE and recent advances in understanding the genetic basis for EoE may eventually translate into targeted management of the disease. EoE diagnosis is based on clinical symptoms, micro, and macroscopic findings along with exclusion of gastroesophageal reflux disease (GERD) evidence. Management of the disease encompasses both dietary and pharmacological solutions that need to be specifically targeted on patients' history, clinical symptoms, and diagnostic evaluations. New therapies, currently not available in children, may represent the basis for future therapeutic options in the next years.