EOSINOPHILIC ESOPHAGITIS AT PEDIATRIC AGE

Authors

  • Maria João Candeias dos Santos Sousa Immunoallergology Department, Unidade I, Centro Hospitalar de Vila Nova de Gaia/ Espinho
  • Inês Lopes Immunoallergology Department, Unidade I, Centro Hospitalar de Vila Nova de Gaia/ Espinho
  • Arminda Guilherme Immunoallergology Department, Unidade I, Centro Hospitalar de Vila Nova de Gaia/ Espinho
  • José Pedro Moreira da Silva Immunoallergology Department, Unidade I, Centro Hospitalar de Vila Nova de Gaia/ Espinho

DOI:

https://doi.org/10.25753/BirthGrowthMJ.v26.i2.9517

Keywords:

Eosinophilic esophagitis, pediatric, etiopathogenesis, diagnosis, treatment

Abstract

Introduction: Eosinophilic esophagitis (EoE) is an increasingly common cause of esophagitis in children and adults that requires intensive monitoring and treatment to prevent complications.

Objective: To review the literature available about EoE in children, namely the pathogenesis, diagnosis, treatment and follow-up.

Development: EoE can affect any person at any age. Irritability, food refusal and failure to thrive are classic features that appear in childhood, while dysphagia and food impaction occur more characteristically in schoolchildren and young adult. Esophagogastroduodenoscopy with biopsies specimens of different parts of the esophagus is essential for the diagnosis of EoE. The treatment is based on three main pillars: elimination diets, pharmacotherapy and esophageal dilation. The aim is a symptomatic and histological response to reduce the risk of injury of the esophagus and to improve quality of life. In children (and more recently in adults) various types of elimination diets were effective in reducing eosinophilic inflammation. In older children and adults, swallowed topical corticosteroids have often been used.

Conclusion: EoE is an emerging disease with diagnostic criteria and treatment options proved to be effective. Early diagnosis is important to prevent complications. A less invasive biomarker for diagnosis and monitoring of EoE has not yet been found. A multidisciplinary team is importante to manage these patients.

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References

Rothenberg ME. Eosinophilic gastrointestinal disorders. J

Allergy Clin Immunol 2004; 113:11-28.

Kelley ML Jr, Frazer JP. Symptomatic mid-esophageal webs.

JAMA 1966; 197:143-6.

Merves J, Muir A, Chandramouleeswaran PM, Cianferoni A,

Wang ML, Spergel JM. Eosinophilic esophagitis. Ann Allergy

Asthma Immunol 2014; 112:397-403.

Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE,

Bonis PA, et al. Eosinophilic esophagitis: updated consensus

recommendations for children and adults. J Allergy Clin

Immunol 2011; 28:3-20.

Papadopoulou A, Koletzko S, Heuschkel R, Dias JA,

Allen KJ, Murch SH, et al. For the ESPGHAN Eosinophilic

Esophagitis Working Group and the Gastroenterology

Comittee. Management guidelines of eosinophilic esofagitis

in childhood. J Pedriatr Gastroenterol Nutr 2014; 58: 107-18.

Furuta GT, Liacouras CA, Collins MH, Gupta SK,

Justinich C, Putnam PE, et al. Eosinophilic esophagitis in

children and adults: a systematic review and consensus

recommendations for diagnosis and treatment.

Gastroenterology 2007;133:1342-63.

Soon IS, Butzner JD, Kaplan GG, deBruyn JCC. Incidence

and prevalence of eosinophilic esophagitis in children.

Gastroenterology 2013;57:72-80.

DeBrosse CW, Collins MH, Butz BKB, Allen CL, King EC,

Assaád AH, et al. Identification, epidemiology, and chronicity

of pediatric esophageal eosinofilia, 1982-1999. J Allergy Clin

Immunol 2010; 126: 112-9.

Dalby K, Nielse RG, Kruse-Andersen S, et al. Eosinophilic

oesophagitis in infants and children in the region of Southern

Denmark: a prospective study of prevalence and clinical

presentation. J Pediatr Gastroenterol Nutr 2010; 51:280-2.

Noel RJ, Putnam PE, Rothenberg ME. Eosinophilic

esophagitis. N Engl J Med 2004; 351: 940-1.

Dantuluri S, Ramani P, Basude D, et al. Eosinophilic

esophagitis: are we missing it? J Pediatr Gastroenterol Nutr

; 48: E143.

Cherian S, Smith NM, Forbes Da, et al. Rapidly increasing

prevalence of eosinophilic esophagitis in Western Australia.

Arch Dis Child 2006; 91:1000-4.

Spergel JM. Eosinophilic esophagitis in adults and children:

evidence for food allergy componente in many patients. Curr

Opin Allergy Clin Immunol 2007; 7:274-8.

Markowitz JE, Spergel JM, Ruchelli E, et al. Elemental diet is

an effective treatment for eosinophilic esophagitis in children

and adolescentes. Am J Gastroenterol 2003; 98:777-82.

