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Review of eosinophilic oesophagitis in children and young people

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Abstract

Eosinophilic oesophagitis is a relapsing inflammatory disorder involving oesophagus identified over 30 years ago. Diagnosis is made by upper gastrointestinal endoscopy and oesophageal biopsies. There is huge variation in management practices across the globe. Therapeutic options include the use of proton pump inhibitors, topical steroids, and elimination diet. Biologics and immunomodulator drugs are being explored but not yet recommended in children. Long-term treatment may be required to control symptoms and to prevent complications such as fibrosis/stricture.

Conclusion: Even though clinicians have better understanding of eosinophilic oesophagitis, further research is warranted in exploring the unmet needs of developing a highly sensitive non-invasive biomarker for its diagnosis and response to treatment along with a robust and easily deliverable therapeutic option.

What is Known:

•Incidence of eosinophilic oesophagitis has increased over the recent years.

•Diagnostic confirmation requires upper gastrointestinal endoscopy and therapeutic options include elimination diet and/or topical steroids.

What is New:

•There is a lack of consensus ion management strategy with wide variation across the globe.

•There is a need to develop a highly reliable and non-invasive biomarker to diagnose eosinophilic oesophagitis and to monitor the response to treatment.

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Abbreviations

EoE:

Eosinophilic oesophagitis

GORD:

Gastro-oesophageal reflux disease

OGD:

Oesophago-gastro-duodenoscopy

PPI:

Proton pump inhibitors

RAT:

Radio Allergo Sorbent Test

SPT:

Skin Prick Test

References

  1. Attwood SE, Smyrk TC, Demeester TR, et al (1993) Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 38:109–16. https://doi.org/10.1007/BF01296781pmidhttp://www.ncbi.nlm.nih.gov/pubmed/8420741

  2. CPT. International statistical classification of diseases and related health problems: ICD-10. Available: https://coder.aapc.com/icd-10-codes/K20.0#:~:text=ICD%2D10%20code%20K20.,Diseases%20of%20the%20digestive%20system%20 [Accessed 30 Mar 2021] https://icd.codes/icd10cm/K20 [Accessed 25 Jun 2021].

  3. Furuta GT, Liacouras CA, Collins MH, et al (2007) Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 133:1342–1363

    Article  CAS  Google Scholar 

  4. Attwood S, Epstein J (2020) Eosinophilic oesophagitis: recent advances and practical management. Frontline Gastroenterology flgastro-2019–101313; https://doi.org/10.1136/flgastro-2019-101313

  5. Navarro P, Arias Ángel, Arias-González L, et al (2019) Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 49:1116–25. https://doi.org/10.1111/apt.15231pmidhttp://www.ncbi.nlm.nih.gov/pubmed/30887555

  6. Dellon ES (2019) Editorial: the evolving epidemiology of EoE-up, up, and away? Aliment Pharmacol Ther 49(11):1448–1449. https://doi.org/10.1111/apt.15252

    Article  PubMed  PubMed Central  Google Scholar 

  7. Dellon ES (2014) Epidemiology of eosinophilic esophagitis. Gastroenterol Clin North Am 43(2):201–218. https://doi.org/10.1016/j.gtc.2014.02.002

    Article  PubMed  PubMed Central  Google Scholar 

  8. Vinit C, Dieme A, Courbage S, et al (2019) Eosinophilic esophagitis: pathophysiology, diagnosis, and management. Arch Pediatr 26:182–190. https://doi.org/10.1016/j.arcped.2019.02.005

    Article  PubMed  CAS  Google Scholar 

  9. Davis BP (2018) Pathophysiology of eosinophilic esophagitis. Clin Rev Allergy Immunol 55:19–42. https://doi.org/10.1007/s12016-017-8665-9

    Article  PubMed  CAS  Google Scholar 

  10. Spergel JM (2015) An Allergist’s perspective to the evaluation of eosinophilic esophagitis. Best Pract Res Clin Gastroenterol 29(5):771–781

    Article  Google Scholar 

  11. Ryu S, Lee KH, Tizaoui K, et al (2020) Pathogenesis of eosinophilic esophagitis: a comprehensive review of the genetic and molecular aspects. Int J Mol Sci 21(19):7253. https://doi.org/10.3390/ijms21197253

    Article  PubMed Central  CAS  Google Scholar 

  12. Martin LJ, He H, Collins MH, et al (2018) Eosinophilic esophagitis (EoE) genetic susceptibility is mediated by synergistic interactions between EoE-specific and general atopic disease loci. J Allergy Clin Immunol 141(5):1690–1698

    Article  Google Scholar 

  13. Kottyan LC, Davis BP, Sherrill JD, et al (2014) Genome-wide association analysis of eosinophilic esophagitis provides insight into the tissue specificity of this allergic disease. Nat Genet 46(8):895–900

    Article  CAS  Google Scholar 

  14. Shaheen NJ, Mukkada V, Eichinger CS, Schofield H, Todorova L, Falk GW (2018) Natural history of eosinophilic esophagitis: a systematic review of epidemiology and disease course. Dis Esophagus 31(8):doy015. https://doi.org/10.1093/dote/doy015

