Symptoms Of Esophageal Dysfunction Research Articles

Eosinophilic esophagitis prevalence, incidence, and presenting features: a 22-year population-based observational study from southwest Sweden.

Eosinophilic esophagitis (EoE) is a chronic inflammatory condition of the esophagus that affects both children and adults. Symptoms in adults are mainly esophageal dysphagia, which ranges from mild symptoms to acute food bolus obstruction of the esophagus. Diagnosis is defined as symptoms of esophageal dysfunction and ≥ 15 eosinophils/high power field (HPF) in at least one of the biopsies taken from the esophagus. EoE appears to be increasing in both prevalence and incidence. The aim of this study was to investigate the prevalence, incidence, and presenting symptoms of patients with EoE within the catchment area of Northern Älvsborg County Hospital in Trollhättan. Patient records with the ICD code of EoE between 2012 and 2022 and pathology reports from esophageal biopsies from 2000-2022 were examined. Patients with symptoms of esophageal dysfunction and > 15 eosinophils/HPF were classified as having EoE. In total, 409 EoE patients (379 adults and 30 children) fulfilled the diagnostic criteria during the follow-up period. The overall prevalence was 113 cases/100000 inhabitants (adults 127/100000 and children 57/100000) at 31 December 2022. The incidence was 7/100000 and increased during the observation period. At diagnosis, 46% of the adults and 11% of the children had a history of acute bolus obstruction requiring hospitalization, while 51% of adults and 22% of children exhibited endoscopic findings of fibrosis. The prevalence of EoE is significantly higher than that generally reported in an area of southwest Sweden. The results indicate that the incidence is increasing; however, whether this is due to an actual increase or heightened awareness of EoE is inconclusive. Acute bolus obstruction is a common presenting symptom among EoE patients and is most likely an effect of late diagnosis.

Clinical Utility of Dupilumab for the Treatment of Eosinophilic Esophagitis in Pediatric Patients

Background:Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and 15 or more eosinophils per high-powered field (HPF) on esophageal biopsy. Treatment options for EoE include proton pump inhibitors (PPIs), topical corticosteroids (TCS), dietary elimination, and dupilumab. Dupilumab is monoclonal antibody against IL-4 and IL-13 administered subcutaneously and was granted FDA approval for EoE in adults and adolescents recently in 2022. Outcomes of real-world, clinical use of dupilumab for EoE remains unknown.
 Objectives:To observe outcomes in pediatric patients with EoE treated with dupilumab.
 Methods:A retrospective cohort study of pediatric patients prescribed dupilumab for EoE was conducted. Medical records were reviewed for demographic and clinical information as well as endoscopic and histologic findings before and after dupilumab treatment.
 Results:A total of 28 patients were included (mean age 15y, 71.4% male). Mean baseline maximum eosinophils/HPF was 48 ± 41. 75% of patients were treated with combination therapy of EoE with diet elimination, PPIs, or TCS prior to being prescribed dupilumab. Prior authorization for dupilumab was required in 85.7% of cases. Ten patients had follow-up endoscopy with biopsy after starting dupilumab, and among these patients the mean maximum eosinophils/HPF with dupilumab significantly improved from 44 ± 37 to 13 ± 15 (p=0.027). Among 12 patients who had follow up clinic visits, two patients reported pain or swelling at injection sites, but no otheradverse events were reported
 Conclusions:Dupilumab significantly improves histologic findings of EoE and is well tolerated among pediatric patients. We hope for continued monitoring of these patients to understand the clinical utility of dupilumab for EoE over time.

Recent Advances in the Treatment of Eosinophilic Esophagitis.

Eosinophilic esophagitis is an increasingly common inflammatory allergic disease of the esophagus characterized by esophageal eosinophilia and symptoms of esophageal dysfunction. The therapeutic landscape has rapidly evolved for this emerging type 2 inflammatory disorder. We review traditional therapies including updates and expert opinions in addition to promising therapies on the horizon and the history of therapies that failed to meet end points and highlight knowledge gaps for future investigations.