Jensen ET, Kappleman MD, Kim HP, Ringel-Kulka T, Dellon

ES. Early exposures as risk factos for pediatric eosinophilic

esophagitis. J Pediatr Gastroenterol Nutr 2013; 57: 67-71.

Codispoti CD, Levin L, LeMasters GK, et al. Breast-feeding,

aeroallergen sensitization, and environmental exposures

during infancy are determinants of childhood allergic rhinitis.

J Allergy Clin Immunol 2010; 125:1054.

Verhasselt V. Neonatal tolerance under breastfeeding

influence: the presence of allergen and transforming growth

facto-beta in breast milk protects the progeny from allergic

asthma. J Pediatr 2010; 156: S16-20.

Gronlund MM; Lehtonen OP, Eerola E, et al. Fecal microflora

in healthy infants born by diferente methods of delivery:

permanente changes in intestinal flora after cesarean

delivery. J Pediatr Gastroenterol Nutr 1999; 28: 19-25.

Epstein J, Warner JO. Recent advancesin the pathophysiology

and management of eosinophilic oesophagitis. Clinical et

Experimental Allergy 2014; 44:802-12.

Blanchard C, Mingler MK, Vicario M, Abonia JP, Wu YY,

Lu TX, et al. IL-13 involvement in eosinophilic esophagitis:

transcriptome analysis and reversibility with glucocorticoids.

J Allergy Clin Immunol 2007; 120:1292-300.

Bullock JZ, Villanueva JM, Blanchard C, Filipovich AH,

Putman PE, Collins MH, et al. Interplay of adaptative th2

immunity with eotaxin-3/c-C chemokine receptor 3 in

eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2007;

:22-31.

Sherril JD, Rothenberg ME. Genetic dissection of eosinophilic

esophagitis provides insight into disease pathogenesis and

treatment strategies. J Allergy Clin Immunol 2011; 128:23-

Blanchard C, Wang N, Stringer KF, Mishra A, Fulkerson PC,

Abonia JP, et al. Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis. J Clin Invest

; 116:536-47.

Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil

JL, Liacouras CA. Treatment of eosinophilic esophagitis with

specific food elimination diet directed by combination of skin

prick tests and patch tests. Ann Allergy Asthma Immunol

; 95:336-43.

Almansa C, Krishna M, Buchner AM, Ghabril MS, Talley N,

DeVault, et al. Seasonal distribution in newly diagnosed cases

of eosinophilic esophagitis in adults. Am J Gastoenterol

; 104:828-33.

Wang FY, Gupta SK, Fitzgerald JF: Is there a seasonal

variation in the incidence or intensity of allergic eosinophilic

esophagitis in newly diagnosed children? J Clin Gastroenterol

; 41:451-3.

Straumann A, Aceves SS, Blanchard C, Collins MH, Furuta

GT, Hirano I. Pediatric and adult eosinophilic esophagitis:

similarities and diferences. Allergy 2012; 67: 477-90.

Jyonouchi S, Brown-Whitehorn TA, Spergel JM. Association

of eosinophilic gastrointestinal disorders with other atopic

disorders. Immunol Allergy Clin North Am 2009; 29: 85-97.

Assa’ad AH, Putnam PE, Collins MH, Akers RM, Jameson

SC, Kirby CL, et al. Pediatric patients with eosinophilic

esophagitis: an 8-year follow-up. J Allergy Clin Immunol

; 119:731-8.

Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA,

Katzka DA. ACG clinical guideline: evidence based aproach

to the diagnosis and management of esophageal eosinofilia

and eosinophilic esophagitis (EoE). Am J Gastroenterol

; 118:679-92.

Kim HP, Vance RB, Shaheen NJ, Dellon ES. The prevalence

and diagnostic utility of endoscopic features of eosinophilic

esophagitis: a meta-analysis. Clin Gastroenterol Hepatol

; 10-988-96.

Lieberman JA. Pharmacotherapy for eosinophilic esophagitis.

Ann Allergy Asthma Immunol 2015; 114:357-63.

Lucendo AJ. Meta-analysis-based guidance for dietary

management in eosinophilic esophagitis. Curr Gastroenterol

Rep 2015; 17:37.

Peterson KA, Byme KR, Vinson LA, et al. Elemental diet

induces histologic response in adult eosinophilic esophagitis.

Am J Gastroenterol 2013; 108:759-66.

Liacouras CA, Spergel JM, Ruchelli E, et al. Eosinophilic

esophagitis: a 10-year experience in 381 children. Clin

Gastroenterol Hepatol 2005; 3: 1198-206.

Kagalwalla AF, Sentongo TA, Ritz S, et al. Effect of sixfood

elimination diet on clinical and histologic outcomes in

eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006;

:1097-102.

Arias A, Gonzalez-Cervera J, Tenias JM, Lucendo AJ. Efficacy

of dietary interventions for inducing histologic remission in

patients with eosinophilic esophagitis: a systematic review

and meta-analysis. Gastroenterology 2014; 146:1639-48.

