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Published on: May 10, 2024
Idiopathic eosinophilic disorders of the gastrointestinal tract in children
Vincent A Mukkada1, Glenn T Furuta
1University of Colorado School of Medicine, Department of Pediatrics, The Children's Hospital, Denver, CO, USA.
Insights
Eosinophilic gastrointestinal diseases (EGIDs) are increasingly recognized, impacting adults and children. Nutritional management is a promising long-term option for eosinophilic esophagitis (EO) due to high relapse rates with standard treatments.
Area of Science:
- Gastroenterology
- Immunology
- Allergy
Background:
- Eosinophilic gastrointestinal diseases (EGIDs) are increasingly recognized in adults and children.
- Pathogenesis involves eosinophil recruitment and inflammation, driven by Th2 cytokines like eotaxin and allergen exposure.
- Eosinophilic esophagitis (EO) is the most studied EGID, with improved understanding leading to new treatments.
Purpose of the Study:
- To review the current understanding of EGID pathogenesis and management.
- To highlight the role of nutritional management in EO.
- To identify unanswered questions in EGID management.
Main Methods:
- Review of recent investigations into EGID mechanisms.
- Analysis of current treatment strategies for EO.
- Discussion of clinical challenges and future research directions.
Main Results:
- Elemental diets and corticosteroids are current EO treatments.
- High relapse rates occur after discontinuing medical treatment for EO.
- Nutritional management presents an attractive long-term option for EO.
Conclusions:
- Further research is needed to establish optimal treatment protocols, non-invasive monitoring, and therapeutic endpoints for EGIDs.
- Understanding EGID pathogenesis is crucial for developing effective therapies.
- Nutritional interventions show promise for long-term management of EO.
Abstract:
Over the last decade, eosinophilic gastrointestinal diseases have emerged as increasingly recognised diseases affecting both adults and children. While the exact morbidity is uncertain, it has become evident that they carry a significant cost to affected patients. Recent investigations shed light on basic mechanisms of eosinophilic recruitment and inflammation, and suggest a critical role for Th2 cytokines, such as eotaxin, and allergen exposure in their pathogenesis. Eosinophilic oesophagitis (EO) is the best characterised of these diseases, and improved understanding of its basic biology stimulated development of new treatment regimens. Current evidence supports the use of elemental diets and systemic or topical corticosteroids to treat EO. A major clinical problem is the fact that most patients relapse when medical treatment is discontinued, thus making nutritional management an attractive long term option. Many areas remain unanswered in the management of patients with EGIDs, including identification of optimal treatment protocol, development of appropriate non-invasive monitoring, and choice of appropriate therapeutic endpoints.
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