Eosinophilic Oesophagitis in Children and Adolescents: Current State of the Problem
https://doi.org/10.31550/1727-2378-2024-23-6-70-76
Abstract
Aim. To provide up-to-date data regarding the epidemiology, pathogenesis, clinical manifestations and therapeutic approaches of EoE with a focus on childhood and adolescence.
Key points. Current epidemiologic data indicate a steady increase in the incidence of EoE in pediatric populations in many countries around the world. The key role in the development of EoE is played by genetic factors, atopy and hypersensitivity to food antigens. Clinical manifestations of EoE in children are age-dependent and include eating disorders, vomiting, abdominal pain, dysphagia, and food sticking in the esophagus. Diagnosis of EoE is based on the combination of characteristic clinical symptoms and histologic picture of eosinophilic infiltration of esophageal mucosa, while excluding other causes of eosinophilia. The main directions of EoE therapy are dietary therapy with elimination of causative products, drug treatment with topical corticosteroids and endoscopic dilation of esophageal strictures.
Conclusion. Further research is needed to better understand the molecular mechanisms of EoE, develop new diagnostic biomarkers, and optimize therapeutic approaches. Given the chronic recurrent course of EoE, long-term dynamic follow-up of patients by a multidisciplinary team of specialists is important to improve the quality of life and prevent complications.
Supporting agencies: The work was carried out within the framework of the theme of the state task of EGISU No. 124020100064-6.
About the Authors
S. Yu. Tereshchenko
Federal Research Centre “Krasnoyarsk Science Centre” of the Siberian Branch of Russian Academy of Science, separate division “Scientific Research Institute of Medical Problems of the North”
Russian Federation
Russian Federation
3g Partisan Zheleznyak Str., Krasnoyarsk, 660022
O. L. Moskalenko
Federal Research Centre “Krasnoyarsk Science Centre” of the Siberian Branch of Russian Academy of Science, separate division “Scientific Research Institute of Medical Problems of the North”
Russian Federation
Russian Federation
3g Partisan Zheleznyak Str., Krasnoyarsk, 660022
References
1. Maev I.V., Dicheva D.T., Andreev D.N., Lobanova E.G. et al. Eosinophilic esophagitis diagnostics and treatment: review of the 2017 European guidelines. Consilium Medicum. 2019;21(8):9–14. (in Russian). DOI: 10.26442/20751753.2019.8.190499
2. Kaibysheva V.O., Kashin S.V., Mikhaleva L.M., Vidyayeva N.S. et al. Eosinophilic esophagitis: current view on the problem and own clinical observations. Russian Journal of Evidence-Based Gastroenterology. 2019;8(1):58–83. (in Russian). DOI: 10.17116/dokgastro2019801158
3. Liacouras C.A., Furuta G.T., Hirano I., Atkins D. et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J. Allergy Clin. Immunol. 2011;128(1):3–20.e6; quiz 21–2. DOI: 10.1016/j.jaci.2011.02.040
4. Winter H.S., Madara J.L., Stafford R.J., Grand R.J. et al. Intraepithelial eosinophils: a new diagnostic criterion for reflux esophagitis. Gastroenterology. 1982;83(4):818–23.