Eosinophilic esophagitis—from definition to therapy

SummaryEosinophilic esophagitis (EoE) is a chronic immune-mediated disorder that is characterized clinically by symptoms of esophageal dysfunction and histologically by a dense eosinophilic inflammation of the esophagus. This article provides an overview of the current knowledge in the field of EoE. EoE has seen significant progress in its understanding, including its definition, clinical presentation, diagnosis, and treatment. Consensus criteria have been established for diagnosing EoE, with symptoms commonly including dysphagia, food impaction, and reflux-like symptoms. Diagnosis involves clinical evaluation, endoscopy, and histological assessment. Therapeutic strategies for EoE aim to alleviate symptoms, induce and maintain remission, and prevent complications. These strategies include dietary modifications, pharmacotherapy, and endoscopic interventions. Treatment choice depends on disease severity, patient preferences, and comorbidities. Despite progress, challenges persist in EoE management. Long-term outcomes and optimal treatment duration are still under investigation. Research efforts focus on identifying predictive markers for treatment response and developing personalized approaches. In conclusion, EoE is a chronic, progressive and recurrent disease with various clinical manifestations and treatment options. Improved understanding has led to better diagnostic criteria and therapeutic strategies. However, further research is necessary to enhance our understanding of disease pathogenesis, refine treatment algorithms, and optimize long-term outcomes for individuals with EoE.

Impact of environmental factors on the epidemiology of eosinophilic esophagitis in southwestern Europe (2007-2020).

Eosinophilic esophagitis (EoE) is a disease characterized by symptoms of esophageal dysfunction and at least 15 eosinophils/hpf in the esophagus. Other systemic and local causes of esophageal eosinophilia should be excluded. The study objectives were to examine the annual epidemiology of EoE for 14 consecutive years, investigate whether there is a relationship between the count of aeroallergens and the incidence of EoE for 12 years, evaluate whether there are family ties between the patients with EoE, and determine whether there are cases of EoE that are triggered or exacerbated by pollens. We conducted a prospective, descriptive, and analytic study in patients with EoE for 14 years (2007-2020). The study variables were age, sex, relatives with EoE, time of evolution of the symptoms until diagnosis of the disease, and symptoms. We examined incidence and prevalence, annual counts of aeroallergens for 12 years, and number of diagnoses per year (in 2007-2020). We studied patients with active EoE (in April-July) and EoE in remission (in August-March) for 2 consecutive years. Exacerbations were investigated by measuring symptoms using a visual analog scale of 1 to 10. Of the 366 patients with EoE (studied from 2007 to 2020), 83.5% were atopic, with respiratory allergy and 28% had a food allergy. Their mean age was 35 years. The time of evolution of the symptoms was more than 6 years. Only 11% of the patients had a degree of kinship. Of the 366 patients, 87% had dysphagia, 27% had had impactions, and 12.5% had other symptoms of esophageal dysfunction. We found a positive correlation between the incidence of EoE and Platanaceae pollens. We did not detect any case of EoE triggered or exacerbated by pollens. The epidemiology of EoE in southwestern Europe continues to grow. We have corroborated the relevant impact of the environment on genetics. Future studies will clarify the possible relevance of Platanaceae pollens in the increased epidemiology of EoE. The role of grass and Oleaceae pollens in triggering EoE is limited by having a short pollination in time.

S394 Esophageal Cytology Collection Device for Assessment of Esophageal Eosinophilia in Eosinophilic Esophagitis: Real World Experience

