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Barchi A, Vespa E, Passaretti S, Dell’Anna G, Fasulo E, Yacoub MR, Albarello L, Sinagra E, Massimino L, Ungaro F, Danese S, Mandarino FV. The Dual Lens of Endoscopy and Histology in the Diagnosis and Management of Eosinophilic Gastrointestinal Disorders-A Comprehensive Review. Diagnostics (Basel) 2024; 14:858. [PMID: 38667503 PMCID: PMC11049211 DOI: 10.3390/diagnostics14080858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/13/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Eosinophilic Gastrointestinal Disorders (EGIDs) are a group of conditions characterized by abnormal eosinophil accumulation in the gastrointestinal tract. Among these EGIDs, Eosinophilic Esophagitis (EoE) is the most well documented, while less is known about Eosinophilic Gastritis (EoG), Eosinophilic Enteritis (EoN), and Eosinophilic Colitis (EoC). The role of endoscopy in EGIDs is pivotal, with applications in diagnosis, disease monitoring, and therapeutic intervention. In EoE, the endoscopic reference score (EREFS) has been shown to be accurate in raising diagnostic suspicion and effective in monitoring therapeutic responses. Additionally, endoscopic dilation is the first-line treatment for esophageal strictures. For EoG and EoN, while the literature is more limited, common endoscopic findings include erythema, nodules, and ulcerations. Histology remains the gold standard for diagnosing EGIDs, as it quantifies eosinophilic infiltration. In recent years, there have been significant advancements in the histological understanding of EoE, leading to the development of diagnostic scores and the identification of specific microscopic features associated with the disease. However, for EoG, EoN, and EoC, precise eosinophil count thresholds for diagnosis have not yet been established. This review aims to elucidate the role of endoscopy and histology in the diagnosis and management of the three main EGIDs and to analyze their strengths and limitations, their interconnection, and future research directions.
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Affiliation(s)
- Alberto Barchi
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
| | - Edoardo Vespa
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
| | - Sandro Passaretti
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
| | - Giuseppe Dell’Anna
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
| | - Ernesto Fasulo
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
| | - Mona-Rita Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Luca Albarello
- Pathology Unit, IRCCS Ospedale San Raffaele, 20132 Milan, Italy;
| | - Emanuele Sinagra
- Gastroenterology and Endoscopy Unit, Fondazione Istituto S. Raffaele—G. Giglio, 90015 Cefalu, Italy;
| | - Luca Massimino
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
| | - Federica Ungaro
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
| | - Silvio Danese
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
- Faculty of Medicine, Università Vita-Salute San Raffaele, 20132 Milan, Italy
| | - Francesco Vito Mandarino
- Gastroenterology and Digestive Endoscopy, IRCCS Ospedale San Raffaele, Via Olgettina 58, 20132 Milan, Italy; (A.B.); (E.V.); (S.P.); (G.D.); (E.F.); (L.M.); (F.U.); (S.D.)
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Saad AJ, Genta RM, Turner KO, Kamboj AP, Dellon ES, Chehade M. Do General Pathologists Assess Gastric and Duodenal Eosinophilia? Arch Pathol Lab Med 2023; 147:1086-1092. [PMID: 36399607 DOI: 10.5858/arpa.2022-0204-oa] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2022] [Indexed: 09/01/2023]
Abstract
CONTEXT.— Eosinophilic diseases of the gastrointestinal tract (EGIDs), eosinophilic gastritis (EoG), and eosinophilic duodenitis (EoD) are rarely suspected clinically and infrequently detected by pathologists. OBJECTIVE.— To determine whether histories of allergic or eosinophilic disorders and requests to rule out EoG and EoD affect pathologists' awareness of eosinophils in gastrointestinal biopsies. DESIGN.— Thirty-one community-based pathologists were given 16 sets of biopsies from gastric and duodenal mucosa with elevated eosinophils, Helicobacter pylori gastritis, atrophic gastritis, normal stomach and duodenum, lymphocytosis, and celiac disease. Participants were assigned to 3 groups: group A did not receive histories of allergic or eosinophilic conditions; group B received similar histories plus a clue of possible allergic or eosinophilic conditions; and group C received the same histories as B and was asked to rule out EoG/EoD. A list of gastric and duodenal diagnoses and a space for comments were provided. Results were analyzed descriptively. RESULTS.— Pathologists correctly diagnosed most noneosinophilic gastrointestinal disorders, indicating competence in gastrointestinal pathology. With respect to EoG and EoD, pathologists in group C performed significantly better that those in groups A and B. The combined odds ratio with 95% CI was 12.34 (2.87-53.04), P < .001, for A versus C and 4.02 (1.60-10.09), P < .02, for B versus C. CONCLUSIONS.— Most pathologists neither reported gastric/duodenal eosinophilia nor diagnosed EoG/EoD, even when provided histories of eosinophilic disorders. Requests to rule out EoG/EoD resulted in only 4 of 11 participants evaluating and counting eosinophils in some cases. Simple evidence-based histopathologic criteria are needed before pathologists can be expected to consider and diagnose EGIDs.
