Clinical Manifestations and Treatment Outcomes of Eosinophilic Gastroenteritis in Children

Choi, Jong Sub; Choi, Shin Jie; Lee, Kyung Jae; Kim, Ahlee; Yoo, Jung Kyung; Yang, Hye Ran; Moon, Jin Soo; Chang, Ju Young; Ko, Jae Sung; Kang, Gyeong Hoon

doi:10.5223/pghn.2015.18.4.253

Cited by 34 publications

(55 citation statements)

References 23 publications

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“…Eosinophilia at onset is a remarkable laboratory finding in neonates and young infants with FPIES. Eosinophilia is also a representative hematological abnormality of eosinophilic gastrointestinal diseases (EGID) . Given that both FPIES and EGID involve GI symptoms and eosinophilia, they could be assumed to be similar disorders, but there is a distinct difference in the clinical course between FPIES and EGID.…”

Section: Discussionmentioning

confidence: 99%

“…Eosinophilia is also a representative hematological abnormality of eosinophilic gastrointestinal diseases (EGID). 25,26 Given that both FPIES and EGID involve GI symptoms and eosinophilia, they could be assumed to be similar disorders, but there is a distinct difference in the clinical course between FPIES and EGID. EGID is a chronic disorder, and eosinophilia persists for a long time until the disease resolves.…”

Section: Discussionmentioning

confidence: 99%

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Prognosis of infantile food protein‐induced enterocolitis syndrome in Japan

Kimura

Shimomura

Morishita

et al. 2017

Pediatrics International

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Background: Although serum C-reactive protein (CRP) and the percentage of eosinophils in peripheral blood (Eo) are increased at onset in infants with food protein-induced enterocolitis syndrome (FPIES), the relationship of these laboratory findings to prognosis is presently unknown. Methods: Correlation of serum CRP and Eo at onset with prognosis was analyzed in 32 patients with FPIES caused by cow's milk (CM).Results: The rate of tolerance acquisition was 18.8%, 56.3%, 87.5%, and 96.9% at the ages of 6, 12, 24, and 36 months, respectively. Serum CRP increased in 50% of subjects at onset (median, 0.21 mg/dL; range, <0.20-18.2 mg/dL) and Eo was elevated in 71.9% of subjects at onset (median, 7.1%; range, 1.0-50.5%). Age at tolerance acquisition was significantly positively correlated with serum CRP at onset (r = 0.45, P < 0.01), and significantly negatively correlated with Eo at onset (r = À0.36, P < 0.05). Although CM-specific immunoglobulin E antibody (sIgE) was positive in nine of 32 FPIES patients at onset (median, 0.93; range, 0.38-18.9 kU/L), it decreased thereafter. CM-sIgE at onset did not correlate significantly with prognosis (r = 0.22, P > 0.05).Conclusions: Serum CRP is not only an indicator of the activity of intestinal inflammation, it is also a useful parameter of poor prognosis in FPIES. In contrast, eosinophilia at onset could be used as a marker of good prognosis, suggesting that it has some beneficial effects in the pathophysiology of FPIES.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prognosis of infantile food protein‐induced enterocolitis syndrome in Japan

Kimura

Shimomura

Morishita

et al. 2017

Pediatrics International

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“…However, unlike EoE, consensus on the histological criteria for diagnosis of EG and EC has not yet been reached. Blood tests may be useful for the diagnosis of EG since peripheral eosinophilia is reported in 70-90% of confirmed cases, while it seems to be not as useful in the diagnosis of EoE [79][80][81] .…”

Section: Oit and Eg And Eosinophilic Colitismentioning

confidence: 99%

“…Due to the proposed association between FA and EG and EC, the initial treatment is usually dietary intervention but when it is not effective, use of oral corticosteroids has been most frequently reported [79,[88][89][90] .…”

Section: Oit and Eg And Eosinophilic Colitismentioning

confidence: 99%

Oral and Sublingual Immunotherapy: Potential Causes for Eosinophilic Gastrointestinal Disorders?