5. Furuta G.T. Eosinophils in the esophagus: acid is not the only cause. J.Pediatr. Gastroenterol. Nutr. 1998;26(4):468–71. DOI: 10.1097/00005176-199804000-00021
6. Ahmad M., Soetikno R.M., Ahmed A. The differential diagnosis of eosinophilic esophagitis. J. Clin. Gastroenterol. 2000;30(3):242–4. DOI: 10.1097/00004836-200004000-00007
7. Yamada Y. Recent topics on gastrointestinal allergic disorders. Clin. Exp. Pediatrics. 2023;66(6):240–9. DOI: 10.3345/cep.2022.01053
8. Kelly K.J., Lazenby A.J., Rowe P.C., Yardley J.H. et al. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995;109(5):1503–12. DOI: 10.1016/0016-5085(95)90637-1
9. Lucendo A.J., Molina-Infante J., Arias Á., von Arnim U. et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United Eur. Gastroenterol. J. 2017;5(3):335–58. DOI: 10.1177/2050640616689525
10. Dellon E.S., Liacouras C.A., Molina-Infante J., Furuta G.T. et al. Updated International Consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE Conference. Gastroenterology. 2018;155(4): 1022–33. DOI: 10.1053/j.gastro.2018.07.009
11. Kaibysheva V.O., Erdes S.I., Kashin S.V., Tertychnyi A.S. et al. Eosinophilic esophagitis: own experience of diagnosis and treatment. Experimental and Clinical Gastroenterology. 2018;158(10):92–109. (in Russian). DOI: 10.31146/1682-8658-ecg-158-10-92-109
12. Ivashkin V.T., Maev I.V., Trukhmanov A.S., Lapina T.L. et al. Clinical guidelines of the Russian Gastroenterological Association on the diagnostics and treatment of eosinophilic esophagitis. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(6):84–98. (in Russian). DOI: 10.22416/1382-4376-2018-28-6-84-98
13. Burlutskaya A.V., Statova A.V., Dolbneva O.V., Borlakova I.I. et al. Eosinophilic esophagitis in children: clinical cases. Kuban Scientific Medical Bulletin. 2022;29(4): 94–106. (in Russian). DOI: 10.25207/1608-6228-2022-29-4-94-106
14. Dellon E.S., Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology. 2018;154(2):319–32. DOI: 10.1053/j.gastro.2017.06.067
15. Soon I.S., Butzner J.D., Kaplan G.G., deBruyn J. Incidence and prevalence of eosinophilic esophagitis in children. J. Pediatr. Gastroenterol. Nutr. 2013;57(1):72–80. DOI: 10.1097/mpg.0b013e318291fee2
16. de Rooij W.E., Barendsen M.E., Warners M.J., van Rhijn B.D. et al. Emerging incidence trends of eosinophilic esophagitis over 25 years: results of a nationwide register-based pathology cohort. Neurogastroenterol. Motility. 2021;33(7):e14072. DOI: 10.1111/nmo.14072
17. Trifan A., Stoica O., Chihaia C.-A., Danciu M. et al. Eosinophilic esophagitis in an octogenarian. Medicine. 2016;95(41):e5169. DOI: 10.1097/md.0000000000005169
18. Franciosi J.P., Tam V., Liacouras C.A., Spergel J.M. A case-control study of sociodemographic and geographic characteristics of 335 children with eosinophilic esophagitis. Clin. Gastroenterol. Hepatol. 2009;7(4):415–19. DOI: 10.1016/j.cgh.2008.10.006
19. Witmer C.P., Susi A., Min S.B., Nylund C.M. Early infant risk factors for pediatric eosinophilic esophagitis. J. Pediatr. Gastroenterol. Nutr. 2018;67(5):610–15. DOI: 10.1097/mpg.0000000000002123
20. Jensen E.T., Kuhl J., Martin L.J., Langefeld C.D. et al. Early-life environmental exposures interact with genetic susceptibility variants in pediatric patients with eosinophilic esophagitis. J. Allergy Clin. Immunol. 2018;141(2):632–7. DOI: 10.1016/j.jaci.2017.07.010