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Affiliation(s)
- A Joe Saad
- From Surgical Pathologists of Dallas, The Methodist Dallas, Dallas, Texas (Saad)
- The Department of Pathology, University of Texas Southwestern Medical School, Dallas (Saad)
| | - Robert M Genta
- The Department of Pathology and Medicine (Gastroenterology), Houston, Texas
| | - Kevin O Turner
- The Department of Baylor College of Medicine, Houston, Texas (Genta)
| | - Amol P Kamboj
- The Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis (Turner)
| | | | - Mirna Chehade
- The Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill (Dellon)
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Janssens J, Vanuytsel T. Non-esophageal eosinophilic gastrointestinal diseases: a narrative review. Acta Gastroenterol Belg 2023; 86:449-459. [PMID: 37814561 DOI: 10.51821/86.3.11869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Eosinophilic gastrointestinal disorders are a group of rare diseases characterized by the infiltration of eosinophils in the gastrointestinal wall in a greater amount than in homeostatic conditions. 'Non-esophageal eosinophilic gastrointestinal disorders' is the umbrella term for all eosinophilic gastrointestinal disorders outside of the well known eosinophilic esophagitis. This includes eosinophilic gastritis, eosinophilic enteritis and eosinophilic colitis. The clinical presentation is atypical and not very different for the three disorders. The depth of infiltration has a bigger influence on the presenting symptoms than the disease location. Although the frequency of diagnosis and research in this subject is increasing over time, non-esophageal eosinophilic disorders are rare and high quality evidence is limited to date. In this narrative review, we provide an overview of the latest insights in the pathophysiology, diagnostic approach and available treatment options. Transcriptome studies have found the pathogenesis to be T helper type 2 driven. Various laboratory findings can be used to trigger raised suspicion and investigation with endoscopy. As the endoscopic appearance of the mucosa is normal in most cases, multiple biopsies in each segment are needed to quantify the amount of eosinophils in the tissue. Eosinophilic cut-offs for diagnosis are a controversial topic and a consensus is still lacking. A recently developed tissue based diagnostic platform which measures differentially expressed genes might be available in the future to classify patients with intermediate eosinophilic tissue levels under the cut-off. For the treatment, corticosteroids are still the cornerstone of treatment but promising research suggests a role of biologicals, such as Lirentelimab (anti-siglec 8) in particular.
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Affiliation(s)
- J Janssens
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - T Vanuytsel
- Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
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Dellon ES, Gonsalves N, Abonia JP, Alexander JA, Arva NC, Atkins D, Attwood SE, Auth MKH, Bailey DD, Biederman L, Blanchard C, Bonis PA, Bose P, Bredenoord AJ, Chang JW, Chehade M, Collins MH, Di Lorenzo C, Dias JA, Dohil R, Dupont C, Falk GW, Ferreira CT, Fox AT, Genta RM, Greuter T, Gupta SK, Hirano I, Hiremath GS, Horsley-Silva JL, Ishihara S, Ishimura N, Jensen ET, Gutiérrez-Junquera C, Katzka DA, Khoury P, Kinoshita Y, Kliewer KL, Koletzko S, Leung J, Liacouras CA, Lucendo AJ, Martin LJ, McGowan EC, Menard-Katcher C, Metz DC, Miller TL, Moawad FJ, Muir AB, Mukkada VA, Murch S, Nhu QM, Nomura I, Nurko S, Ohtsuka Y, Oliva S, Orel R, Papadopoulou A, Patel DA, Pesek RD, Peterson KA, Philpott H, Putnam PE, Richter JE, Rosen R, Ruffner MA, Safroneeva E, Schreiner P, Schoepfer A, Schroeder SR, Shah N, Souza RF, Spechler SJ, Spergel JM, Straumann A, Talley NJ, Thapar N, Vandenplas Y, Venkatesh RD, Vieira MC, von Arnim U, Walker MM, Wechsler JB, Wershil BK, Wright BL, Yamada Y, Yang GY, Zevit N, Rothenberg ME, Furuta GT, Aceves SS. International Consensus Recommendations for Eosinophilic Gastrointestinal Disease Nomenclature. Clin Gastroenterol Hepatol 2022; 20:2474-2484.e3. [PMID: 35181570 PMCID: PMC9378753 DOI: 10.1016/j.cgh.2022.02.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/28/2022] [Accepted: 02/07/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Substantial heterogeneity in terminology used for eosinophilic gastrointestinal diseases (EGIDs), particularly the catchall term "eosinophilic gastroenteritis," limits clinical and research advances. We aimed to achieve an international consensus for standardized EGID nomenclature. METHODS This consensus process utilized Delphi methodology. An initial naming framework was proposed and refined in iterative fashion, then assessed in a first round of Delphi voting. Results were discussed in 2 consensus meetings, and the framework was updated and reassessed in a second Delphi vote, with a 70% threshold set for agreement. RESULTS Of 91 experts participating, 85 (93%) completed the first and 82 (90%) completed the second Delphi surveys. Consensus was reached on all but 2 statements. "EGID" was the preferred umbrella term for disorders of gastrointestinal (GI) tract eosinophilic inflammation in the absence of secondary causes (100% agreement). Involved GI tract segments will be named specifically and use an "Eo" abbreviation convention: eosinophilic gastritis (now abbreviated EoG), eosinophilic enteritis (EoN), and eosinophilic colitis (EoC). The term "eosinophilic gastroenteritis" is no longer preferred as the overall name (96% agreement). When >2 GI tract areas are involved, the name should reflect all of the involved areas. CONCLUSIONS This international process resulted in consensus for updated EGID nomenclature for both clinical and research use. EGID will be the umbrella term, rather than "eosinophilic gastroenteritis," and specific naming conventions by location of GI tract involvement are recommended. As more data are developed, this framework can be updated to reflect best practices and the underlying science.