Introduction: Eosinophilic esophagitis (EoE) is a chronic condition characterized by symptoms of esophageal dysfunction and tissue eosinophilia. One barrier to clinical care in EoE is the need for repeat upper endoscopy (EGD) with biopsies to assess for tissue esophageal eosinophilia. A non-endoscopic esophageal cytology collection device (CytospongeTM) may be a viable alternative to assess for esophageal eosinophilia, but few studies have examined its use in EoE. Methods: We first performed a pilot study in which individuals with confirmed EoE underwent CytospongeTM procedure prior to a clinically-indicated EGD. The cytology results were compared to histology obtained via EGD (gold standard). Cytology and histology from mucosal biopsies were classified as active disease (≥1 eos/hpf cytology; ≥15 eos/hpf, respectively) or remission (0 eos/hpf; < 15 eos/hpf, respectively). The eosinophil-associated protein, eosinophil-derived neurotoxin (EDN) was assayed in the supernatant using ELISAs. We subsequently used the CytospongeTM to assess for mucosal eosinophils, in place of standard EGD with biopsy, in a subset of patients for clinical care. Results: For the pilot study, 7 patients (ages 20-53; 57% males) underwent the CytospongeTM procedure 1 hour prior to EGD. When using a cut-off of 1 eos/hpf on cytology, there was 100% concordance between the CytospongeTM cytology and esophageal biopsies for identifying active EoE and remission (3 active, 4 remission). There was also a trend towards higher concentrations of EDN in the CytospongeTM supernatant of active EoE (median 34.11 ng/mL) versus remission (median 9.5 ng/mL, p=0.057). Between September 2020 and May 2022, 15 CytospongeTM procedures were performed for clinical care (9 patients; ages 30-61; 56% male). Eight patients were undergoing food elimination diets and one was undergoing surveillance after sustained deep remission. No eosinophilia was seen in 10/15 cytology specimens and 5/15 had eosinophilia (range 1-15 eos)(Table). One patient underwent EGD shortly after CytospongeTM (1 eos on cytology), which demonstrated 10-30 eos/hpf on mucosal biopsy. The CytospongeTM procedure was well-tolerated with no significant adverse events. (Figure) Conclusion: The CytospongeTM is a novel mucosal assessment tool that is easily performed and correlates well with gold standard esophageal biopsies in EoE. It should be considered for use in eosinophilic esophagitis to avoid numerous EGD procedures.Figure 1.: a) Esophageal cytology collection device (CytospongeTM), b) Histology from standard esophageal biopsy, c) Cytology from CytospongeTM (same patient as b). Arrows point to eosinophils. Note: images previously published in McGowan EC, Aceves SS, CME Review: Noninvasive tests for eosinophilic esophagitis: Ready for use?. Ann Allergy Asthma Immunol 129 (2022); 27-34. Table 1. - Esophageal Cytology Collection Device (CytospongeTM) Results in Clinical Use Patient Age/Sex Current Treatment CytospongeTM Results Interpretation 1 61M Food Elimination Diet - reintroduced soy 0 eos/hpf Soy is not a trigger 2 50F Food Elimination Diet - reintroduced dairy 2 eos/hpf Dairy is a trigger 3a 30F Food elimination diet - reintroduced soy 0 eos/hpf Soy is not a trigger 3b Food elimination diet - reintroduced egg 0 eos/hpf Egg is not a trigger 3c Food elimination diet - reintroduced wheat 0 eos/hpf Wheat is not a trigger 4 44F Food elimination diet - four food elimination (4FED) 3 eos/hpf Not in remission on 4FED 5a 40F Food elimination diet - reintroduced wheat 0 eos/hpf Wheat is not a trigger 5b Food elimination diet - reintroduced dairy 1 eos/hpf Dairy is a trigger 6a 32M Food elimination diet - two food elimination (2FED) 0 eos/hpf Remission on 2FED Food elimination diet - reintroduced wheat 0 eos/hpf Wheat is not a trigger 7a 43M Food elimination diet - reintroduced fish 0 eos/hpf Fish is not a trigger Food elimination diet - reintroduced soy 0 eos/hpf Soy is not a trigger 8a 39M Food elimination diet - two food elimination (2FED) 6 eos/hpf Not in remission on 2FED Food elimination diet - four food elimination (4FED) 15 eos/hpf Not in remission on 4FED 9 36M Swallowed steroids twice daily and PPI 0 eos/hpf Maintenance of remission

Esophageal Distensibility Defines Fibrostenotic Severity in Pediatric Eosinophilic Esophagitis