21. D'Alessandro A., Esposito D., Pesce M., Cuomo R. et al. Eosinophilic esophagitis: from pathophysiology to treatment. World J. Gastrointestinal Pathophysiol. 2015;6(4):150–8. DOI: 10.4291/wjgp.v6.i4.150
22. Kaibysheva V.O., Mikhaleva L.M., Nikonov E.L., Shapoval’yants S.G. Epidemiology, etiology and pathogenesis of eosinophilic esophagitis. The latest data. Russian Journal of Evidence-Based Gastroenterology. 2019;8(2):50–72. DOI: 10.17116/dokgastro2019802150
23. Ryu S., Lee K.H., Tizaoui K., Terrazzino S. et al. Pathogenesis of Eosinophilic esophagitis: a comprehensive review of the genetic and molecular aspects. Int. J. Mol. Sci. 2020;21(19):7253. DOI: 10.3390/ijms21197253
24. Blanchard C., Stucke E.M., Rodríguez-Jiménez B., Burwinkel K. et al. A striking local esophageal cytokine expression profile in eosinophilic esophagitis. J. Allergy Clin. Immunol. 2011;127(1):208–17, 217.e1–7. DOI: 10.1016/j.jaci.2010.10.039
25. Furuta G.T., Katzka D.A. Eosinophilic esophagitis. New Engl. J. Med. 2015;373(17):1640–8. DOI: 10.1056/nejmra1502863
26. De Matteis A., Pagliaro G., Corleto V.D., Pacchiarotti C. et al. Eosinophilic esophagitis in children: clinical findings and diagnostic approach. Curr. Pediatr. Rev. 2020;16(3):206–14. DOI: 10.2174/1573396315666191004110549
27. Carr S., Chan E.S., Watson W. Eosinophilic esophagitis. Allergy Asthma Clin. Immunol. 2018;14(suppl.2):58. DOI: 10.1186/s13223-018-0287-0
28. Cohen M.S., Kaufman A.B., Palazzo J., Nevin D. et al. An audit of endoscopic complications in adult eosinophilic esophagitis. Clin. Gastroenterol. Hepatol. 2007;5(10):1149–53. DOI: 10.1016/j.cgh.2007.05.017
29. Kidambi T.D. Temporal trends in the relative prevalence of dysphagia etiologies from 1999–2009. World J. Gastroenterol. 2012;18(32):4335–41. DOI: 10.3748/wjg.v18.i32.4335
30. Desai T.K., Stecevic V., Chang C.H., Goldstein N.S. et al. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest. Endoscopy. 2005;61(7):795–801. DOI: 10.1016/s0016-5107(05)00313-5
31. Mukkada V.A., Haas A., Maune N.C., Capocelli K.E. et al. Feeding dysfunction in children with eosinophilic gastrointestinal diseases. Pediatrics. 2010;126(3):e672–7. DOI: 10.1542/peds.2009-2227
32. Budkina T.N., Makarova S.G., Lokhmatov M.M., Oldakovsky V.I. et al. New in the diagnosis of eosinophilic esophagitis in children. Pediatria n.a. G.N. Speransky. 2021;100(2):146–52. (in Russian). DOI: 0.24110/0031-403X-2021-100-2-146-152
33. Schoepfer A., Safroneeva E., Bussmann C., Kuchen T. et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013;145(6):1230–6.e1–2. DOI: 10.1053/j.gastro.2013.08.015
34. Rodríguez-Sánchez J., Barrio J., Castillejo Ó.N., Valdivieso-Cortazar E. et al. The endoscopic reference score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis. Aliment. Pharmacol. Ther. 2016;45(2):300–9. DOI: 10.1111/apt.13845
35. Pentiuk S., Putnam P.E., Collins M.H., Rothenberg M.E. Dissociation between symptoms and histological severity in pediatric eosinophilic esophagitis. J. Pediatr. Gastroenterol. Nutr. 2009;48(2):152–60. DOI: 10.1097/MPG.0b013e31817f0197
36. Safroneeva E., Straumann A., Coslovsky M., Zwahlen M. et al. Symptoms have modest accuracy in detecting endoscopic and histologic remission in adults with eosinophilic esophagitis. Gastroenterology. 2016;150(3):581–90. DOI: 10.1053/j.gastro.2015.11.004