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Affiliation(s)
- Evan S Dellon
- Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - J Pablo Abonia
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | - Nicoleta C Arva
- Department of Pathology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan Atkins
- Section of Pediatric Allergy and Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Stephen E Attwood
- Department of Health Services Research, Durham University, Durham, United Kingdom
| | - Marcus K H Auth
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust and University of Liverpool, Liverpool, United Kingdom
| | - Dominique D Bailey
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York; Division of Digestive and Liver Disease, Department of Medicine, Columbia University Irving Medical Center, New York, New York; Columbia Center for Human Development, Columbia University Irving Medical Center, New York, New York
| | - Luc Biederman
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Carine Blanchard
- Department of Gastro-Intestinal Health, Immunology group, Nestlé Institute of Health Sciences, Nestlé Research, Société des Produits Nestlé S.A., Lausanne, Switzerland
| | - Peter A Bonis
- Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
| | - Paroma Bose
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Community Health Network, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - Albert J Bredenoord
- Department of Gastroenterology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joy W Chang
- Division of Gastroenterology, Department of Internal Medicine, University of Michigan, Ann Arbor, MichiganI
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Margaret H Collins
- Division of Pathology and Laboratory Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Carlo Di Lorenzo
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Ranjan Dohil
- Division on Pediatric Gastroenterology, Rady's Children's Hospital, University of California, San Diego, San Diego, California
| | - Christophe Dupont
- Ramsay Group, Marcel Sembat Clinic, Paris Descartes University, Paris, France
| | - Gary W Falk
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | - Cristina T Ferreira
- Hospital Santo Antônio, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil
| | - Adam T Fox
- Paediatric Allergy, Guy's & St. Thomas' Hospitals NHS Foundation Trust, London, United Kingdom
| | - Robert M Genta
- Division of Gastroenterology, Department of Pathology and Medicine, Baylor College of Medicine, Houston, Texas; Inform Diagnostics, Irving, Texas
| | - Thomas Greuter
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children and Community Health Network, Indiana University School of Medicine, Indianapolis, Indianapolis
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Girish S Hiremath
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Shunji Ishihara
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Norihisa Ishimura
- Department of Internal Medicine II, Shimane University Faculty of Medicine, Shimane, Japan
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro Majadahonda, Autonomous University of Madrid, Majadahonda, Spain
| | - David A Katzka
- Division of Gastroenterology, Mayo Clinic Rochester, Minnesota
| | - Paneez Khoury
- Human Eosinophil Section, National Institute of Allergy and Infectious Diseases/National Institutes of Health, Bethesda, Maryland
| | | | - Kara L Kliewer
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sibylle Koletzko
- Department of Pediatrics, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany; Department of Pediatrics, Gastroenterology and Nutrition, School of Medicine Collegium Medicum University of Warmia and Mazury, Olsztyn, Poland
| | - John Leung
- Division of Gastroenterology, Tufts University School of Medicine, Boston, Massachusetts
| | - Chris A Liacouras
- Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Tomelloso, Spain
| | - Lisa J Martin
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily C McGowan
- Division of Allergy and Immunology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Calies Menard-Katcher
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - David C Metz
- Division of Gastroenterology, Perelman School of Medicine, University of Pennsylvania Philadelphia, Pennsylvania
| | | | - Fouad J Moawad
- Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, California
| | - Amanda B Muir
- Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Vincent A Mukkada
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Simon Murch
- Warwick University Medical School, Coventry, United Kingdom
| | - Quan M Nhu
- Division of Gastroenterology and Hepatology, Scripps Clinic, La Jolla, California; Department of Molecular Medicine, Scripps Research Institute, San Diego, California; Division of Allergy and Immunology, University of California, San Diego, La Jolla, California
| | - Ichiro Nomura
- Division of Eosinophilic Gastrointestinal Disorders, Allergy Center, National Center for Child Health and Development, Tokyo, Japan
| | - Samuel Nurko
- Center for Motility and Functional Gastrointestinal Disorders, Boston Children's Hospital, Boston, Massachusetts
| | - Yoshikazu Ohtsuka
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Salvatore Oliva
- Pediatric Digestive Endoscopy, Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, University Hospital, University of Rome, Rome, Italy
| | - Rok Orel
- University Children's Hospital Ljubljana, Faculty of Medicine, University of Ljubljana, Slovenia