Identification of fibrosis in pediatric eosinophilic esophagitis (EoE) relies on symptom assessment and endoscopy. Symptoms are highly variable, and early fibrotic remodeling may go undetected on endoscopy yet contribute to esophageal dysfunction. We aimed to assess whether esophageal distensibility has utility in defining fibrostenotic severity in a cohort of pediatric patients with EoE with symptoms of esophageal dysfunction. We analyzed a prospectively recruited a cohort of children ages 9 to 21 years undergoing upper endoscopy and Endoscopic Functional Lumen Imaging Probe (EndoFLIP) for suspected or previously diagnosed EoE. Esophageal distensibility was evaluated by the distensibility index (DI) and esophageal diameter at the distensibility plateau. The association of esophageal distensibility to clinical, endoscopic, and histologic parameters of disease severity was assessed. Receiver operating characteristic analysis was performed to determine the utility of distensibility in defining esophageal rigidity in pediatric EoE. We identified 59 pediatric patients with EoE undergoing endoscopy and EndoFLIP at a single pediatric tertiary referral center. DI (mm2/mmHg) was significantly lower in patients with fibrotic as compared with inflammatory features on endoscopy (median, 3.3; interquartile range, 2.3-4.4) vs median, 5.5; interquartile range, 4.1-6.0; P= .02) and showed no correlation with eosinophil count. DI <4.5 mm2/mmHg predicted grade 2 rings on endoscopy with area under the curve of 0.81 (P= .0004). DI predicted food impaction in both unadjusted and adjusted models (fully adjusted odds ratio, 1.44; 95% confidence interval, 1.02-2.14; P= .0486). Esophageal distensibility determined by EndoFLIP is a measure of fibrostenotic severity that can be used to clinically phenotype pediatric EoE. We propose parameters of DI <4.5 mm2/mmHg for defining esophageal rigidity in pediatric patients with EoE ages 9 years and older.

Eosinophilic Esophagitis in Children: Clinical Cases

Background. Eosinophilic esophagitis (Ee) is a chronic immune-mediated disease of the esophagus, which is characterized by symptoms of esophageal dysfunction and marked eosinophilic infiltration of the mucous membrane (MM) of the organ. Currently, interest in the problem of eosinophilic esophagitis in the global medical scientific community is steadily growing. Eosinophilic esophagitis has no pathognomonic symptoms, which causes a great difficulty for diagnosis.Clinical case description. The paper describes two clinical cases of eosinophilic esophagitis in patient T. (4 years 10 months) and patient M. (5 years 2 months). Patient T. was admitted to the gastroenterology department of the Children’s Regional Clinical Hospital (CRCH), with complaints of hiccups, flatulence, intermittent abdominal pain, coughing when swallowing. The medical history showed that the child has been ill since the beginning of March 2021, when pain appeared in the epigastric region and along the esophagus when eating. Parents sought help in the Central District Hispital, where surgical and ENT pathologies were excluded. The child was referred to the gastroenterological department of the CRCH, where, according to the results of esophagogastroduodenoscopy (EGDS), the diagnosis of “Erosive reflux — esophagitis” was made. After stopping the erosive process the patient underwent repeated EGDS with biopsy, and was diagnosed with “Eosinophilic esophagitis”. Prescribed treatment: hypoallergenic diet, topical glucocorticosteroids (fluticasone propionate), proton pump inhibitors (PPIs), antacids. As a result of the treatment, no improvement was noted — it was decided to transfer the patient to budesonide therapy in the form of a viscous suspension, after which a persistent positive effect was observed. In the second case, the girl M. was admitted to the gastroenterological department of the Children’s Clinical Hospital with complaints of constant nausea after eating and abdominal pain. The medical history showed that the child has been sick since she was 1. The examination also revealed moderate eosinophilia, an increase in the level of alkaline phosphatase. Fibrogastroduodenoscopy with biopsy revealed endoscopic signs of EoE. A diagnosis of eosinophilic esophagitis was made. Treatment: hypoallergenic diet, glucocorticosteroids, PPI, antacids, antiemetic drugs. The treatment brought about certain positive dynamics. Conclusion. The presented clinical cases show the difficulty of diagnosing eosinophilic esophagitis, since the symptoms of this disease are not very specific.

Diagnosis and Treatment of Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. The diagnostic criteria for EoE have changed with our growing knowledge over the past two decades. Esophageal eosinophilia, which responds histologically to a proton pump inhibitor (PPI) is not a distinct disease but a subset of EoE. An endoscopic scoring system that relies on the assessment of exudates, rings, edema, furrows, and strictures is a useful tool for assessing endoscopic severity. PPIs are regarded as safe and effective first-line treatments for EoE. Oral topical corticosteroids or dietary therapy are also options for first-line treatment. Endoscopic dilation is effective for relieving the dysphagia symptoms of a patient with an esophageal stricture.

