Endoscopic Ultrasonography in Children with Eosinophilic Esophagitis—A Review

Pytrus, Tomasz; Akutko, Katarzyna; Kofla-Dłubacz, Anna; Stawarski, Andrzej

doi:10.3390/pediatric14010003

Cited by 5 publications

(2 citation statements)

References 25 publications

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“…In parallel with its increased utility in conditions such as inflammatory bowel disease, GI ultrasonography, using advanced ultrasound probes, has shown utility in the assessment of flow through segments of the bowel (44) as well as the stomach (eg, in gastroparesis) (45). The use of endoscopic ultrasound may also provide information on esophageal motility in conditions such as eosinophilic esophagitis (46). Compared to MRI, ultrasonography comes with considerable benefits of lower cost and easier storage and use.…”

Section: Less Invasive Investigative Toolsmentioning

confidence: 99%

Pediatric Neurogastroenterology and Motility: Moving Rapidly Into the Future

Chanpong

Thapar

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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The field of pediatric neurogastroenterology and motility encompasses some of the most common and severe gastrointestinal (GI) disorders that affect children. GI motility disorders remain, in general, poorly understood, variably diagnosed, and inadequately treated. Although the field progressed relatively slowly over the last decades, the coming years will, no doubt, see it move into a prolific and dynamic era. With this review, we look forward to this brighter future for the field and highlight emerging areas that show promise and deserve focus in the coming years. This includes the role of early life programming and insult of the enteric neuromusculature as a key determinant of motility diseases and factors that are likely to be relevant in disease etiopathogenesis. We discuss several recent and futuristic developments and advancements in investigative and diagnostic tools as well as novel approaches that have been introduced in the management of GI motility disorders. These include targeted and personalized medicine in both pharmacological and multidisciplinary approaches as well as the emerging therapeutic options such as bioelectrical neuromodulation and regenerative medicine.

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Section: Less Invasive Investigative Toolsmentioning

confidence: 99%

Pediatric Neurogastroenterology and Motility: Moving Rapidly Into the Future

Chanpong

Thapar

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Most significantly, a couple of anecdotal reports have suggested that the resolution of symptoms, endoscopic abnormalities, and esophageal eosinophilia occur prior to the normalization of the EUS observed esophageal wall thickening in EoE 33,34 . A recent review article on the utilization of EUS in EoE has concluded that preliminary data "suggest that EUS and TWT measurement may become an important test in diagnostics, monitoring the effectiveness of therapy, assessing disease progression, and in individualizing the method and duration of EoE treatment in children" 35 .…”

Section: Endoscopic Ultrasound In Eosinophilic Esophagitismentioning

confidence: 99%

Endoscopic Point of Care Ultrasound: Foundations, Present Applications, Future Potentials

Rabinowitz,

Sharma,

Grossman

2023

MRAJ

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Introduction: The present review details the evolution of endoscopic ultrasound, the acquisition of subepithelial imaging of the gastrointestinal tract during endoscopy, in pediatrics. Similar to its use in adults, the majority of its present applications involve obtaining fluid and or tissue for diagnosis. Simultaneously, the indications for point of care ultrasound, in which physicians caring for a patient personally obtains images which can be incorporated immediately into diagnosis and management, are also expanding. A history of endoscopic ultrasound from its inception to its current utilization is presented. The data reflecting its successful current employment as the procedure of choice to analyze and drain pancreatic cysts, to diagnose biliary tract and pancreatic diseases, to direct subepithelial biopsies, and to evaluate gastrointestinal tumors as well as less common gastrointestinal pathologies, is summarized with an emphasis on pediatric studies. In addition, the recent expansion of point of care ultrasound and endoscopic ultrasound to yield images to analyze subepithelial pathology including fibrosis in eosinophilic esophagitis and in inflammatory bowel disease is highlighted. A brief summary of the challenges, range of instruments, costs, and safety provides the reader with the background to fully appreciate this emerging technique. Finally, there is an overview of exciting new developments that will further extend its indications. Conclusions: With anticipated improvements including better resolution of endoscopic ultrasound probes, the routine incorporation of point of care elastography and contrast enhanced ultrasound, and the potential of artificial intelligence to provide more reproducible and uniform analysis of endosonographic images, new indications are anticipated to enable endoscopic point of care ultrasound, E-POCUS, to further improve patient care in the near future

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Manometric findings in children with eosinophilic esophagitis and persistent post‐remission dysphagia

Yogev,

Dorfman,

Mansi

et al. 2024

JPGN rep.

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ObjectivesDysphagia is a frequent symptom of active eosinophilic esophagitis (EoE), but at times it persists despite attaining histologic healing and lack of fibro‐stenotic changes. We aimed to describe the manometric findings in this subset of patients.MethodsA retrospective review of charts between 2013 and 2023 at a tertiary pediatric gastroenterology center, treating roughly 1500 EoE patients per year. We included children with EoE referred to high‐resolution impedance manometry (HRIM) for persistent dysphagia despite histologic healing (i.e., <15 Eos/hpf). Data including initial EoE diagnosis, endoscopy reports, esophageal biopsies, treatment regimens, and HRIM were retrospectively collected.ResultsThe estimated prevalence of post‐remission dysphagia in our cohort was exceedingly rare (<0.05%). Four patients met the eligibility criteria of histologic remission and absence of fibro‐stenotic features on endoscopic evaluation and thus, were included in this case series. Patients achieved remission with steroids, proton‐pump inhibitor, or both within a median time of 5 months from diagnosis. Peak Eosinophil count at remission was ≤5 Eos/hpf in three patients and ≤10 Eos/hpf in one. On HRIM, all four patients had a hypomotile esophagus and abnormal bolus clearance. Lower esophageal sphincter integrated relaxation pressure values were normal in three patients and elevated in one. Two patients were diagnosed with ineffective esophageal motility, one with aperistalsis and one with achalasia type 1.ConclusionsPost‐remission dysphagia is rare in EoE. Esophageal dysmotility with a hypomotile pattern may contribute to the persistent dysphagia in children with EoE. HRIM should be considered in patients with EoE in whom symptoms persist despite histologic remission.

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Endoscopic Ultrasonography in Children with Eosinophilic Esophagitis—A Review

Cited by 5 publications

References 25 publications

Pediatric Neurogastroenterology and Motility: Moving Rapidly Into the Future

Pediatric Neurogastroenterology and Motility: Moving Rapidly Into the Future

Endoscopic Point of Care Ultrasound: Foundations, Present Applications, Future Potentials

Manometric findings in children with eosinophilic esophagitis and persistent post‐remission dysphagia

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