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, Children's Hospital Agia Sofia, First Department of Pediatrics, University of Athens, Athens, Greece
| | - Dhyanesh A Patel
- Center for Esophageal Disorders, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert D Pesek
- Division of Allergy and Immunology, Department of Pediatrics, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | | | - Hamish Philpott
- Department of Gastroenterology, Lyell McEwin Hospital, University of Adelaide, Adelaide, Australia
| | - Philip E Putnam
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Joel E Richter
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Rachel Rosen
- Aerodigestive Center, Boston Children's Hospital, Boston, Massachusetts
| | - Melanie A Ruffner
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ekaterina Safroneeva
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Schreiner
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Alain Schoepfer
- Division of Gastroenterology and Hepatology, University Hospital Lausanne, Lausanne, Switzerland
| | - Shauna R Schroeder
- Division of Gastroenterology, Hepatology, and Nutrition, Phoenix Children's Hospital, Phoenix, Arizona
| | - Neil Shah
- Portland Hospital, London, United Kingdom; Reckitt Healthcare, Slough, United Kingdom
| | - Rhonda F Souza
- Division of Gastroenterology and Center for Esophageal Diseases, Baylor Scott & White Center for Esophageal Research, Baylor University Medical Center, Baylor Scott & White Research Institute, Dallas, Texas
| | - Stuart J Spechler
- Division of Gastroenterology and Center for Esophageal Diseases, Baylor Scott & White Center for Esophageal Research, Baylor University Medical Center, Baylor Scott & White Research Institute, Dallas, Texas
| | - Jonathan M Spergel
- Division of Allergy and Immunology, Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Alex Straumann
- Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | - Nicholas J Talley
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia; National Health and Medical Research Council Centre of Research Excellence on Digestive Health, Newcastle, Australia; Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Nikhil Thapar
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, School of Medicine, University of Queensland, Brisbane, Australia; Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
| | - Yvan Vandenplas
- KidZ Health Castle, Vrije Universiteit Brussel, Brussels, Belgium
| | - Rajitha D Venkatesh
- Division of Gastroenterology, Hepatology and Nutrition, Nationwide Children's Hospital, Columbus, Ohio
| | - Mario C Vieira
- Center for Pediatric Gastroenterology, Hospital Pequeno Príncipe, Curitiba, Brazil
| | - Ulrike von Arnim
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Magdeburg, Magdeburg, Germany
| | - Marjorie M Walker
- Department of Pathology, College of Health, Medicine and Wellbeing, Faculty of Health and Medicine, University of Newcastle Callaghan, Australia
| | - Joshua B Wechsler
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Barry K Wershil
- Division of Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Arizona; Section of Allergy and Immunology, Division of Pulmonology, Phoenix Children's Hospital, Phoenix, Arizona
| | - Yoshiyuki Yamada
- Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Noam Zevit
- Institute of Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel-Aviv University, Petah-Tikva, Israel
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Glenn T Furuta
- Digestive Health Institute, Children's Hospital Colorado, Aurora, Colorado; Gastrointestinal Eosinophilic Diseases Program, University of Colorado School of Medicine, Aurora, Colorado
| | - Seema S Aceves
- Division of Allergy, Immunology, and Rheumatology, Departments of Pediatrics and Medicine, Rady Children's Hospital, University of California San Diego, San Diego, California
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Redd WD, Dellon ES. Eosinophilic Gastrointestinal Diseases Beyond the Esophagus: An Evolving Field and Nomenclature. Gastroenterol Hepatol (N Y) 2022; 18:522-528. [PMID: 36397988 PMCID: PMC9666791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The eosinophilic gastrointestinal diseases (EGIDs) are a group of chronic, immune-mediated gastrointestinal (GI) diseases characterized by GI symptoms and pathologic eosinophilic infiltration of specific areas within the GI tract in the absence of secondary causes of eosinophilia. The non-eosinophilic esophagitis EGIDs remain understudied and likely underdiagnosed, owing in part to the lack of clarity in the terminology previously used to describe these diseases. The newly established EGID nomenclature framework includes a first-tier description of the specific location of GI tract involvement and a second-tier description with more granular characterizations of disease involvement. EGIDs can involve any segment or layer of the GI tract, so patients can present with a wide array of common, nonspecific GI symptoms. Diagnosing EGIDs requires endoscopic evaluation and biopsies showing increased eosinophilic tissue infiltration in the correct clinical context after ruling out other causes of eosinophilia. Although the pathogenesis is not yet fully understood, EGIDs are likely allergic conditions triggered by food antigen exposure. Most patients are currently treated with corticosteroids, but investigations of other pharmacologic and dietary therapies are ongoing. This article highlights the recently updated EGID nomenclature and summarizes the current understanding of the diagnosis, pathogenesis, and treatment of EGIDs.
