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Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis
Published on: May 10, 2024
[Clinical characteristics of 267 children with eosinophilic gastrointestinal disease: a multicenter study]
Chun-Lei Zhan1, Jie-Yu You, Xiao-Qin Li
1Department of Gastroenterology, Jiangxi Children's Hospital, Nanchang 330000, China (Wan S-H, Email: jeft1210@ 126. com).
Insights
Eosinophilic gastrointestinal disease (EGID) in children is often mild to moderate, presenting with varied symptoms. Treatment primarily involves dietary changes, acid suppression, and anti-allergic medications, leading to a generally favorable prognosis.
Area of Science:
- Pediatric Gastroenterology
- Allergy and Immunology
- Gastrointestinal Disorders
Background:
- Eosinophilic gastrointestinal disease (EGID) is an immune-mediated condition characterized by eosinophilic infiltration of the gastrointestinal tract.
- Understanding the clinical spectrum, diagnostic challenges, and treatment outcomes of EGID in pediatric populations is crucial for effective management.
- Limited awareness among pediatricians can delay diagnosis and appropriate intervention for EGID in children.
Purpose of the Study:
- To comprehensively investigate the clinical manifestations, endoscopic and histopathological findings, treatment strategies, and prognosis of EGID in a pediatric cohort.
- To enhance pediatricians' awareness and recognition of EGID, facilitating earlier diagnosis and improved patient care.
- To identify key clinical features and effective therapeutic approaches for pediatric EGID.
Main Methods:
- A prospective study involving 267 children diagnosed with EGID was conducted across three major children's hospitals from January 2019 to July 2022.
- Data collected included age of onset, presenting symptoms, physical examination findings, laboratory results, endoscopic observations, histopathological analysis, and treatment responses.
- Statistical analysis was performed to evaluate the significance of findings, including platelet counts and differences across severity groups (P>0.05).
Main Results:
- The majority of pediatric EGID cases were mild (61.4%) or moderate (35.6%) in severity, with a higher prevalence in school-aged children.
- Common symptoms varied by age group, including vomiting, hematemesis, and bloody stools in infants and toddlers, and abdominal pain and vomiting in older children.
- While 85.0% received acid suppression, 34.5% dietary avoidance, and 20.9% anti-allergic medication, all patients showed symptom relief, with a few recurrences noted after discontinuing treatment for peptic ulcers.
Conclusions:
- Mild to moderate EGID is prevalent in children, often lacking specific endoscopic or histopathological markers.
- Key treatments include dietary modifications, acid suppression therapy, and anti-allergic medications, demonstrating efficacy in symptom resolution.
- Pediatric EGID generally has a favorable prognosis, although vigilance for complications like peptic ulcers and potential recurrence is warranted.
Objectives:
To explore the clinical manifestations, endoscopic findings, histopathological changes, treatment, and prognosis of eosinophilic gastrointestinal disease (EGID) in children, with the aim of enhancing awareness among pediatricians about this condition.
Methods:
Data of 267 children with EGID were prospectively collected from January 2019 to July 2022 at Jiangxi Children's Hospital, Hunan Children's Hospital, and Henan Children's Hospital. The age of onset, symptoms, physical signs, laboratory examination results, endoscopic findings, histopathological changes, and treatment outcomes were observed.
Results:
Among the 267 children with EGID, the majority had mild (164 cases, 61.4%) or moderate (96 cases, 35.6%) clinical severity. The disease occurred at any age, with a higher prevalence observed in school-age children (178 cases). The main symptoms in infants were vomiting and hematemesis, while in toddlers, vomiting and bloody stools were prominent. Abdominal pain and vomiting were the primary symptoms in preschool and school-age children. Nearly half (49.4%) of the affected children showed elevated platelet counts on hematological examination, but there was no significant difference in platelet counts among children with mild, moderate, and severe EGID (P>0.05). Endoscopic findings in EGID children did not reveal significant specificity, and histopathological examination showed no specific structural damage. Among them, 85.0% (227 cases) received acid suppression therapy, 34.5% (92 cases) practiced dietary avoidance, 20.9% (56 cases) received anti-allergic medication, and a small proportion (24 cases, 9.0%) were treated with prednisone. Clinical symptoms were relieved in all patients after treatment, but three cases with peptic ulcers experienced recurrence after drug discontinuation.
Conclusions:
Mild and moderate EGID are more common in children, with no specific endoscopic findings. Dietary avoidance, acid suppression therapy, and anti-allergic medication are the main treatment methods. The prognosis of EGID is generally favorable in children.
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