Babaie

Mesdaghi

Nishino

et al. 2017

Int Arch Allergy Immunol

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Food allergy is a common health problem worldwide, with increasing prevalence during recent decades. The only approved treatments for food allergy are food avoidance and administration of emergency medications in case of accidental exposure, which negatively affects patients' quality of life, so new treatments are highly desirable. Different food immunotherapy modalities have recently been used, with variable success rates in the induction of desensitization and tolerance, and different numbers and types of adverse reactions. Adverse reactions, especially intolerable gastrointestinal symptoms, are the most important causes of immunotherapy withdrawal. Eosinophilic esophagitis has been reported as a complication of milk, egg, and peanut oral immunotherapies and sublingual immunotherapy for respiratory allergies, but not for food allergies. Eosinophilic gastritis and eosinophilic colitis also rarely happened following egg and milk oral immunotherapies. The patients undergoing oral and sublingual immunotherapies should be closely followed up for a long time, and those with gastrointestinal symptoms should be evaluated by endoscopy of the gastrointestinal tract. These complications are usually reversible after early diagnosis and stopping the immunotherapy protocol.

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“…Fibrosis is much less common in EGE compared to EoE; therefore, oral steroids can be used at a minimum effective dose, e.g., 0.5–1 mg/kg with a maximum dose of 40 mg, while the whole duration of the treatment with oral steroids should not exceed 6 weeks. It should be noted, however, that discontinuation of steroids is often associated with disease relapse [45]. …”

Section: Eosinophilic Gastroenteritismentioning

confidence: 99%

Eosinophilic Gastrointestinal Diseases in Childhood

Koutri

Papadopoulou

2018

Ann Nutr Metab

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Eosinophilic gastrointestinal diseases (EGIDs) comprise a group of chronic, inflammatory diseases of the gastrointestinal (GI) tract, that are characterized, clinically, by symptoms related to the dysfunction of the involved segment(s) of the GI tract, and histologically, by dense eosinophilic inflammation, in the absence of an identifiable secondary cause. The group of EGIDs comprises eosinophilic esophagitis (EoE), eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC). EoE is the most common and the best described EGID compared to EG, EGE, and EC. The clinical presentation of the EGIDs differs depending on the location and the extent of the eosinophilic infiltration in the GI tract, as well as its depth through the bowel wall. In the absence of biological markers, the diagnosis is based on the combination of clinical symptoms with the histological features of EGIDs, after the exclusion of secondary causes of eosinophilic inflammation of the GI tract. Treatment is individualized and includes elimination diets (mainly empiric or elemental) and/or drugs, according to the involved GI segment: proton pump inhibitors or local steroids in EoE; local or oral systemic steroids in EG/EGE limited to the duodenum; oral systemic steroids in EGE with lower small intestine and/or colon involvement. In patients with EoE, maintenance treatment with lower doses may be considered following histological remission with the means of drugs. In patients treated with elimination diets, disease food triggers identified during food reintroduction need to be further eliminated. Esophageal stenosis despite medical treatment requires endoscopic dilation, while the use of thiopurines or anti-TNF drugs may be considered in refractory or steroid-dependent EGID (other than EoE). The aim of this review is to provide the available evidence on each of the above disorders, to aid clinicians to interpret the clinical manifestations and the laboratory findings and choose the best available treatment option.

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Clinical Manifestations and Treatment Outcomes of Eosinophilic Gastroenteritis in Children

Cited by 34 publications

References 23 publications

Prognosis of infantile food protein‐induced enterocolitis syndrome in Japan

Prognosis of infantile food protein‐induced enterocolitis syndrome in Japan

Oral and Sublingual Immunotherapy: Potential Causes for Eosinophilic Gastrointestinal Disorders?

Eosinophilic Gastrointestinal Diseases in Childhood

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