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Affiliation(s)
- Walker D Redd
- Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, and Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, and Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Low Prevalence of Extraesophageal Gastrointestinal Pathology in Patients with Eosinophilic Esophagitis. Dig Dis Sci 2022; 67:3080-3088. [PMID: 34195891 DOI: 10.1007/s10620-021-07087-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/29/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Limited data are available to support current guidelines recommendations on obtaining gastric and duodenal biopsies of patients with clinical and histologic manifestations consistent with eosinophilic esophagitis (EoE) to rule out eosinophilic gastritis (EG) or duodenitis (EoD). Our study examined the prevalence of concomitant extraesophageal, gastrointestinal pathology to better characterize the diagnostic yield of additional biopsies. METHODS This was a single-center, retrospective study which utilized ICD 9 codes (530.13) and search queries of pathology reports ("Eosinophilic esophagitis," "EoE") to identify EoE patients. Patient endoscopy reports, pathology reports, and office notes were manually reviewed to characterize cases. RESULTS The electronic health record search yielded 1,688 EoE adults. In those who had extra-esophageal biopsies obtained, EG was identified in 34 (3.4%), H. pylori in 45 (4.6%), EoD in 27 (3.3%), and histology consistent with celiac disease in 20 (2.5%). Endoscopic abnormalities were found in the stomach of 92% of patients with EoE and EG and in the duodenum of 50% of patients with EoE and EoD. Symptoms of dyspepsia and/or abdominal pain occurred in a significantly greater proportion of patients with extraesophageal disease (64% vs. 19% in EoE group, p < 0.001). Overall, extraesophageal pathology would have been missed in 1.4% of patients lacking either symptoms or endoscopic signs suggestive of extraesophageal disease. CONCLUSIONS The yield of gastric and duodenal biopsies in adults with EoE is low, with 6.5% of patients demonstrating histologic features of celiac disease, Helicobacter pylori, EG, and/or EoD. Biopsies of extraesophageal, gastrointestinal sites in patients with suspected or previously diagnosed EoE should consider symptom and endoscopy manifestations as well as the potential impact of histopathologic findings on clinical management.
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Navarro P, Laserna-Mendieta EJ, Casabona S, Savarino E, Pérez-Fernández MT, Ghisa M, Pérez-Martínez I, Guagnozzi D, Perelló A, Guardiola-Arévalo A, Racca F, Betoré E, Blas-Jhon L, Krarup AL, Martín-Domínguez V, Maniero D, Suárez A, Llerena-Castro R, de la Peña-Negro L, Navacerrada AG, Pellegatta G, Alcedo J, de Hurtado Mendoza-Guena L, Feo-Ortega S, Barrio J, Gutiérrez-Junquera C, Fernández-Fernández S, De la Riva S, E Navés J, Carrión S, Ciriza de Los Ríos C, García-Morales N, Rodríguez-Oballe JA, Dainese R, Rodríguez-Sánchez A, Masiques-Mas ML, Palomeque MT, Santander C, Tamarit-Sebastián S, Arias Á, Lucendo AJ. Accurate and timely diagnosis of Eosinophilic Esophagitis improves over time in Europe. An analysis of the EoE CONNECT Registry. United European Gastroenterol J 2022; 10:507-517. [PMID: 35578565 PMCID: PMC9189464 DOI: 10.1002/ueg2.12240] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/24/2022] [Indexed: 12/29/2022] Open
Abstract
Background Poor adherence to clinical practice guidelines for eosinophilic esophagitis (EoE) has been described and the diagnostic delay of the disease continues to be unacceptable in many settings. Objective To analyze the impact of improved knowledge provided by the successive international clinical practice guidelines on reducing diagnostic delay and improving the diagnostic process for European patients with EoE. Methods Cross‐sectional analysis of the EoE CONNECT registry based on clinical practice. Time periods defined by the publication dates of four major sets of guidelines over 10 years were considered. Patients were grouped per time period according to date of symptom onset. Results Data from 1,132 patients was analyzed and median (IQR) diagnostic delay in the whole series was 2.1 (0.7‐6.2) years. This gradually decreased over time with subsequent release of new guidelines (p < 0.001), from 12.7 years up to 2007 to 0.7 years after 2017. The proportion of patients with stricturing of mixed phenotypes at the point of EoE diagnosis also decreased over time (41.3% vs. 16%; p < 0.001), as did EREFS scores. The fibrotic sub‐score decreased from a median (IQR) of 2 (1‐2) to 0 (0‐1) when patients whose symptoms started up to 2007 and after 2017 were compared (p < 0.001). In parallel, symptoms measured with the Dysphagia Symptoms Score reduced significantly when patients with symptoms starting before 2007 and after 2012 were compared. A reduction in the number of endoscopies patients underwent before the one that achieved an EoE diagnosis, and the use of allergy testing as part of the diagnostic workout of EoE, also reduced significantly over time (p = 0.010 and p < 0.001, respectively). Conclusion The diagnostic work‐up of EoE patients improved substantially over time at the European sites contributing to EoE CONNECT, with a dramatic reduction in diagnostic delay.
