Esophagitis In Children Research Articles

Esofagite eosinofílica em idade pediátrica

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.

The advance of clinical research on Eosinophilic esophagitis in children

The advance of clinical research on Eosinophilic esophagitis in children

Eosinophilic esophagitis in children: analysis of 22 cases

Objective: Eosinophilic esophagitis (EoE) is a chronic immune-mediated esophageal disease.The current domestic reports of EoE in children is rare.The aim of this study was to analyze the clinical features, the diagnosis and treatment advance of EoE in children by case analysis and literature review. Method: Clinical data of 22 children with EoE from January, 2011 to December, 2015 in Children's Hospital, Zhejiang University School of Medicine were recorded, retrospective analysis was performed on clinical presentation, gastroendoscopy and histopathological examination features and the treatment. Result: (1) Clinical data: EoE can occur at any age in children (5 months to 13 years). The most common clinical manifestations of EoE are vomiting and abdominal pain, 45% (10/22) and 41%(9/22) respectively. (2) Endoscopy and pathological features of esophageal mucosa: 11 cases with coarse mucous membrane (50%), 6 cases with congestion or erosion of esophageal membrane (27%), 5 cases with longitudinal crack (23%), 3 cases with ring uplift (14%), 3 cases with granular uplift (14%), 3 cases with normal mucosa(14%). Histopathologic manifestation is eosinophil infiltration and the eosinophil counts were all more than or equal to 15/HP. (3) Laboratory results: 13 cases had increasing eosinophil counts and eosinophils proportion (62%). (4)Allergy history: among 22 cases, 7 patients had allergy history (32%). (5) Situation of treatment and remission: 16 cases had clinical remission by oral omeprazole; 2 cases had clinical remission by oral Omeprazole and Montelukast sodium; 1 case acquired remission by elimination diet; 1 case acquired remission by elimination diet and oral prednisone. 2 cases dropped out; Only 2 patients received gastroendoscopy re-examination after 3 months and revealed esophageal mucosal histologic complete recovery. Conclusion: The clinical symptoms of EoE in children varies.Esophageal mucosal features of gastroendoscopy examination in children with EoE were longitudinal crack, white exudates or plaques, paper mucosa, ring uplift and granular uplift.Most patients could achieve remission by using proton-pump inhibitors, only few children needed elimination diet and change formula, or even oral glucocorticoids.

Eosinophilic Esophagitis in Children.

EoE is a significant cause of gastrointestinal morbidity affecting 1:2000. Patients with EoE typically have multiple atopic comorbidities, and additionally, many patients with EoE can be controlled well with elimination diets. The purpose of this review is to summarize the care of pediatric eosinophilic esophagitis patients. EoE represents a distinct clinical syndrome which is characterized by esophageal dysfunction and eosinophil-predominant inflammation of the esophageal mucosa. Patients with EoE can present with varying symptoms depending on their age; in this review, we review the presenting features of eosinophilic esophagitis in children as well as a diagnostic algorithm for EoE. The mucosal inflammation in EoE is driven by exposure to food antigens in many patients with EoE. Therefore, for the majority of patients, the mainstays of treatment remain food elimination diets or swallowed steroids. This review summarizes the diagnostic approach to eosinophilic esophagitis (EoE) in pediatric patients, focusing on the importance of accurate diagnosis and selection of appropriate therapy.

The Changing Prevalence of Eosinophilic Esophagitis in Children after Intestinal Transplantation

The Changing Prevalence of Eosinophilic Esophagitis in Children after Intestinal Transplantation

Eosinophilic oesophagitis in children: an uncommon occurrence in a predominantly Chinese population in Singapore.

