Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
권호 표지
DOI QR코드

DOI QR Code

Nationwide Multicenter Study of Eosinophilic Esophagitis in Korean Children

  • Lee, Kunsong (Department of Pediatrics, Dankook University College of Medicine) ;
  • Choe, Byung-Ho (Department of Pediatrics, School of Medicine, Kyungpook National University) ;
  • Kang, Ben (Department of Pediatrics, School of Medicine, Kyungpook National University) ;
  • Kim, Seung (Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine) ;
  • Kim, Jae Young (Department of Pediatrics, Gyeongsang National University Changwon Hospital) ;
  • Shim, Jung Ok (Department of Pediatrics, Korea University Guro Hospital) ;
  • Lee, Yoo Min (Department of Pediatrics, Soonchunhyang University Bucheon Hospital) ;
  • Lee, Eun Hye (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University School of Medicine) ;
  • Jang, Hyo-Jeong (Department of Pediatrics, Keimyung University School of Medicine) ;
  • Ryoo, Eell (Department of Pediatrics, Gachon University Gil medical Center) ;
  • Yang, Hye Ran (Department of Pediatrics, Seoul National University Bundang Hospital)
  • Received : 2020.01.12
  • Accepted : 2020.03.28
  • Published : 2020.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: In East Asian countries, there are only a few epidemiologic studies of eosinophilic esophagitis (EoE) and no studies in children. We investigated the incidence and compared the clinical characteristics of EoE and eosinophilic gastroenteritis involving the esophagus (EGEIE) in Korean children. Methods: A total of 910 children, who had symptoms of esophageal dysfunction, from 10 hospitals in Korea were included. EoE was diagnosed according to diagnostic guidelines and EGEIE was diagnosed when there were >15 eosinophils in the esophagus per high power field (HPF) and >20 eosinophils per HPF deposited in the stomach and duodenum with abnormal endoscopic findings. Results: Of the 910 subjects, 14 (1.5%) were diagnosed with EoE and 12 (1.3%) were diagnosed with EGEIE. Vomiting was the most common symptom in 57.1% and 66.7% of patients with EoE and EGEIE, respectively. Only diarrhea was significantly different between EoE and EGEIE (p=0.033). In total, 61.5% of patients had allergic diseases. Exudates were the most common endoscopic findings in EoE and there were no esophageal strictures in both groups. The median age of patients with normal endoscopic findings was significantly younger at 3.2 years, compared to the median age of 11.1 years in those with abnormal endoscopic findings (p=0.004). Conclusion: The incidence of EoE in Korean children was lower than that of Western countries, while the incidence of EGEIE was similar to EoE. There were no clinical differences except for diarrhea and no differences in endoscopic findings between EoE and EGEIE.