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Affiliation(s)
- Pilar Navarro
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Spain
| | - Emilio J Laserna-Mendieta
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Spain.,Laboratory Medicine Department. Hospital Universitario de La Princesa, Madrid, Spain
| | - Sergio Casabona
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, Azienza Ospedaliera di Padova, Padova, Italy
| | - María Teresa Pérez-Fernández
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Matteo Ghisa
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, Azienza Ospedaliera di Padova, Padova, Italy
| | - Isabel Pérez-Martínez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Diet, Microbiota and Health Group. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Danila Guagnozzi
- Department of Gastroenterology, Hospital Universitario Valld'Hebrón, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Antonia Perelló
- Department of Gastroenterology, Hospital de Viladecans, Viladecans, Spain
| | | | - Francesca Racca
- Personalized Medicine, Asthma and Allergy. IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Elena Betoré
- Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Leonardo Blas-Jhon
- Department of Gastroenterology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Anne Lund Krarup
- Department of Medicine and Department of Clinical Medicine. The North Danish Regional Hospital, Hjoerring and Aalborg University, Aalborg, Denmark
| | - Verónica Martín-Domínguez
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain
| | - Daria Maniero
- Department of Surgery, Oncology and Gastroenterology, Gastroenterology Unit, Azienza Ospedaliera di Padova, Padova, Italy
| | - Adolfo Suárez
- Department of Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain.,Diet, Microbiota and Health Group. Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Ronald Llerena-Castro
- Department of Gastroenterology, Hospital Universitario Valld'Hebrón, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Gaia Pellegatta
- Endoscopy Unit. IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Javier Alcedo
- Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | | | - Sara Feo-Ortega
- Laboratory Medicine Department. Hospital Universitario de La Princesa, Madrid, Spain.,Pediatric Gastroenterology Unit. Hospital General de Tomelloso, Tomelloso, Spain
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Carolina Gutiérrez-Junquera
- Department of Pediatric Gastroenterology, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Susana De la Riva
- Department of Gastroenterology, Clínica Universidad de Navarra, Pamplona, Spain
| | - Juan E Navés
- Department of Gastroenterology, Parc de Salut Mar, Barcelona, Spain
| | - Silvia Carrión
- Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain.,Department of Gastroenterology, Hospital de Mataró, Mataró, Spain
| | - Constanza Ciriza de Los Ríos
- Department of Gastroenterology. Hospital Clínico Universitario San Carlos, Instituto de Investigacion Sanitaria San Carlos (IdISSC), Madrid, Spain.,Universidad Complutense, Madrid, Spain
| | | | - Juan Armando Rodríguez-Oballe
- Department of Gastroenterology, Hospital Universitario Arnau de Vilanova & Hospital Universitario Santa María, Lérida, Spain
| | - Raffaela Dainese
- Department of Gastroenterology, Centre Hospitalier d'Antibes Juan-les-Pins, Antibes, France
| | | | | | | | - Cecilio Santander
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
| | - Sonsoles Tamarit-Sebastián
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Spain
| | - Ángel Arias
- Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Laboratory Medicine Department. Hospital Universitario de La Princesa, Madrid, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain.,Research Unit. Hospital General Mancha-Centro, Alcázar de San Juan, Alcázar de San Juan, Spain
| | - Alfredo J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Instituto de Investigación Sanitaria La Princesa, Madrid, Spain.,Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Tomelloso, Spain.,Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, Madrid, Spain
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Reed CC, Genta RM, Youngblood BA, Wechsler JB, Dellon ES. Mast Cell and Eosinophil Counts in Gastric and Duodenal Biopsy Specimens From Patients With and Without Eosinophilic Gastroenteritis. Clin Gastroenterol Hepatol 2021; 19:2102-2111. [PMID: 32801015 PMCID: PMC7878575 DOI: 10.1016/j.cgh.2020.08.013] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/23/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Mast cells are believed to contribute to the development of eosinophilic gastrointestinal disorders (EGIDs). We quantified mast cells and eosinophils in biopsy specimens from patients with EGIDs and without known esophageal or gastrointestinal disease to investigate associations between these cell types and EGID and its features. METHODS We conducted a retrospective study of patients with EGID (n = 52) and of children and adults who underwent upper endoscopy and were found to have no evidence of gastrointestinal or systemic conditions (n = 123). We re-reviewed archived gastric and duodenal biopsy specimens to quantify mast cells (by tryptase immunohistochemistry) and eosinophils. We calculated the specificity of cell count thresholds for identification of patients with EGIDs and evaluated the correlation between mast cell and eosinophil counts and clinical and endoscopic features. RESULTS In the gastric biopsy specimens from patients without esophageal or gastrointestinal diseases, the mean mast cell count was 18.1 ± 7.2 cells per high-power field (hpf), and the peak mast cell count was 21.9 ± 8.2 cells/hpf. In the duodenal biopsy specimens from patients without esophageal or gastrointestinal diseases, the mean mast cell count was 23.6 ± 8.1 cells/hpf and the peak mast cell count was 28.1 ± 9.3 cells/hpf. The mean and peak eosinophil counts in gastric biopsy specimens from patients without disease were 3.8 ± 3.6 eosinophils/hpf and 5.8 ± 5.0 eosinophils/hpf; the mean and peak eosinophil counts in duodenal biopsy specimens were 14.6 ± 8.9 eosinophils/hpf and 19.5 ± 11.0 eosinophils/hpf. A mean count of 20 eosinophils/hpf in gastric biopsy specimens or 30 eosinophils/hpf in duodenal biopsy specimens identified patients with EGIDs with high specificity. Gastric and duodenal biopsy specimens from patients with EGIDs had significant increases in mean mast cell counts compared with biopsy specimens from patients without EGIDs. There was a correlation between mean mast cell and eosinophil counts in duodenal biopsy specimens (R = 0.47; P = .01). The mean mast cell and eosinophil counts did not correlate with symptoms or endoscopic features of EGIDs. CONCLUSIONS We identified thresholds for each cell type that identified patients with EGIDs with 100% specificity. The increased numbers of mast cells and eosinophils in gastric and duodenal tissues from patients with EGIDs supports the concept that these cell types are involved in pathogenesis. However, cell counts are not associated with symptoms or endoscopic features of EGIDs.