A128 PATIENT CHARACTERIZATION AND ASSESSMENT OF REMISSION RATES IN CHILDREN WITH EOSINOPHILIC ESOPHAGITIS AFTER INITIAL TREATMENT AND 1-YEAR POST-DIAGNOSIS

BackgroundEosinophilic esophagitis (EoE) is a chronic immune- or antigen-mediated esophageal disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. With incidence rates rapidly increasing, EoE is the leading cause of food bolus impaction and the second leading cause of chronic esophagitis. The treatment of EoE includes both induction and maintenance therapy to prevent complications including esophageal fibrosis and strictures. Despite significant advances in the diagnosis and treatment of EoE, the natural history and long-term management of the disease remains poorly understood.AimsTo describe the clinical characterization of children with EoE, and to assess remission rates after initial treatment and 1-year post-diagnosis.MethodsIn this ongoing, single-center retrospective study, the electronic medical charts of children newly diagnosed with EoE between January 2017-March 2021 participating in the EoE-AHEAD Registry study were reviewed. Children aged 6 months-18 years with a confirmed diagnosis of EoE based on consensus guidelines and receiving outpatient care at the SickKids EoE clinic were included.ResultsA total of 37 children with a median age of 11 years (IQR: 4.5, 12.5) were included, the majority of which were male (86.5%). Demographic and clinical characteristics are shown in Table 1. On initial treatment, 2.7% of children were on an elemental diet, 18.9% on a food elimination diet, 40.5% on proton-pump inhibitor (PPI) therapy, 16.2% on topical steroids, 8.1% on systemic steroids, and 13.5% on a combination therapy. Of the 30 children with a second endoscopy (mean interval since diagnosis of 6.1 months (3.9)), 30% achieved histological remission after the initial treatment (see Figure 1). Of the 14 children with a one-year follow-up endoscopy, 14.2% were in remission, 3 of which had relapsed. No significant differences in treatment modality were found between those who achieved remission and those who did not.ConclusionsThis is the first Canadian registry study to examine the longitudinal outcomes of EoE in a pediatric setting. Our preliminary results show that only 30% of children achieved histological remission following first-line treatment. The choice of initial therapy varied, although the majority of patients (62.2%) were prescribed a PPI and/or a topical steroid. Our findings highlight the importance of identifying different disease phenotypes to develop personalized therapeutic approaches for the management of EoE.Demographic and clinical characterization (n=37)Age, year (median, IQR)11 (4.5, 12.5)Sex (% Male)86.5%Ethnicity (% Caucasian)40.9%Personal history of atopy91.9%Family history of atopy73.0% Funding AgenciesSickKids start-up funds (JM Hulst) and the Comprehensive Research Experience for Medical Students (CREMS) Program

Diet Therapy in Eosinophilic Esophagitis. Focus on a Personalized Approach.

Eosinophilic esophagitis (EoE) is a chronic allergic disease defined by a marked eosinophilic inflammation and symptoms of esophageal dysfunction. EoE is a heterogeneous disease and severely impacts the quality of life of affected patients. The current therapeutic management of EoE is based on two cornerstones: medication and diet therapy, both effective but limited by several critical issues. The choice of one or the other therapy might depend on the different disease phenotypes (allergic vs. non-allergic, inflammatory vs. fibro-stenotic), patient's age (adult vs. childhood-onset), food habits, patient/family preference, and familiar financial resource. Diet therapy is a successful treatment but limited by low patient adherence, the need for several endoscopies, food restrictions, psychosocial impact, and potential nutritional deficiencies. All these limitations could be effectively overcome with multidisciplinary and personalized management. This review summarizes the most recent evidence on the dietary elimination approaches and will provide a practical guide to clinicians in managing and implementing dietary therapy for patients with EoE.

Evidence-based treatments for eosinophilic esophagitis: insights for the clinician.

