Infectious Esophagitis in Children

O’Donnell, Jonathan E M; Krishnan, Usha

doi:10.1097/mpg.0000000000003523

Cited by 3 publications

(3 citation statements)

References 83 publications

(125 reference statements)

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“…While EA/TEF is a common cause of pediatric dysmotility, there is minimal research on its potential role as a risk factor of FE (44,46–48). Although we found a positive association between EA/TEF and FE on univariate analysis, this did not hold true after multivariate analysis, which may be due to the low number of FE cases in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Although EoE has been hypothesized to promote fungal colonization due to esophageal strictures and associated dysmotility (40)(41)(42)(43)(44), no studies have examined EoE as a predictive factor of FE. In this study, while EoE was a risk factor for FE on univariate analysis, it was no longer significant after multivariate analysis.…”

Section: Eosinophilic Esophagitismentioning

confidence: 99%

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Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Correia,

Weber,

Krishnan

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: Fungal esophagitis (FE) is the most common cause of esophageal infection and its prevalence in immunocompetent adults is rising. However, there is minimal data on FE in children without human immunodeficiency virus. Therefore, the objective of this study was to determine the prevalence, symptoms, endoscopic appearances and predictive factors of FE in children, regardless of immune status. Methods: A 2010-2020 retrospective case-control study was conducted on 1823 children presenting to Sydney Children’s Hospital for elective endoscopy with esophageal biopsy. Histopathology reports were reviewed to identify FE cases and determine prevalence rates. 32 patients with FE were age- and sex-matched (1:2) to 64 controls. Significant symptoms and risk factors of FE were identified via univariate and multivariate logistic regression analysis. Results ;The prevalence of FE in children was 1.76%. Common symptoms included dysphagia (25%), heartburn (25%), poor oral intake (21.9%), vomiting (18.8%), cough (15.6%), nausea (12.5%) and weight-loss (9.4%). No significant differences in symptoms were found between cases and controls. On endoscopy, although white plaques were associated with FE (p<0.001), visually-normal findings were reported in 28.1% of cases. Topical swallowed corticosteroids were a significant independent risk factor for FE (adjusted odds ratio [aOR]=10.740, 95% confidence interval [CI]: 1.213-95.101, p=0.033). Conclusions: The prevalence of FE in this pediatric cohort reflects rates amongst immunocompetent adults. Given that many of these children presented with a wide range of gastrointestinal symptoms, esophageal biopsy is required to accurately diagnose FE. Pediatricians should consider the risk of FE when prescribing topical swallowed corticosteroids.

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Section: Discussionmentioning

confidence: 99%

Section: Eosinophilic Esophagitismentioning

confidence: 99%

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Correia,

Weber,

Krishnan

2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…PPI-associated intestinal microbial changes have been linked to adverse gastrointestinal and systemic effects. 7,23 PPI use has also been linked to proinflammatory bacterial alterations in the upper gastrointestinal tract microbiota, 30,31 which may cause opportunistic infections such as Candida esophagitis. 30 Given the risk of both upper and lower gastrointestinal tract inflammation, it is important to carefully consider the prescribing of PPIs in this cohort.…”

Section: Firmicutes ↑Bacilli ↑Lactobacillalesmentioning

confidence: 99%

Intestinal dysbiosis and inflammation in children with repaired esophageal atresia

Traini,

Chan,

Menzies

et al. 2023

J. pediatr. gastroenterol. nutr.

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ObjectivesThis study aims to compare the intestinal microbiota and intestinal inflammation of children with esophageal atresia (EA) to matched healthy controls, and to investigate the relationship between these factors and clinical outcomes.MethodsA cross‐sectional study of 35 children with EA and 35 matched healthy controls (HC) from a single tertiary pediatric hospital in Australia was conducted. Demographic and dietary data were collected using surveys. Stool samples were analyzed using 16S rRNA sequencing, and fecal calprotectin measurements were used to measure intestinal inflammation. Comparisons were made between the groups, and correlations between the microbiota and clinical factors were investigated in the EA cohort.ResultsCompared to HC, children with EA had similar alpha diversity, but beta diversity analysis revealed clustering of EA and HC cohorts. Children with EA had a significantly higher relative abundance of the order Lactobacillales, and a lower abundance of the genus uncultured Bacteroidales S24‐7. Fecal calprotectin was significantly higher in children with EA compared to HC. In the EA cohort, children taking proton pump inhibitors (PPI's) had lower alpha diversity and higher calprotectin levels compared to those not taking PPI's. There was a negative correlation between calprotectin and length/height‐for‐age z scores, and children with higher calprotectin levels had a greater burden of gastrointestinal symptoms.ConclusionsChildren with EA have an altered intestinal microbiota compared to HC, which is likely related to PPI use, and may be impacting on growth and quality of life. It is important to rationalize PPI use in this cohort.

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Cytomegalovirus/Herpes Simplex Virus Co-infection with Associated Oesophageal Stricture in a Young Immunocompetent Woman: A Case Report and Literature Review

Godfrey,

Patwardhan

2024

EMJ Gastroenterol

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The authors report the first case of oesophageal cytomegalovirus (CMV) and herpes simplex virus (HSV) co-infection in an immunocompetent patient with an associated oesophagal stricture. The authors also review the literature on oesophageal strictures related to CMV and/or HSV oesophagitis. CMV and HSV co-infection is well documented in immunocompromised patients. The oesophagus is one of several organs known to harbour co-infection. To the knowledge of the authors’, its association with an oesophageal stricture is rare and has only been noted in patients with HIV. The authors report a case of an immunocompetent 40-year-old woman with a past history of iron deficiency anaemia and idiopathic hypertension who presented with dysphagia. Investigations revealed a circumferential oesophageal stricture, with biopsies positive for CMV and HSV. This patient was HIV-negative and had no evidence of immunodeficiency. The patient was treated successfully with valganciclovir and multiple endoscopic oesophageal dilatations. This presentation in an immunocompetent patient has not been described in the literature to the authors’ knowledge and represents a valid differential diagnosis to be recognised in clinical practice.

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Infectious Esophagitis in Children

Cited by 3 publications

References 83 publications

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Prevalence, Predictive Factors, and Clinical Manifestations of Fungal Esophagitis in Children

Intestinal dysbiosis and inflammation in children with repaired esophageal atresia

Cytomegalovirus/Herpes Simplex Virus Co-infection with Associated Oesophageal Stricture in a Young Immunocompetent Woman: A Case Report and Literature Review

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