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Affiliation(s)
- Craig C. Reed
- Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
| | - Robert M. Genta
- Inform Diagnostics, Irving, TX,Dallas Veterans Affairs Medical Center, University of Texas Southwestern Medical Center, Dallas, TX
| | | | | | - Evan S. Dellon
- Center for Esophageal Diseases and Swallowing, and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine; University of North Carolina School of Medicine, Chapel Hill, NC
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9
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Brenner EJ, Greenberg SB, Chang NC, Corder SR, Cowherd EL, Dellon ES. Peripheral eosinophilia and hypoalbuminemia are associated with a higher biopsy diagnostic yield for eosinophilic gastroenteritis. Clin Res Hepatol Gastroenterol 2021; 45:101746. [PMID: 34182183 PMCID: PMC8966911 DOI: 10.1016/j.clinre.2021.101746] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/07/2021] [Accepted: 06/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastric and duodenal mucosa may appear normal in eosinophilic gastroenteritis (EGE). Adult gastroenterologists typically biopsy only in the setting of mucosal abnormalities or symptoms, while pediatric providers biopsy all patients. The biopsy yield of EGE has not been adequately evaluated. AIMS To evaluate the biopsy yield of EGE in a pediatric cohort and assess predictors of increased biopsy yield. METHODS We identified patients age 0-18 who underwent upper endoscopy. We recorded endoscopic findings, pathology, demographics, and clinical and laboratory characteristics. We identified EGE cases (>20 eosinophils per high-power field on stomach and/or duodenum biopsy). We compared characteristics between EGE and non-EGE cases, calculated biopsy diagnostic yield, and performed multivariate analysis for predictors of increased biopsy yield. RESULTS In 509 patients (55.6% female, mean age 10.3 years, 69.7% white, 58.7% atopic), biopsy diagnostic yield for EGE was 1.2% (6/509) among all subjects, 7.7% (3/39) for those with peripheral eosinophilia (≥500 eos/uL), 9.1% (3/33) for those with hypoalbuminemia (<3.5 g/dL), and 25.0% (3/12) for those with peripheral eosinophilia and hypoalbuminemia. The odds of EGE were 27.8 (95% CI 3.3-231.8) times greater among those with peripheral eosinophilia. The mean total biopsy surface area and number of fragments was similar between patients with and without EGE. The area under the ROC curve for blood eosinophil counts and albumin level for predicting EGE was 0.926. CONCLUSIONS The biopsy diagnostic yield for EGE is low but increases with peripheral eosinophilia and hypoalbuminemia. Patients with these features should have biopsies obtained, regardless of endoscopic appearance.