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. Left untreated, EoE progresses to fibrous remodeling and stricture formation that impairs quality of life. Therefore, EoE requires either repeated treatments or maintenance therapy. Current guidelines recommend swallowed topical corticosteroids (STCs), proton-pump inhibitors (PPIs), or dietary intervention as initial options to induce and maintain long-term disease remission. Impractical exclusive elemental diets and suboptimal allergy testing-directed food avoidance paved the way for empirical elimination diets. These are moderately effective and highly reproducible in inducing EoE remission and allow for identification of specific food triggers. Step-up strategies, including two- and four-food rather than six-food elimination diets, should be considered as initial approaches for dietary treatment in patients of all ages, as they reduce the need for endoscopic procedures, shorten diagnostic processing time, and avoid unnecessary restrictions. Formulations of STC originally designed for asthma therapy are suboptimal for EoE treatment, with new effervescent orodispersible tablets and viscose formulations designed to coat the esophageal mucosa providing increased effectiveness at reduced doses. The anti-inflammatory effects of PPI in EoE are independent from gastric acid secretion inhibition; despite evidence from observational research, PPIs are the most commonly prescribed first-line therapy for EoE due to their accessibility, low cost, and safety profile. Double doses of PPI only induce remission in half of EoE patients, irrespective of the drug used or patients’ age. Inflammatory rather than stricturing EoE phenotype and treatment duration up to 12 weeks increase chances of achieving EoE remission. Most responders effectively maintain long-term remission with standard PPI doses. Finally, endoscopic dilation should be considered in patients with reduced esophageal caliber or persistent dysphagia despite histological remission. This article provides a state-of-the-art review and updated discussion of current therapies and newly developed options for EoE.

Maintenance Therapy With the Lowest Effective Dose of Oral Viscous Budesonide in Children With Eosinophilic Esophagitis

Eosinophilic esophagitis (EoE) is an immune-mediated condition characterized by symptoms of esophageal dysfunction and an eosinophilic inflammation of the esophagus.1 Swallowed topical steroids represent one of the possible strategies for inducing and maintaining remission in EoE.2 To date, a validated maintenance strategy has yet to be defined, especially in children. The available evidence suggests decreasing the dose after a successful induction therapy.3 No study has reported the efficacy of a continuous progressive dose reduction; thus, it is unknown if all patients need to use the same dosages and for how long.4,5.

173 CATERPILLAR SIGN: NOVEL ENDOSCOPIC FINDING IN PATIENTS WITH EOSINOPHILIC ESOPHAGITIS

Abstract Pathological identification of esophageal eosinophilia (EE) is considered to be most important and critical step for diagnosis of eosinophilic esophagitis (EoE). Although several endoscopic findings related with EoE have been reported, it is still difficult to exclude other causes of EE, such as gastroesophageal reflux disease. Here, we noted a novel endoscopic finding related with EoE termed ‘Caterpillar sign’. The aim of this study was to evaluate its clinical significance for the diagnosis of EoE. Methods One hundred and seventy-four patients who were endoscopically suspected with EoE at our hospital and affiliated institutions were enrolled. EoE was defined clinically by symptoms of esophageal dysfunction and histologically by the presence of EE [≧15 eosinophils/high power field (HPF)]. Endoscopic findings at baseline were retrospectively reviewed. ‘Caterpillar sign’ was defined as a stair-like, fragile, slight mucosal protruded lesion sandwiched between longitudinal furrows, such as the Caterpillar traces remaining on the ground (Figure). Furthermore, the clinicopathological features of patients having ‘Caterpillar sign’ were evaluated. Results One hundred and seventy-four patients (92 males, 82 females with mean age of 49.7) suspected with EoE were evaluated, of whom 60 (34.5%) was finally diagnosed as EoE. ‘Caterpillar sign’ was found in 48 patients (80.0%). Sensitivity and Specificity of ‘Caterpillar sign’ for the diagnosis of EoE was 0.80 (95% confidence interval [CI] 0.72–0.85) and 0.94 (95% CI 0.90–0.97), respectively. Furthermore, the presence of ‘Caterpillar sign’ was associated with degree of eosinophil infiltration (Caterpillar sign positive: 42.9 ± 49.3/HPF vs. Caterpillar sign negative: 6.7 ± 24.4/HPF, p &amp;lt; 0.0001). Conclusion This novel finding termed ‘Caterpillar sign’ was clinically useful for the definitive diagnosis of EoE and associated with degree of eosinophil infiltration.

Noninvasive biomarkers identify eosinophilic esophagitis: A prospective longitudinal study in children.