37. Dellon E.S., Gonsalves N., Hirano I., Furuta G.T. et al. ACG Clinical Guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am. J. Gastroenterol. 2013;108(5):679–92. DOI: 10.1038/ajg.2013.71
38. Sayej W.N., Patel R., Baker R.D., Tron E. et al. Treatment with high-dose proton pump inhibitors helps distinguish eosinophilic esophagitis from noneosinophilic esophagitis. J. Pediatr. Gastroenterol. Nutr. 2009;49(4): 393–9. DOI: 10.1097/mpg.0b013e31819c4b3e
39. Molina-Infante J., Ferrando-Lamana L., Ripoll C., Hernandez-Alonso M. et al. Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults. Clin. Gastroenterol. Hepatol. 2011;9(2):110–17. DOI: 10.1016/j.cgh.2010.09.019
40. Budkina T.N., Makarova S.G., Mukhametova E.M., Fisenko A.P. et al. Modern approaches and prospects for the treatment of eosinophilic esophagitis in children (Part I). Pediatria n.a. G.N. Speransky. 2022;101(5):120–8. (in Russian). DOI: 10.24110/0031-403X-2022-101-5-120-128
41. Hirano I., Chan E.S., Rank M.A., Sharaf R.N. et al. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters clinical guidelines for the management of eosinophilic esophagitis. Gastroenterology. 2020;158(6):1776–86. DOI: 10.1053/j.gastro.2020.02.038
42. Spergel J.M., Aceves S.S., Greenhawt M. Challenges with the technical review of eosinophilic esophagitis: discussion points for the practicing allergist. Ann. Allergy Asthma Immunol. 2020;124(5):411–13. DOI: 10.1016/j.anai.2020.03.011
43. Rank M.A., Sharaf R.N., Furuta G.T., Aceves S.S. et al. Technical review on the management of eosinophilic esophagitis: a report from the AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters. Gastroenterology. 2020;158(6):1789–810.e15. DOI: 10.1053/j.gastro.2020.02.039
44. Kagalwalla A.F., Sentongo T., Ritz S., Hess T. et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin. Gastroenterol. Hepatol. 2006;4(9):1097–102. DOI: 10.1016/j.cgh.2006.05.026
45. Spergel J.M., Brown-Whitehorn T.F., Cianferoni A., Shuker M. et al. Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. J. Allergy Clin. Immunol. 2012;130(2): 461–7.e5. DOI: 10.1016/j.jaci.2012.05.021
46. Eckmann J.D., Ravi K., Katzka D.A., Davis D.R. et al. Efficacy of atopy patch testing in directed dietary therapy of eosinophilic esophagitis: a pilot study. Dig. Dis. Sci. 2018;63(3):694–702. DOI: 10.1007/s10620-018-4928-4
47. Hirano I., Furuta G.T. Approaches and challenges to management of pediatric and adult patients with eosinophilic esophagitis. Gastroenterology. 2020;158(4):840–51. DOI: 10.1053/j.gastro.2019.09.052
48. Munoz-Osores E., Maldonado-Campos I., Olivares-Labbe M.T., Villarroel L. et al. Corticosteroids for eosinophilic esophagitis in children: a meta-analysis. Pediatrics. 2020;146(5):e20200874. DOI: 10.1542/peds.2020-0874
49. Furuta G.T., Katzka D.A. Eosinophilic esophagitis. N. Engl. J. Med. 2015;373(17):1640–8. DOI: 10.1056/NEJMra1502863
50. Hirano I., Dellon E.S., Hamilton J.D., Collins M.H. et al. Efficacy of dupilumab in a phase 2 randomized trial of adults with active eosinophilic esophagitis. Gastroenterology. 2020;158(1):111–22.е10. DOI: 10.1053/j.gastro.2019.09.042
Review
For citations:
Tereshchenko S.Yu., Moskalenko O.L. Eosinophilic Oesophagitis in Children and Adolescents: Current State of the Problem. Title. 2024;23(6):70-76. (In Russ.) https://doi.org/10.31550/1727-2378-2024-23-6-70-76
Views:
23
Email this article 