Characterization of a group of children with eosinophilic esophagitis in Cali, Colombia

Main Article Content

Laura Del Mar Vásquez
Carlos Daniel Serrano
Margarita Peña
Veronica Botero
Diana Quimbayo
Rafael Milanés
Laura Torres-Canchala
Manuela Olaya

Keywords

Child, Eosinophilic Esophagitis, Gastrointestinal Disease, Histologic Techniques, Hospitalized, Immunoglobulin, Inv Allotype

Abstract

Purpose: Eosinophilic esophagitis (EoE) is an immunologically mediated chronic disease of the gastrointestinal tract. The objective of this study was to clinically and demographically describe a child population with EoE diagnosed in a high-complexity hospital in Cali, Colombia.


Methods: A retrospective study was carried out. The clinical histories of patients between 0 and 18 years with clinical suspicion and a histological diagnosis of EoE were analyzed. All patients underwent an allergy study, either by measurement of specific immunoglobulin (Ig) E and/or an intraepidermal skin-prick test.


Results: Thirty-five patients were included in the study, of which 21 (60%) women. The median age was 8 years (interquartile range [IQR] 5–12), and the age of onset of symptoms was 5 years (IQR 2–10). Thirty patients (85.7%) reported a history of allergic disease, with rhinitis being the most frequent (n = 25, 71.4%). Only one patient reported with food allergy mediated by IgE. The main symptoms in patients included abdominal pain (17 [48.6%]), refractory gastroesophageal reflux (16 [45.7%]), and choking (9 [25.7%]). Upper gastrointestinal endoscopy was normal in 10 patients (38.5%). The median number of eosinophils in the biopsy was 42 (IQR 31–92). Allergenic sensitization was verified in 25 of 35 patients (71.4%). Of these, dust mite allergy was positive in 21 patients (84%), while the most frequent food allergy was toward cow’s milk, in five patients (31.3%).


Conclusions: The majority of patients with EoE were females. The most frequent symptom was abdominal pain. Endoscopic abnormalities were also observed frequently, and the prevalence of other allergic diseases (especially rhinitis) and allergenic sensitization (especially to mites) was high.

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References

1. Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, et al. Updated International Consensus Diagnostic Criteria for eosinophilic esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155(4):1022–1033.e10. 10.1053/J.GASTRO.2018.07.009

2. Aceves SS. Eosinophilic esophagitis. Immunol Allergy Clin North Am. 2015;35(1):145–59. 10.1016/J.IAC.2014.09.007

3. Ali MA, Lam-Himlin D, Voltaggio L. Eosinophilic esophagitis: A clinical, endoscopic, and histopathologic review. Gastrointest Endosc. 2012;76(6):1224–37. 10.1016/J.GIE.2012.08.023

4. Mukkada V, Falk GW, Eichinger CS, King D, Todorova L, Shaheen NJ. Health-related quality of life and costs associated with eosinophilic esophagitis: A systematic review. Clin Gastroenterol Hepatol. 2018;16(4):495–503.e8. 10.1016/J.CGH.2017.06.036

5. Dellon ES. Cost-effective care in eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2019;123(2):166–72. 10.1016/J.ANAI.2019.04.010

6. Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology. 2018;154(2):319–332.e3. 10.1053/J.GASTRO.2017.06.067

7. Pierre R, Vieira M, Vázquez R, Ninomiya I, Messere G, Daza W, et al. Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Rev Gastroenterol Mexico (Engl Ed). 2019;84(4):427–33. 10.1016/J.RGMX.2018.08.001

8. Straumann A, Katzka DA. Diagnosis and treatment of eosinophilic esophagitis. Gastroenterology. 2018;154(2):346–59. 10.1053/J.GASTRO.2017.05.066

9. Carr S, Chan ES, Watson W. Eosinophilic esophagitis. Allergy Asthma Clin Immunol. 2018;14(Suppl 2). 10.1186/S13223-018-0287-0

10. Hernandez PV, Amer S, Lam-Himlin DM, DiSantis DJ, Menias CO, Horsley-Silva JL. Eosinophilic esophagitis: Imaging features with endoscopic and pathologic correlation. Abdom Radiol (NY). 2020;45(3):591–600. 10.1007/S00261-019-02374-9

11. Hurrell JM, Genta RM, Melton SD. Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract. Adv Anat Pathol. 2011;18(5):335–48. 10.1097/PAP.0B013E318229BFE2

12. Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR. Endoscopic assessment of the oesophageal-features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut. 2013;62(4):489–95. 10.1136/GUTJNL-2011-301817

13. Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, et al. Eosinophilic esophagitis: A 10-year experience in 381 children. Clin Gastroenterol Hepatol. 2005;3(12):1198–206. 10.1016/S1542-3565(05)00885-2

14. 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(1):3–20.e6. 10.1016/J.JACI.2011.02.040

15. Guarino MPL, Cicala M, Behar J. Eosinophilic esophagitis: New insights in pathogenesis and therapy. World J Gastrointest Pharmacol Ther. 2016;7(1):66. 10.4292/wjgpt.v7.i1.66

16. Allen KJ, Heine RG. Eosinophilic esophagitis: Trials and tribulations. J Clin Gastroenterol. 2011;45(7):574–82. 10.1097/MCG.0B013E31820656DD

17. Spergel J, Aceves SS. Allergic components of eosinophilic esophagitis. J Allergy Clin Immunol. 2018;142(1):1–8. 10.1016/J.JACI.2018.05.001

18. Teoh T, Chan ES, Avinashi V, Ko HH, Goldman RD. Diagnosis and management of eosinophilic esophagitis in children. Can Fam Physician. 2015;61(8):687–90.

19. Gonsalves NP, Aceves SS. Diagnosis and treatment of eosinophilic esophagitis. J Allergy Clin Immunol. 2020;145(1):1–7. 10.1016/J.JACI.2019.11.011

20. Spergel JM, Brown-Whitehorn TF, Beausoleil JL, Franciosi J, Shuker M, Verma R, et al. 14 years of eosinophilic esophagitis: Clinical features and prognosis. J Pediatr Gastroenterol Nutr. 2009;48(1):30–6. 10.1097/MPG.0B013E3181788282

21. Papadopoulou A, Koletzko S, Heuschkel R, Dias JA, Allen KJ, Murch SH, et al. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr. 2014;58(1):107–18. 10.1097/MPG.0b013e3182a80be1

22. Dellon ES. Epidemiology of eosinophilic esophagitis. Gastroenterol Clin North Am. 2014;43(2):201–18. 10.1016/j.gtc.2014.02.002

23. Jurado LF, Arroyave-Benavides J, Jiménez-Uribe A, Vera-Chamorro JF, Zambrano-Pérez C, López-Panqueva R del P., et al. Caracterización clínico-patológica de la esofagitis eosinofílica en niños y adolescentes en el Hospital Universitario Fundación Santa Fe de Bogotá. Rev Colomb Gastroenterol. 2019;34(1):23–30. 10.22516/25007440.264

24. Holguín L, Gallego-Yépes C, Toro Y, Díez-Zuluaga LS, Mopan J, Chinchilla C. [Epidemiological, clinical and diagnostic characterization of children with eosinophilic gastroenteropathy. A retrospective study of three high complexity health institutions]. Rev Alerg Mex. 2018;65(2):148–59. 10.29262/RAM.V65I2.354

25. Ruffner MA, Spergel JM. Eosinophilic esophagitis in children. Curr Allergy Asthma Rep. 2017;17(8):54. 10.1007/S11882-017-0721-2

26. Chehade M, Jones SM, Pesek RD, Burks AW, Vickery BP, Wood RA, et al. Phenotypic characterization of eosinophilic esophagitis in a large multicenter patient population from the consortium for food allergy research. J Allergy Clin Immunol Pract. 2018;6(5):1534–1544.e5, 10.1016/J.JAIP.2018.05.038

27. Williamson P, Aceves S. Allergies and eosinophilic-esophagitis—Current Updates for the Pediatric Gastroenterologist. Curr Gastroenterol Rep. 2019;21(11):56. 10.1007/S11894-019-0729-Y

28. 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(1):262. 10.1186/S12967-019-2014-0

29. Shah A, Kagalwalla AF, Gonsalves N, Melin-Aldana H, Li BUK, Hirano I. Histopathologic variability in children with eosinophilic esophagitis. Am J Gastroenterol. 2009;104(3):716–21. 10.1038/AJG.2008.117

30. Spergel JM, Brown-Whitehorn TF, Cianferoni A, Shuker M, Wang ML, Verma R, et al. Identification of causative foods in children with eosinophilic esophagitis treated with an elimination diet. J Allergy Clin Immunol. 2012;130(2):461–7.e5. 10.1016/J.JACI.2012.05.021

31. Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol. 2002;109(2):363–8. 10.1067/mai.2002.121458