Esophageal histology is critical for diagnosis and surveillance of disease activity in eosinophilic esophagitis (EoE). A validated noninvasive biomarker has not been identified. We aimed to determine the utility of blood and urine eosinophil-associated proteins to diagnose EoE and predict esophageal eosinophilia. Blood and urine were collected from children undergoing endoscopy with biopsy. Absolute eosinophil count (AEC), plasma eosinophil-derived neurotoxin (EDN), eosinophil cationic protein (ECP), major basic protein-1 (MBP-1), galectin-10 (CLC/GAL-10), Eotaxin-2 and Eotaxin-3, and urine osteopontin (OPN) and matrix metalloproteinase-9 (MMP-9) were determined. Differences were assessed between EoE and control, and with treatment response. The capacity to predict EoE diagnosis and esophageal eosinophil counts was assessed. Of 183 specimens were collected from 56 EoE patients and 15 non-EoE controls with symptoms of esophageal dysfunction; 33 EoE patients had paired pre- and post-treatment specimens. Plasma (CLC/GAL-10, ECP, EDN, Eotaxin-3, MBP-1) and urine (OPN) biomarkers were increased in EoE compared to control. A panel comprising CLC/GAL-10, Eotaxin-3, ECP, EDN, MBP-1, and AEC was superior to AEC alone in distinguishing EoE from control. AEC, CLC/GAL-10, ECP, and MBP-1 were significantly decreased in patients with esophageal eosinophil counts <15/hpf in response to treatment. AEC, CLC/GAL-10, ECP, EDN, OPN, and MBP-1 each predicted esophageal eosinophil counts utilizing mixed models controlled for age, gender, treatment, and atopy; AEC combined with MBP-1 best predicted the counts. We identified novel panels of eosinophil-associated proteins that along with AEC are superior to AEC alone in distinguishing EoE from controls and predicting esophageal eosinophil counts.

Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults.

In the absence of secondary causes, eosinophilic esophagitis (EoE) is a chronic, local, progressive, T-helper type 2 immune-mediated disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In the last 20 years, the incidence and prevalence of EoE have risen sharply, and the chances of encountering affected patients in clinics and endoscopy rooms have increased. Nevertheless, it is estimated that the mean diagnostic delay of EoE is 4–6 years in both children and adults. Unfortunately, the longer the disease stays unrecognized, the likelier it is for the patient to have persistent or increased esophageal eosinophilic inflammation, to complain of non-resolving symptoms, and to develop fibrotic complications. Early detection depends on the recognition of initial clinical manifestations that vary from childhood to adulthood and even among patients of the same age. The disease phenotype also influences therapeutic approaches that include drugs, dietary interventions, and esophageal dilation. We have herein reviewed epidemiologic, clinical, endoscopic, and histologic features and therapeutic options of EoE focusing on differences and similarities between children and adults that may certainly serve in daily clinical practice.

Non-invasive biomarkers of eosinophilic esophagitis.

Eosinophilic esophagitis (EoE) is an emerging allergen-mediated disease characterized by symptoms of esophageal dysfunction and eosinophilic inflammation. EoE diagnosis requires 15 eosinophils per high power field (eos/HPF) in tissue biopsies endoscopically obtained. The need for several endoscopies to monitoring the disease and the absence of validated non-invasive biomarkers or tools are the main reasons for the significant burden on affected patients and the healthcare system. There is a critical need for non-invasive or minimally invasive biomarkers. In the last years, several efforts have been made to identify potential biomarkers for diagnosing and monitoring the disease that we summarized in this review. The future of EoE is exciting from both a diagnostic and therapeutic standpoint. Further research is required to confirm pheno-types and histological or serological biomarkers to provide a novel endotype classification based on different cytokine or genetic signatures relevant to precision medicine. (www.actabiomedica.it)