We aimed to determine the prevalence and clinical manifestations of eosinophilic oesophagitis (EoE) in children who presented to a tertiary care hospital in Singapore. We conducted a retrospective review of all oesophageal biopsies taken during oesophagogastroduodenoscopy (OGD) from March 2010 to December 2011. The patients' demographics and clinical characteristics were collected. Biopsies were reviewed by a single pathologist who was blinded to the original reports, using the current consensus criteria for the histological diagnosis of EoE. Of the 88 children who had biopsies during OGD, 4 (4.5%) children (three boys, one girl; three Chinese, one Caucasian) were diagnosed with EoE. Their median age was 9.5 (range 4.0-12.0) years. The main clinical presentations were abdominal pain (in the three older children) and vomiting (in the youngest child). Three children had a history of atopy. Three children were diagnosed with EoE in the original histology reports, while one was diagnosed after the second review following histology demonstrating > 15 eosinophil granulocytes per high power field and microabscess formation. Endoscopy findings revealed oesophagitis in two children, one of whom was already on acid suppression therapy. Although three children were started on acid suppression therapy, they continued to be symptomatic. One child was also treated with swallowed fluticasone and two with food allergen avoidance, resulting in symptom improvement. Although EoE is uncommon in Singapore, greater awareness is needed among family physicians and general paediatricians. Paediatric gastroenterologists should alert pathologists when sending biopsy specimens that are suspicious for EoE.

Use of Magill Forceps to Remove Foreign Bodies in Children.

Introduction Esophageal foreign body (FB) in all age groups can cause serious morbidity or mortality. The study aims to report our experience retrieving FBs from the upper esophagus in children using Magill forceps. Materials and Methods In this study, 88 patients (45 males [51.1%] and 43 females [48.9%]) were presented with suspected FB ingestion. FB ingestion was determined via endoscopic analysis, or lateral and posterior–anterior radiographies, including oropharynx, neck, chest, and abdomen. Cases were classified into seven groups, according to history, diagnostic method, and postintervention findings, as follows: (1) coins, (2) toys, (3) metals, (4) bones, (5) battery, (6) glass, and (7) food. A laryngoscope was used to elevate the larynx and expose the esophageal entrance. Magill forceps were advanced into the esophagus and opened to observe and extract the FB. Results All 88 patients who underwent endoscopic examination due to suspected FB ingestion were confirmed to have ingested a FB. Median age was 12 years; 15 patients were aged < 5 years; 63 (71.5%) were diagnosed based on routine radiographic findings, and others were diagnosed based on physical findings and history. The most common type of FB was coins ( n = 51 [57.9%]). Mean surgical duration was 20 minutes. Conclusion FBs located at cervical esophageal level are usually the most difficult to remove. Magill forceps should be used before other methods.

Sa2047 - The Epidemiology of Eosinophilic Esophagitis in Children Over the Past Decade in Olmsted County, Minnesota

Sa2047 - The Epidemiology of Eosinophilic Esophagitis in Children Over the Past Decade in Olmsted County, Minnesota

Prevalence and Epidemiological Characteristics of Endoscopically Proven Reflux Esophagitis in Children in Korea.

PurposeThe prevalence of reflux esophagitis (RE) has increased recently in Korea. Little is known concerning the prevalence and characteristics of RE in pediatric patients. This study investigated the prevalence and influence of risk factors in endoscopically proven RE in Korea in pediatric patients over a period of 14 years.MethodsA retrospective chart review of all patients between the ages of 1 month and 20 years who underwent esophagogastroduodenoscopy at Samsung Medical Center between 2001 and 2014 was carried out. Univariate and multivariate analyses were conducted to identify independent risk factors for RE.ResultsThe prevalence rate of endoscopically proven RE in this study was 28.7% (978/3,413). The prevalence of RE increased from 11.8% from 2001 to 2007 to 37.7% from 2008 to 2014. Multivariate logistic regression analysis revealed that residency in the Greater Gangnam area (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.02-1.44) and age (OR, 1.13; 95% CI, 1.11-1.15) were significant predictive factors for the presence of RE.ConclusionThe prevalence rate of endoscopically proven pediatric RE has increased over the past 14 years. Residency and older age are more important independent risk factors for pediatric RE in Korea.

Перспективы использования фитопрепарата на основе календулы лекарственной в комплексном лечении химического ожога пищевода

Currently worldwide chemical burns of the esophagus rank first among all diseases of the esophagus in children and second in adults. Because of commonly accepted algorithms of rendering of medical aid in case of chemical burns of the esophagus in the prehospital and hospital stages (washing of the esophagus and the stomach, adequate anesthesia, corticosteroid, antibiotic therapy, the group of antacids and symptomatic treatment), the choice of drug and method of local impact on the surface of chemical burn of the esophagus remain an urgent problem. The lack of standardized approach in treatment of local changes in chemical burns of the esophagus, severe and unsatisfactory results of using medication algorithms inspire a search for alternative methods of treatment and drug development. Herbal remedies are comparable in effectiveness, but also have the combined multivalent effect on the entire body, causing minimum of side effects. Basing on the literature review, we have come to a conclusion that the most balanced composition of biologically active substances and a positive influence on the basic pathogenesis of esophageal chemical burns has Calendula officinalis. Features and scope of Calendula officinalis are not fully understood. The creation of a multidrug for the local treatment chemical burns of the esophagus based on this herb proves to be very promising.

