[Clinical Characteristics of 267 Children with Eosinophilic Gastrointestinal Disease: a Multicenter Study]

Overview

Journal Zhongguo Dang Dai Er Ke Za Zhi

Specialty Pediatrics

Date 2024 Mar 4

PMID 38436310

Authors

Chun-Lei Zhan

Jie-Yu You

Xiao-Qin Li

Yong Wang

Xian-Qin Mei

Sheng-Hua Wan

Affiliations

Soon will be listed here.

Abstract

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 (>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.

References

Egan M, Furuta G . Eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2018; 121(2):162-167. DOI: 10.1016/j.anai.2018.06.013. View

Shoda T, Wen T, Caldwell J, Collins M, Besse J, Osswald G . Molecular, endoscopic, histologic, and circulating biomarker-based diagnosis of eosinophilic gastritis: Multi-site study. J Allergy Clin Immunol. 2019; 145(1):255-269. PMC: 6949389. DOI: 10.1016/j.jaci.2019.11.007. View

Huang B, Chen Z, Geng L, Wang J, Liang H, Cao Y . Mucosal Profiling of Pediatric-Onset Colitis and IBD Reveals Common Pathogenics and Therapeutic Pathways. Cell. 2019; 179(5):1160-1176.e24. DOI: 10.1016/j.cell.2019.10.027. View

Grandinetti T, Biedermann L, Bussmann C, Straumann A, Hruz P . Eosinophilic Gastroenteritis: Clinical Manifestation, Natural Course, and Evaluation of Treatment with Corticosteroids and Vedolizumab. Dig Dis Sci. 2019; 64(8):2231-2241. DOI: 10.1007/s10620-019-05617-3. View

Jung Y, Rothenberg M . Roles and regulation of gastrointestinal eosinophils in immunity and disease. J Immunol. 2014; 193(3):999-1005. PMC: 4109658. DOI: 10.4049/jimmunol.1400413. View

Kuang F, Sampaio de Melo M, Makiya M, Kumar S, Brown T, Wetzler L . Benralizumab Completely Depletes Gastrointestinal Tissue Eosinophils and Improves Symptoms in Eosinophilic Gastrointestinal Disease. J Allergy Clin Immunol Pract. 2022; 10(6):1598-1605.e2. PMC: 9210216. DOI: 10.1016/j.jaip.2022.02.037. View

Walker M, Potter M, Talley N . Eosinophilic gastroenteritis and other eosinophilic gut diseases distal to the oesophagus. Lancet Gastroenterol Hepatol. 2018; 3(4):271-280. DOI: 10.1016/S2468-1253(18)30005-0. View

Pesek R, Reed C, Muir A, Fulkerson P, Menard-Katcher C, Falk G . 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(6):984-994. PMC: 6554065. DOI: 10.14309/ajg.0000000000000228. View

Ashitani K, Tsuzuki Y, Yamaoka M, Ohgo H, Ichimura T, Kusano T . Endoscopic Features and Diagnostic Procedures of Eosinophilic Gastroenteritis. Intern Med. 2019; 58(15):2167-2171. PMC: 6709335. DOI: 10.2169/internalmedicine.2298-18. View

10.

Collins M . Histopathology associated with eosinophilic gastrointestinal diseases. Immunol Allergy Clin North Am. 2009; 29(1):109-17, x-xi. DOI: 10.1016/j.iac.2008.10.005. View

11.

Raffaele A, Vatta F, Votto M, Licari A, Ruffoli M, Brunero M . Eosinophilic colitis in children: a new and elusive enemy?. Pediatr Surg Int. 2021; 37(4):485-490. DOI: 10.1007/s00383-020-04832-8. View

12.

Talley N, SHORTER R, Phillips S, Zinsmeister A . Eosinophilic gastroenteritis: a clinicopathological study of patients with disease of the mucosa, muscle layer, and subserosal tissues. Gut. 1990; 31(1):54-8. PMC: 1378340. DOI: 10.1136/gut.31.1.54. View

13.

Mansoor E, Saleh M, Cooper G . Prevalence of Eosinophilic Gastroenteritis and Colitis in a Population-Based Study, From 2012 to 2017. Clin Gastroenterol Hepatol. 2017; 15(11):1733-1741. DOI: 10.1016/j.cgh.2017.05.050. View

14.

Walker M . Inflammation, Genetics, Dysbiosis, and the Environment: New Paradigms for Diagnosis in Complex Chronic Gut Syndromes. J Clin Gastroenterol. 2016; 50 Suppl 1:S4-5. DOI: 10.1097/MCG.0000000000000613. View

15.

Pesek R, Reed C, Collins M, Muir A, Fulkerson P, Menard-Katcher C . Association Between Endoscopic and Histologic Findings in a Multicenter Retrospective Cohort of Patients with Non-esophageal Eosinophilic Gastrointestinal Disorders. Dig Dis Sci. 2019; 65(7):2024-2035. PMC: 7315780. DOI: 10.1007/s10620-019-05961-4. View

16.

OShea K, Aceves S, Dellon E, Gupta S, Spergel J, Furuta G . Pathophysiology of Eosinophilic Esophagitis. Gastroenterology. 2017; 154(2):333-345. PMC: 5787048. DOI: 10.1053/j.gastro.2017.06.065. View

17.

Dellon E, Gonsalves N, Abonia J, Alexander J, Arva N, Atkins D . International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature. Clin Gastroenterol Hepatol. 2022; 20(11):2474-2484.e3. PMC: 9378753. DOI: 10.1016/j.cgh.2022.02.017. View