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Published on: May 10, 2024
Eosinophilic oesophagitis in children: responders and non-responders to swallowed fluticasone
Renzo Boldorini1, Francesca Mercalli, Giuseppina Oderda
1Department of Pathology, Università del Piemonte Orientale, Novara, Italy.
Insights
Children with more severe eosinophilic oesophagitis (EO) showed better response to swallowed fluticasone propionate. This finding helps predict treatment success in pediatric EO patients.
Area of Science:
- Gastroenterology
- Pediatric Allergy
- Immunology
Background:
- Eosinophilic oesophagitis (EO) is an immune-mediated esophageal disease characterized by eosinophilic infiltration.
- Current treatments like elimination diets and corticosteroids have suboptimal efficacy in children.
- Identifying predictors of treatment response is crucial for optimizing pediatric EO management.
Observation:
- This study investigated clinical, endoscopic, and histological features associated with treatment response to swallowed fluticasone propionate in 34 children with EO.
- Patients received fluticasone propionate spray (250 μg/puff, three puffs three times daily for 6 weeks).
- Response to therapy was assessed via follow-up endoscopy and histology.
Findings:
- No significant differences were observed in age, sex, height, symptoms, allergy type, allergen number, peripheral eosinophils, or serum IgE between responders and non-responders.
- Responders to fluticasone propionate exhibited more severe baseline esophageal inflammation.
- Higher median peak eosinophils/high power field (76 vs. 44, p=0.04), presence of eosinophilic microabscesses (p=0.04), and higher peak mast cells/high power field (p=0.001) were noted in responders.
Implications:
- Baseline histological severity, specifically higher eosinophil and mast cell counts, predicts a better response to swallowed fluticasone propionate in children with EO.
- These histological markers can aid in stratifying patients and predicting treatment outcomes.
- Further research may refine targeted therapeutic strategies for pediatric eosinophilic oesophagitis based on disease severity.
Unlabelled:
Eosinophilic Oesophagitis (EO) is characterised by large numbers of eosinophils in oesophageal mucosa in response to food or inhaled antigens. Treatment with elimination diet or corticosteroids lead to improvement in some children, but their efficacy is not optimal.
Aim:
of this study is to identify clinical, endoscopic and/or histological features associated with response to treatment with swallowed fluticasone propionate.
Patients And Methods:
In the last 12 years 34 children (M/F 25/9) with EO were treated with fluticasone propionate spray 250 μg/puff by inhaler without spacer, three puffs three times a day for 6 weeks, and returned for a follow-up endoscopy. At histology 25 of them were found to be responders to therapy (73.5%) and 9 were non-responders. Anthropometric characteristics, symptoms at presentation, endoscopic and histological data at baseline between responders and non-responders were compared.
Results:
Age, sex, height, duration and type of main symptom at presentation, type of allergy and number of allergens, peripheral eosinophil counts an serum IgE were similar in responders and non-responders. At baseline histology findings responders had a more severe inflammation: median peak eosinophils/high power field was higher (76 vs 44 in non responders p=0.04), eosinophilic microabscesses were present in a significantly higher number of responders (p=0.04) and peak mast cells/ high power field was significantly higher (p=0.001).
Conclusions:
Clinical characteristics of children with EO at baseline were similar in responders and non-responders, but a more severe inflammation in oesophageal mucosa was associated with a higher response rate to fluticasone treatment.
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