Role of Intraluminal Esophageal Impedance Baseline in the Diagnosis of Esophagitis in Children.

Introduction Low values of esophageal impedance baseline (EIB) have been related to esophagitis. The aim of this study was to evaluate the diagnostic performance of EIB for erosive esophagitis (ErE) and histological esophagitis (HiE) in children studied for gastroesophageal reflux. Material and Methods Children who underwent esophageal multichannel intraluminal impedance-pH monitoring (MII-pH) and upper-endoscopy with esophageal biopsies were studied retrospectively. EIB values were obtained by MII-pH. ErE was assessed by endoscopy following the Hetzel-Dent classification; HiE was defined by basal zone hyperplasia, papillary lengthening, or inflammatory infiltration. EIB was compared between groups. Receiver operating characteristic (ROC) curves were obtained to calculate the global diagnostic performance of EIB and to find cut-off values for sensitivity and specificity. Logistic regression was used for age adjustment. Results Fifty-one patients were studied: 11 had ErE and 23 had HiE. EIB median values were 1,159 in ErE versus 2,583 in non-ErE (U = 80, p < 0.01). The adjusted ROC curve analysis for ErE was 0.85 (95% CI = 0.74-0.96); the EIB cut-off value = 2,379 determined sensitivity = 100% and specificity = 52.6% in children < 4 years old. and sensitivity = 100% and specificity = 63.2% in children > 4 years old. EIB median values were 1,666 in HiE versus 2,669 in non-HiE (U = 80, p < 0.01). The adjusted ROC curve analysis for HiE was 0.75 (95% CI = 0.59-0.90); the EIB cut-off value = 2,296 determined sensitivity = 71.2% and specificity = 83.1% in children < 4 years old, and sensitivity = 75.1% and specificity = 80.1% in children > 4 years old. Conclusion EIB provides statistically significant diagnostic performances for ErE and HiE. It could become a useful tool, especially to discriminate between ErE and non-ErE, avoiding other invasive tests.

Esophageal replacements in children.

Replacement of the esophagus in children can be performed in cases of malformations, injuries, or acquired conditions. The new esophagus should allow normal oral feeding, with little or no gastroesophageal reflux, and be able to work well for the lifetime of the patient. For over a century, many substitutes have been used, such as segments of colon, the entire stomach, gastric tubes, or parts of the small bowel, but none are perfect or function like a normal esophagus. Esophageal replacements are demanding challenges for pediatric surgeons. Here, I review the different techniques and the pitfalls related to these procedures on the basis of our experience of more than 300 esophageal replacements in children performed since 1989.

Celiac Disease and Eosinophilic Esophagitis in Children

Celiac disease is a chronic<SUB>, </SUB>Th<SUB>1</SUB>- type immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy, which leads to malabsorption of nutrients,after the ingestion of gluten or related proteins from rye and barley by genetically susceptible individuals. Exclusion of offending food antigens results in disease remission and reexposure leads to recurrence. Extraintestinal manifestations have been associated with celiac disease in children and adults. Eosinophilic esophagitis is a chronic, Th2- type immune-mediated disorder, isolated to the esophagus, which is most often triggered by exposure to food antigens in children and aeroallergens in adults. During the last decade, the increasing prevalence of celiac disease and eosinophilic esophagitis has been recognized in pediatric and adult populations all over the world. Case series have suggested an association between eosinophilic esophagitis and celiac disease. The prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. The aim of this review is to analyse the similarity between these two frequent associated conditions. Coexistent eosinophilic esophagitis should be considered in children with celiac disease who have persistent esophageal symptoms.