Eozinofilni ezofagitis - potencijalna komplikacija sublingvalne terapije

Introduction. Eosinophilic esophagitis (EoE) represents chronic, a local immune-mediated disease with symptoms of esophageal dysfunction and histologically eosinophil-predominant inflammation and requires immediate endoscopy. Male gender is a strong risk factor. Case report. We presented a case of a 25-year-old young man with a history of allergic rhino-conjunctivitis, asthma, and intermittent severe feeding disturbance. The patient had begun sublingual immunotherapy therapy, containing specific soluble allergens for ambrosia. Six weeks after starting the ambrosia sublingual immunotherapy he developed burning epigastric pain, dysphagia, and odynophagia. Six days later, he was admitted to an emergency department due to choking on a solid of food. Esophageal histopathological findings were in favor of EoE. Sublingual immunotherapy was discontinued. He feels well now. Conclusion. The majority of cases of Eosinophilic esophagitis are diagnosed in spring or fall, 1-2 months following the peak of pollen season. Dysphagia, chest pain, food sticking, and bolus obstruction are the most common symptoms. Endoscopic findings are Schatzki ring, edema, exudates, furrows, and strictures. Six biopsies should be taken from areas with endoscopic mucosal abnormalities, and infiltration of eosinophils (more than 15 eosinophils/HRI) (HRI - high resolution imaging) is necessary for the diagnosis confirmation. Treatment options are proton pump inhibitors - oral dispersible tablets of budesonide or fluticasone propionate, an elimination diet. Sublingual immunotherapy should be discontinued. Family physicians should be aware of this complication in evaluating patients with dysphagia.

Eozinofilní ezofagitida – 10 let zkušeností pěti českých pediatrických endoskopických center

Background: Eosinophilic esophagitis (EoE) is a chronic, progressive inflammatory disease of the esophagus characterized by local eosinophilic infiltration accompanied by symptoms of esophageal dysfunction. The aim of this study was to characterize features of EoE dia gnosed regionally and to describe local strategies for its treatment. Methods: The observational survey retrospectively analyzed a data set of child patients with histologically proven EoE from five pediatric endoscopy centers. This analysis focused on describing their general situation (age, gender, symptoms) and also aimed to investigate any possible linkage between age and symptoms or length of dia gnosis period. Demographic features; clinical symptoms; laboratory, endoscopic, and histopathological findings; and chosen treatment of patients were recorded and analyzed. Results: From January 2010 to September 2020, 33 new cases of EoE were reported. Strong association of EoE with male sex is consistent with the results from formerly published studies (81.8%). The median age of symptom onset was 7 years, while the median age for dia gnosis was almost 13 years. The most common symptoms were reflux symptoms in general (39.4%), followed by vomiting (36.4%), and dysphagia (33.3%). Examination for sensitization to food allergens was performed on 23 (69.7%) patients with dia gnosed EoE. Out of these, 17 (51.5% of all cases) were found to be sensitive to some allergens. Most of this subgroup (and 48.5% of all cases) were examined by specific IgE testing, and just 2 (6.1% of all cases) patients were tested only by skin prick tests. Another allergic comorbidity was present in 75.8% of patients, and the most common of these were bronchial asthma and allergic rhinoconjunctivitis (45.5% and 42.2%, respectively). More than two-thirds of patients (69.7%) had abnormal macroscopic findings during dia gnostic endoscopy, and the most common were longitudinal furrows and white exudates. The most common initial modality of treatment was to use proton-pump inhibitors (PPI; 93.9%), followed by food elimination (75.8%) and then by corticosteroid administration (63.6%). The vast majority of patients treated with corticosteroids received a topical preparation (90.9%). Conclusion: This is the first retrospective study on pediatric patients with EoE in the Czech Republic. We found similar features of EoE as reported in formerly published works elsewhere. Collecting long-term prospective observational data in a national EoE register of patients in the Czech Republic would significantly improve our knowledge of this disease.

Eosinophilic esophagitis: definition, epidemiology and quality of life

Eosinophilic esophagitis (EoE) is a clinicopathological disease defined by symptoms of esophageal dysfunction and ≥15 eosinophils/HPF after excluding other causes of esophageal eosinophilia. Increasing attention has been paid by clinicians and researchers after its first description in 1978. Many consensuses and guidelines have been issued over the years, as gastroenterologists did not reach an agreement on EoE definition, especially regarding the controversial responsiveness to proton pump inhibitor (PPI) therapy. Of note, recent evidence suggests that the incidence and prevalence of EoE have been increasing through the years: many risk factors have been advocated as possible reasons for this, although further studies are needed. In this brief review, we will first cover the history of EoE in the literature, with a focus on its varying definition throughout the years. Then, we will discuss EoE epidemiology, emphasizing potential risk factors explaining its increasing incidence and prevalence. Last, we will deal with the quality of life of adult and pediatric patients with EoE.