Arias Á, Lucendo AJ. Dietary therapies for eosinophilic

esophagitis. Expert Rev Clin Immunol 2014; 10:133-42.

Kagalwalla AF, Shah , Li BU, Sentongo TA, Ritz S, Manuel-

Rubio M, et al. Identification of specific foods responsible

for inflamtion in children with eosinophilic esophagitis

successfully treated with empiric elimination diet. J Pediatr

Gastroenterol Nutr 2011; 53: 145-9.

Molina-Infante J, Arias A, Barrio J, Rodríguez-Sánchez

J, Sánchez-Cazalila M, Lucendo AJ. Four-food group

elimination diet for adult eosinophilic esophagitis: a

prospective multicentre study. J Allergy Clin Immunol 2014;

:1093-9.

Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras

CA. The use of skin prick tests and patch tests to identify

causative foods in eosinophilic esophagitis. J Allergy Clin

Immunol 2002; 109: 363-8.

Zhang X, Cheng E, Huo X, et al. Omeprazol blocks STAT6

binding to eotaxin-3 promoter in eosinophilic esophagitis

cells. PLoS One 2012; 7:e50037.

Faubion WA, Perrault J, Burgart LJ, Zein NN, Clawson M,

Freese DK. Treatment of eosinophilic esophagitis with inhaled

corticosteroids. J Pediatr Gastroenterol Nutr 1998;27: 90-3.

Konikoff MR, Noel RJ, Blanchard C, et al. A randomized,

doubleblind, placebo-controlled trial of fluticasone

proprionate for pediatric eosinophilic esophagitis.

Gastroenterology 2006; 131: 1381-91.

Aceves SS, Dohil R, Newbury RO, et al. Topical viscous

budesonide suspension for treatment of eosinophilic

esophagitis. J Allergy Clin Immunol 2005; 116: 705-6.

Teitelbaum JE, Fox VL, Twarog FJ, et al. Eosinophilic

esophagitis in children: immunopathological analysis and

response to fluticasone propionate. Gastroenterology 2002;

: 1216-25.

Shaefer ET, Fitzgerald JF, Molleston JP, et al. Comparison

of oral prednisone and topical fluticasone in the treatment of

eosinophilic esophagitis: a randomized trial in children. Clin

Gastroenterol Hepatol 2008; 6:165-73.

Gupta SK, Collins MH, Lewis JD, et al. Efficacy and safety of

oral budesonide suspension (OBS) in pediatric subjects with

eosoniphilic esophagitis (EoE): results from the double-blind,

placebo-controled PEER study. Gastroenterology 2011;

:S179.

Spergel JM, Brown-Whitehorn TF, Cianferoni A, et al.

Identification of causative foods in children with eosinophlic

esophagitis treated with na elimination diet. J Allergy Clin

Immunol 2012. 130:461-7.

Lucendo AJ, De Rezende LC, Jimenez-Contreras S, et al.

Montelukast was ineficiente in maintaining steroid-induced

remission in adult eosinophilic esophagitis. Dig Dis Sci 2011;

:3551-8.

Stein ML, Collins MH, Villanueva JM, Kushner JP, Putnam

PE, Buckmeier BK, et al. Anti-IL-5 (mepolizumab) therapy

for eosinophilic esophagitis. J Allergy Clin Immunol 2006;

:1312-9.

Straumann A, Conus S, Grzonka P, Kita H, Kephart G,

Bussmann C, et al. Anti-interleukin-5 antibody treatment

(mepolizumab) in active eosinophilic oesophagitis: a radomised, placebo-controlled, double-blind trial. Gut 2010;

:21-30.

Spergel JM, Rothenberg ME, Collins MH, Furuta GT,

Markowitz JE, Fuchs G, et al. Reslizumab in children and

adolescentes with eosinophilic esophagitis: results of a

doble-blind, randomized, placebo-controlled trial. J Allergy

Clin Immunol 2012; 129:456-63.

Pentiuk S, Putnam PE, Collins MH, Rothenberg ME.

Dissociation between symptoms and histologic severity in

pediatric eosinophilic esophagitis. J Pediatr Gastroenterol

Nutr 2009; 48:152-60.

Spergel JM, Brown-Whitehorn TF, Beausoleil JL, et al. 14

Years of eosinophilic esophagitis: clinical features and

prognosis. J Pediatr Gastroenterol Nutr 2009; 48: 30-6.

Franciosi JP, Hommel KA, DeBrosse CW, Greenberg AB,

Greenler AJ, Abonia JP, et al. Quality of life in pediatric

eosinophilic esophagitis: what is importante to patients?

Child Care Health Dev 2012; 38:477-83.

Published

2017-07-24

How to Cite

1.
Candeias dos Santos Sousa MJ, Lopes I, Guilherme A, Moreira da Silva JP. EOSINOPHILIC ESOPHAGITIS AT PEDIATRIC AGE. REVNEC [Internet]. 2017Jul.24 [cited 2024Apr.19];26(2):114-21. Available from: https://revistas.rcaap.pt/nascercrescer/article/view/9517

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