P-38: Risk Factors for Eosinophilic Esophagitis in Children with Esophageal Atresia

P-38: Risk Factors for Eosinophilic Esophagitis in Children with Esophageal Atresia

O-09 (09:57 to 10:09): Treatment Outcomes for Eosinophilic Esophagitis in Children With Esophageal Atresia

O-09 (09:57 to 10:09): Treatment Outcomes for Eosinophilic Esophagitis in Children With Esophageal Atresia

Oral viscous budesonide can be successfully delivered through a variety of vehicles to treat eosinophilic esophagitis in children

Oral viscous budesonide can be successfully delivered through a variety of vehicles to treat eosinophilic esophagitis in children

Surgical diseases of the esophagus in children.

Surgical diseases of the esophagus in children.

Screening and Identifying Erosive Esophagitis in Children with Non-cardiac Chest Pain.

Non-cardiac chest pain is a common disorder that leads to costly evaluations to distinguish it from cardiac pain. The present study aimed to clarify the clinical characteristics of erosive esophagitis in children with non-cardiac chest pain. Ninety nine patients (mean age, 9.55 ± 2.95 years, 49 girls) with non-cardiac chest pain were enrolled. Patients were classified into two groups: erosive esophagitis and non-erosive esophagitis-related non-cardiac chest pain by esophagogastroduodenoscopy. Children in the erosive esophagitis-related non-cardiac chest pain group were significantly older (10.95 ± 2.54 years vs. 8.52 ± 2.83 years). Multivariate logistic regression analysis identified the following predictors of gastroesophageal reflux: chest pain related to sleep (odds ratio = 18.05, 95% confidence interval: 3.18–102.49); unfavorable dietary habits (odds ratio = 7.11, 95% confidence interval: 1.53–32.87); chest pain related to food (odds ratio = 5.09, 95% confidence interval: 1.37–18.86); epigastric pain (odds ratio = 3.73, 95% confidence interval: 1.12–12.33); and nausea, vomiting, and/or regurgitation (odds ratio = 4.35, 95% confidence interval: 1.22–15.54). Gastroesophageal reflux disease should be considered first in children with non-cardiac chest pain. Children with gastroesophageal reflux disease should receive medical treatment and lifestyle modifications.

Esophageal perforation by swallowing of removable partial denture

Ingestion of Foreign body whether intensional or inadvertent is a common cause of esophageal perforation. Any delay in the diagnosis or treatment can lead to respiratory compromise, sepsis, or hemorrhage. Any complications in the gastrointestinal tract, primarily in the esophagus may requires an urgent approach. If the treatment is delayed more than 24 hrs, the mortality rate may approach to 21%. Among the various causes, coins are the most commonly seen foreign body in the esophagus in children, in adults are the solid components of meals, like bones, and in the elderly population loose tooth or dental prostheses are the most frequently observed ingested foreign bodies. Swallowed Dental prosthesis causing esophageal perforation are commonly encountered in elderly , however they can be seen in any age group using them. Thus, the aim of this report was to present one of these interesting case of esophageal perforation due to a denture ingestion and its treatment in a 42-year-old male.

A Deep Esophageal Injury from a Lithium Battery: A Case Report

Context: Over the last ten years the ingestion of disk batteries and its serious consequences have been increasing. The severity of injury is related to a growing diffusion of the new lithium battery that may cause catastrophic damages when lodged in the esophagus in children. Case report: A five-year-old boy presented to the Emergency Department of our tertiary pediatric Institute for a lithium battery lodged in the mid esophagus. Emergent esophagoscopy revealed a severe deep, mild bleeding ulceration of the wall in which the battery was partially wedged. The investigation was stopped and on-call cardio-vascular surgeon started left thoracotomy to exclude damages of the main vessels. With the thorax open, the endoscopy was repeated and a directional relationship between the battery and the aorta was excluded by means of trans illumination. The cell, a CR2032 lithium battery, was then removed. Central line parenteral nutrition, i.v. omeprazole plus antibiotics were started with a drainage tube left in the chest. During the follow-up the child undergone several chest X-rays with the suspicion of esophageal perforation. Angio-TC done on day 7 showed air into the thickened esophageal wall and in the mediastinum with severe peri-aortic edema without lesion of the vessel. MRi performed on day 21 showed only a persistent thickening of the esophageal wall. On day 28 an esophagogram was normal and the child was discharged asymptomatic. Two months later the investigation was repeated resulting entirely normal. Conclusion:Treatment of disk battery ingestion requires a multidisciplinary approach that can be implemented only in a tertiary pediatric hospital. Surgery can play an important role. Severe complications can occur several days after battery removal