Keywords

References

  1. Koutri E, Papadopoulou A. Eosinophilic gastrointestinal diseases in childhood. Ann Nutr Metab 2018;73 Suppl 4:18-28. https://doi.org/10.1159/000493668
  2. Licari A, Votto M, D'Auria E, Castagnoli R, Caimmi SME, Marseglia GL. Eosinophilic gastrointestinal diseases in children: a practical review. Curr Pediatr Rev 2019;15. doi: 10.2174/1573396315666191022154432. [Epub ahead of print].
  3. Collins MH. Histopathologic features of eosinophilic esophagitis and eosinophilic gastrointestinal diseases. Gastroenterol Clin North Am 2014;43:257-68. https://doi.org/10.1016/j.gtc.2014.02.007
  4. Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995;109:1503-12. https://doi.org/10.1016/0016-5085(95)90637-1
  5. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007;133:1342-63. https://doi.org/10.1053/j.gastro.2007.08.017
  6. Lucendo AJ, Molina-Infante J, Arias A, von Arnim U, Bredenoord AJ, Bussmann C, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017;5:335-58. https://doi.org/10.1177/2050640616689525
  7. Papadopoulou A, Koletzko S, Heuschkel R, Dias JA, Allen KJ, Murch SH, et al.; ESPGHAN Eosinophilic Esophagitis Working Group and the Gastroenterology Committee. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr 2014;58:107-18. https://doi.org/10.1097/MPG.0b013e3182a80be1
  8. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 2013;108:679-92; quiz 693. https://doi.org/10.1038/ajg.2013.71
  9. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011;128:3-20.e6; quiz 21-2. https://doi.org/10.1016/j.jaci.2011.02.040
  10. Ferreira CT, Vieira MC, Furuta GT, Barros FCLF, Chehade M. Eosinophilic esophagitis-where are we today? J Pediatr (Rio J) 2019;95:275-81. https://doi.org/10.1016/j.jped.2018.06.012
  11. Markowitz JE, Clayton SB. Eosinophilic esophagitis in children and adults. Gastrointest Endosc Clin N Am 2018;28:59-75. https://doi.org/10.1016/j.giec.2017.07.004
  12. Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology 2018;154:319-32.e3. https://doi.org/10.1053/j.gastro.2017.06.067
  13. Dellon ES, Kim HP, Sperry SL, Rybnicek DA, Woosley JT, Shaheen NJ. A phenotypic analysis shows that eosinophilic esophagitis is a progressive fibrostenotic disease. Gastrointest Endosc 2014;79:577-85.e4. https://doi.org/10.1016/j.gie.2013.10.027
  14. Muir AB, Merves J, Liacouras CA. Role of endoscopy in diagnosis and management of pediatric eosinophilic esophagitis. Gastrointest Endosc Clin N Am 2016;26:187-200. https://doi.org/10.1016/j.giec.2015.08.006
  15. Arias A, Perez-Martinez I, Tenias JM, Lucendo AJ. Systematic review with meta-analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 2016;43:3-15.
  16. Kinoshita Y, Ishimura N, Oshima N, Ishihara S. Systematic review: eosinophilic esophagitis in Asian countries. World J Gastroenterol 2015;21:8433-40. https://doi.org/10.3748/wjg.v21.i27.8433
  17. Moawad FJ. Eosinophilic esophagitis: incidence and prevalence. Gastrointest Endosc Clin N Am 2018;28:15-25. https://doi.org/10.1016/j.giec.2017.07.001
  18. Pesek RD, Reed CC, Muir AB, Fulkerson PC, Menard-Katcher C, Falk GW, et al. Increasing rates of diagnosis, substantial co-occurrence, and variable treatment patterns of eosinophilic gastritis, gastroenteritis, and colitis based on 10-year data across a multicenter consortium. Am J Gastroenterol 2019;114:984-94. https://doi.org/10.14309/ajg.0000000000000228
  19. Mansoor E, Saleh MA, Cooper GS. Prevalence of eosinophilic gastroenteritis and colitis in a population-based study, from 2012 to 2017. Clin Gastroenterol Hepatol 2017;15:1733-41. https://doi.org/10.1016/j.cgh.2017.05.050
  20. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr 2016;62:36-42. https://doi.org/10.1097/MPG.0000000000000865
  21. Robson J, O'Gorman M, McClain A, Mutyala K, Davis C, Barbagelata C, et al. Incidence and prevalence of pediatric eosinophilic esophagitis in Utah based on a 5-year population-based study. Clin Gastroenterol Hepatol 2019;17:107-14.e1. https://doi.org/10.1016/j.cgh.2018.06.028
  22. Ristic N, Jankovic R, Dragutinovic N, Atanaskovic-Markovic M, Radusinovic M, Stevic M, et al. Diagnosis of eosinophilic esophagitis in children: a Serbian single-center experience from 2010 to 2017. Med Princ Pract 2019;28:449-56. https://doi.org/10.1159/000499657
  23. Nakayama Y, Ida S, Horiuchi A, Kusakari M, Hirashima S, Shima Y, et al. Mo1971 the prevalence of eosinophilic esophagitis in Japanese children and adolescents. Gastroenterology 2012;142(5 Suppl 1):S711.
  24. Cavalli E, Brusaferro A, Pieri ES, Cozzali R, Farinelli E, De' Angelis GL, et al. Eosinophilic esophagitis in children: doubts and future perspectives. J Transl Med 2019;17:262. https://doi.org/10.1186/s12967-019-2014-0
  25. De Matteis A, Pagliaro G, Corleto VD, Pacchiarotti C, Di Giulio E, Villa MP, et al. Eosinophilic esophagitis in children: clinical findings and diagnostic approach. Curr Pediatr Rev 2019. doi: 10.2174/1573396315666191004110549. [Epub ahead of print].
  26. Hill DA, Dudley JW, Spergel JM. The prevalence of eosinophilic esophagitis in pediatric patients with IgE-mediated food allergy. J Allergy Clin Immunol Pract 2017;5:369-75. https://doi.org/10.1016/j.jaip.2016.11.020
  27. Gonzalez-Cervera J, Arias A, Redondo-Gonzalez O, Cano-Mollinedo MM, Terreehorst I, Lucendo AJ. Association between atopic manifestations and eosinophilic esophagitis: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2017;118:582-90.e2. https://doi.org/10.1016/j.anai.2017.02.006
  28. Weiler T, Mikhail I, Singal A, Sharma H. Racial differences in the clinical presentation of pediatric eosinophilic esophagitis. J Allergy Clin Immunol Pract 2014;2:320-5. https://doi.org/10.1016/j.jaip.2014.01.011
  29. Vernon N, Shah S, Lehman E, Ghaffari G. Comparison of atopic features between children and adults with eosinophilic esophagitis. Allergy Asthma Proc 2014;35:409-14. https://doi.org/10.2500/aap.2014.35.3768
  30. Bolton SM, Kagalwalla AF, Wechsler JB. Eosinophilic esophagitis in children: endoscopic findings at diagnosis and post-intervention. Curr Gastroenterol Rep 2018;20:4. https://doi.org/10.1007/s11894-018-0607-z
  31. Collins CA, Palmquist J, Proudfoot JA, Qian A, Wangberg H, Khosh-Hemmat E, et al. Evaluation of long-term course in children with eosinophilic esophagitis reveals distinct histologic patterns and clinical characteristics. J Allergy Clin Immunol 2019;144:1050-57.e5. https://doi.org/10.1016/j.jaci.2019.06.015
  32. Caldwell JM, Collins MH, Stucke EM, Putnam PE, Franciosi JP, Kushner JP, et al. Histologic eosinophilic gastritis is a systemic disorder associated with blood and extragastric eosinophilia, TH2 immunity, and a unique gastric transcriptome. J Allergy Clin Immunol 2014;134:1114-24. https://doi.org/10.1016/j.jaci.2014.07.026