Eosinophilic Esophagitis in Children Needing Emergency Endoscopy for Foreign Body and Food Bolus Impaction

El‐Matary, Wael; El‐Hakim, Hamdy; Popel, Jillian

doi:10.1097/pec.0b013e31825cf7bb

Cited by 17 publications

(10 citation statements)

References 14 publications

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“…Along with esophageal eosinophilia, histologic changes can include increased mast cell numbers, epithelial basal cell hyperplasia and increased papillary height, dilated intercellular spaces, and superficial eosinophilic microabscesses [7]. The most common and severe short-term complication is food impaction [8, 9]. If the disease is left untreated, the chronic inflammation can lead to esophageal fibrostenosis and dysmotility [2].…”

Section: Introductionmentioning

confidence: 99%

Pediatric Eosinophilic Esophagitis Endotypes: Are We Closer to Predicting Treatment Response?

Ferguson

Mukkada

Fulkerson

2017

Clinic Rev Allerg Immunol

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Eosinophilic esophagitis (EoE) is a chronic, food antigen-driven gastrointestinal disease that is characterized by esophageal eosinophilia. Currently, there are no Food and Drug Administration (FDA)-approved treatments for EoE, but the two most commonly prescribed therapies include topical corticosteroids and food elimination diets. Clinical trials have revealed a significant proportion of cases that are resistant to topical corticosteroids, and although we define EoE as a food antigen-driven disease, not all patients with EoE respond to elimination diets or even elemental diets. The varied response to treatments highlights the heterogeneity of EoE and the need for new treatment strategies. Despite the clinical differences in treatment response, predicting the outcome remains difficult since factors including age, histologic severity at diagnosis, atopic history, and anthropometrics are not predictive of treatment response. In our practice at an academic pediatric referral center, we observe distinct clinical EoE phenotypes, including cases with atopy, connective tissue disorders, or responsiveness to a proton pump inhibitor. Similar to the work in progress with asthma, stratification of patients with EoE by clinical phenotypes and/or molecular endotypes will likely assist with therapy selection and prediction of natural history. Molecular analysis with gene expression panels also shows promise in helping us classify patients based on molecular endotypes. In additional to the clinical and molecular classifications, more accurate histologic diagnostic criteria for EoE may help us tease out small differences between patient cohorts. Despite the leaps in knowledge over the past decade regarding EoE pathogenesis, it remains a challenge to predict the response to treatment. Future studies focused on molecular, genetic, and immunologic analyses of larger patient cohorts are needed to assist in identifying EoE phenotypes and endotypes as we attempt to improve patient outcomes in pediatric EoE.

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Section: Introductionmentioning

confidence: 99%

Pediatric Eosinophilic Esophagitis Endotypes: Are We Closer to Predicting Treatment Response?

Ferguson

Mukkada

Fulkerson

2017

Clinic Rev Allerg Immunol

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“…Interestingly, when patients are referred for an upper endoscopy due to dysphagia, a diagnosis of EoE can be established in 10-15% of the cases [21,22], with 11% due to food impactions [23]. Considerably higher rates are found when endoscopies were performed for the indication of bolus obstruction in children as an association with the diagnosis of EoE was found in up to 40% [24]. Patients older than 50 years with dysphagia are more likely to be diagnosed with EoE [21,22].…”

Section: Incidence and Prevalence Of Eoe Based On Endoscopy And Histomentioning

confidence: 99%

Epidemiology of Eosinophilic Esophagitis

Hrúz¹

2014

Dig Dis

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Eosinophilic esophagitis (EoE) is an allergy-associated disease defined clinically by esophagus-related symptoms in combination with a dense esophageal eosinophilia, both of which are unresponsive to prolonged acid suppression with proton pump inhibitors. Over the last two decades EoE has increasingly been recognized in various geographical areas (mostly industrialized countries) with high socioeconomic development. The prevalence rate is increasing and reaches up to 50 patients per 100,000 inhabitants in some indicator regions. Whether this increased prevalence is due to a real increase in incidence, a result of increased awareness by health care providers or because of the nonfatal nature of EoE adding more and more cases to the patient pool is still a matter of controversy. Several studies have consistently demonstrated a male predominance in EoE, with a male-to-female risk ratio of 3:1. The average age at diagnosis ranges between 30 and 50 years and suggests that EoE is a disease of the middle-aged man. It can affect patients of every race, but the disease is more common among Caucasians. In both children and adults, EoE has been clearly associated with allergies to food and aeroallergens, and most EoE patients present with a personal allergic background (e.g. asthma, rhinoconjunctivitis or oral allergy syndrome). In conclusion, knowledge of epidemiologic parameters of EoE is crucial for identifying risk factors as well as pathogenic mechanisms, planning preventive measures and determining optimal treatment strategies.

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“…Two presented more than once. Taking biopsies may be wise, especially if endoscopic findings suggest the need or because of repeated presentation [17]. On the other hand, 2 patients had the foreign bodies at the site of oesophageal strictures; one after corrosive ingestion, the second at the anastomosis site of oesophageal atresia operation.…”

Section: Aimmentioning

confidence: 99%

Endoscopic management of foreign body ingestion in children

Altamimi

Yusef

Rawabdeh

2020

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Introduction: Foreign body ingestion is common in children. Most accidental ingestions are passed spontaneously without intervention. Some cases of ingestion require intervention in a timely fashion to reduce risks and morbidities.Aim: To analyse the clinical presentation, aetiology, and outcome of children presenting with foreign body ingestion, who required endoscopic intervention at a tertiary hospital

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Eosinophilic Esophagitis in Children Needing Emergency Endoscopy for Foreign Body and Food Bolus Impaction

Cited by 17 publications

References 14 publications

Pediatric Eosinophilic Esophagitis Endotypes: Are We Closer to Predicting Treatment Response?

Pediatric Eosinophilic Esophagitis Endotypes: Are We Closer to Predicting Treatment Response?

Epidemiology of Eosinophilic Esophagitis

Endoscopic management of foreign body ingestion in children

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