  15. Spergel JM, Brown-Whitehorn TF, Beausoleil JL, Franciosi J, Shuker M, Verma R, Liacouras CA (2009) 14 years of eosinophilic esophagitis: clinical features and prognosis. J Pediatr Gastroenterol Nutr 48:30–36

    Article  Google Scholar 

  16. DeBrosse CW, Franciosi JP, King EC, Butz BK, Greenberg AB, Collins MH, Abonia JP, Assa’ad A, Putnam PE, Rothenberg ME (2011) Long-term outcomes in pediatric-onset esophageal eosinophilia. J Allergy Clin Immunol 128:132–138

    Article  Google Scholar 

  17. Butz BK, Wen T, Gleich GJ, et al (2014) Efficacy, dose reduction, and resistance to high-dose fluticasone in patients with eosinophilic esophagitis. Gastroenterology 147:324–333

    Article  CAS  Google Scholar 

  18. Miehlke S, Hruz P, Vieth M, et al (2016) A randomised, double-blind trial comparing budesonide formulations and dosages for short-term treatment of eosinophilic oesophagitis. Gut 65:390–399

    Article  CAS  Google Scholar 

  19. Lucendo AJ, Arias A, Molina-Infante J (2016) Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 14:13–22

    Article  CAS  Google Scholar 

  20. Dellon ES, Hirano I (2018) Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology 154(2):319–332

    Article  Google Scholar 

  21. Choudhury S, Kozielski R, Hua J, Wilding GE, Baker S (2000) Do histological features of eosinophilic esophagitis in children correlate with peripheral eosinophils? JPGN 70(5):604–607

    Google Scholar 

  22. Lucendo AJ, Molina-Infante J, Arias Ángel, et al (2017) Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 5:335–58. https://doi.org/10.1177/2050640616689525pmidhttp://www.ncbi.nlm.nih.gov/pubmed/2850774

  23. Hirano I, Moy N, Heckman MG, et al (2013) Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 62:489–95. doi:https://doi.org/10.1136/gutjnl-2011-301817pmidhttp://www.ncbi.nlm.nih.gov/pubmed/22619364

  24. Hoofien A, Dias JA, Malamisura M, et al (2019) Pediatric eosinophilic esophagitis: results of the European retrospective pediatric eosinophilic esophagitis registry (RetroPEER). J Pediatr Gastroenterol Nutr 68:552–8. https://doi.org/10.1097/MPG.0000000000002215pmidhttp://www.ncbi.nlm.nih.gov/pubmed/30540712

  25. Papadopoulou A, Koletzko S, Heuschkel R, et al (2014) Management guidelines of eosinophilic esophagitis in childhood. JPGN 58:107–118

    PubMed  CAS  Google Scholar 

  26. Gupta SK, Vitanza JM, Collins MH (2015) Efficacy and safety of oral budesonide suspension in pediatric patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 13:66–76. https://doi.org/10.1016/j.cgh.2014.05.021pmidhttp://www.ncbi.nlm.nih.gov/pubmed/24907502

  27. Lucendo AJ, Miehlke S, Schlag C, et al (2019) Efficacy of budesonide orodispersible tablets as induction therapy for eosinophilic esophagitis in a randomized placebo-controlled trial. Gastroenterology 157:74–86. https://doi.org/10.1053/j.gastro.2019.03.025pmidhttp://www.ncbi.nlm.nih.gov/pubmed/30922997

  28. Visaggi P, Savarino E, Sciume G, et al (2021) Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults. Therap Adv Gastroenterol 31(14):1756284820980860. https://doi.org/10.1177/1756284820980860.eCollection2021

    Article  Google Scholar 

  29. Spergel JM, Andrews T, Brown-Whitehorn TF, et al (2005) Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 95:336–343

    Article  Google Scholar 

  30. Tourlamain G, Garcia-Puig R, Gutiérrez-Junquera C, et al (2020) Differences in management of eosinophilic esophagitis in Europe: an assessment of current practice. JPGN 71(1):83–90

    PubMed  Google Scholar 

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Authors and Affiliations

  1. University Hospitals of Derby and Burton NSH Foundation Trust, Queen’s Hospital Belvedere Road, Burton Upon Trent, DE13 0RB, Staffs, UK

    Mansoor Ahmed, Nyaish Mansoor & Tihami Mansoor

Authors
  1. Mansoor Ahmed
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  2. Nyaish Mansoor
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  3. Tihami Mansoor
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Contributions

All the authors (MA, NM, and TM) have contributed to the inception of the idea, literature search, and writing/finalising this manuscript.

Corresponding author

Correspondence to Mansoor Ahmed.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Ahmed, M., Mansoor, N. & Mansoor, T. Review of eosinophilic oesophagitis in children and young people. Eur J Pediatr 180, 3471–3475 (2021). https://doi.org/10.1007/s00431-021-04174-0

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