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Affiliation(s)
- Erica J. Brenner
- University of North Carolina Department of Pediatric Gastroenterology, Center for Gastrointestinal Biology and Disease, 333 S. Columbia St. 247 MacNider Hall, CB# 7229, Chapel Hill, NC 27599
| | - Sydney B. Greenberg
- University of North Carolina Department of Medicine, 333 S. Columbia St. 126 MacNider Hall, CB# 7005, Chapel Hill, NC 27599
| | - Nicole C. Chang
- University of North Carolina Center for Esophageal Diseases and Swallowing Bioinformatics Building, 130 Mason Farm Rd, CB# 7555, Chapel Hill, NC 27599
| | - S. Ryanne Corder
- University of North Carolina Center for Esophageal Diseases and Swallowing Bioinformatics Building, 130 Mason Farm Rd, CB# 7555, Chapel Hill, NC 27599
| | - Ellen L. Cowherd
- University of North Carolina Department of Pediatrics, 333 S. Columbia St. 260 MacNider Hall, CB# 7220, Chapel Hill, NC 27599
| | - Evan S. Dellon
- University of North Carolina Division of Gastroenterology and Hepatology, Department of Medicine, Center for Esophageal Diseases and Swallowing, Center for Gastrointestinal Biology and Disease, Bioinformatics Building, 130 Mason Farm Rd, CB# 7555, Chapel Hill, NC 27599
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10
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Pesek RD, Reed CC, Collins MH, Muir AB, Fulkerson PC, Menard-Katcher C, Falk GW, Kuhl J, Magier AZ, Ahmed FN, Demarshall M, Gupta A, Gross J, Ashorobi T, Carpenter CL, Krischer JP, Gonsalves N, Hirano I, Spergel JM, Gupta SK, Furuta GT, Rothenberg ME, Dellon ES. Association Between Endoscopic and Histologic Findings in a Multicenter Retrospective Cohort of Patients with Non-esophageal Eosinophilic Gastrointestinal Disorders. Dig Dis Sci 2020; 65:2024-2035. [PMID: 31773359 PMCID: PMC7315780 DOI: 10.1007/s10620-019-05961-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/13/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Little is known about the endoscopic and histologic findings of non-esophageal eosinophilic gastrointestinal diseases (EGID). AIM To characterize the presenting endoscopic and histologic findings in patients with eosinophilic gastritis (EG), eosinophilic gastroenteritis (EGE), and eosinophilic colitis (EC) at diagnosis and 6 months after initiating the treatment. METHODS We conducted a retrospective cohort study at 6 US centers associated with the Consortium of Eosinophilic Gastrointestinal Researchers. Data abstracted included demographics, endoscopic findings, tissue eosinophil counts, and associated histologic findings at diagnosis and, when available, after initial treatment. RESULTS Of 373 subjects (317 children and 56 adults), 142 had EG, 123 EGE, and 108 EC. Normal endoscopic appearance was the most common finding across all EGIDs (62% of subjects). Baseline tissue eosinophil counts were quantified in 105 (74%) EG, 36 (29%) EGE, and 80 (74%) EC subjects. The mean peak gastric eosinophil count across all sites was 87 eos/hpf for EG and 78 eos/hpf for EGE. The mean peak colonic eosinophil count for EC subjects was 76 eos/hpf (range 10-500). Of the 29% of subjects with post-treatment follow-up, most had an improvement in clinical, endoscopic, and histologic findings regardless of treatment utilized. Reductions in tissue eosinophilia correlated with improvements in clinical symptoms as well as endoscopic and histologic findings. CONCLUSIONS In this large cohort, normal appearance was the most common endoscopic finding, emphasizing the importance of biopsy, regardless of endoscopic appearance. Decreased tissue eosinophilia was associated with improvement in symptoms, endoscopic, and histologic findings, showing that disease activity is reversible.
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Affiliation(s)
- Robert D. Pesek
- Division of Allergy/Immunology, Department of Pediatrics, University of Arkansas for Medical Sciences and Arkansas Children’s Hospital, 13 Children’s Way, Slot 512-13, Little Rock, AR 72202, USA
| | - Craig C. Reed
- Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB #7080, Chapel Hill, NC 27599, USA
| | - Margaret H. Collins
- Division of Pathology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Amanda B. Muir
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Patricia C. Fulkerson
- Division of Allergy/Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH 45229, USA
| | - Calies Menard-Katcher
- Division of Gastroenterology, Department of Pediatrics, Children’s Hospital Colorado, 13123 E 16th Avenue #B361, Aurora, CO 80045, USA
| | - Gary W. Falk
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PCAM South Pavilion, 7th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Jonathan Kuhl
- Division of Allergy/Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH 45229, USA
| | - Adam Z. Magier
- Division of Allergy/Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH 45229, USA
| | - Faria N. Ahmed
- Division of Gastroenterology, Department of Pediatrics, Children’s Hospital Colorado, 13123 E 16th Avenue #B361, Aurora, CO 80045, USA
| | - Maureen Demarshall
- Division of Gastroenterology, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PCAM South Pavilion, 7th Floor, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Ankur Gupta
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Jonathan Gross
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Tokunbo Ashorobi
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA
| | - Christina L. Carpenter
- Rare Disease Clinical Research Network Data Coordinating Center, Health Informatics Institute, University of South Florida, 3650 Spectrum Blvd, Suite 100, Tampa, FL 33612, USA
| | - Jeffrey P. Krischer
- Rare Disease Clinical Research Network Data Coordinating Center, Health Informatics Institute, University of South Florida, 3650 Spectrum Blvd, Suite 100, Tampa, FL 33612, USA
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Lavin Family Pavilion, 259 E Erie St, 16th Floor, Chicago, IL 60611, USA
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Feinberg School of Medicine, Northwestern University, Lavin Family Pavilion, 259 E Erie St, 16th Floor, Chicago, IL 60611, USA
| | - Jonathan M. Spergel
- Division of Allergy and Immunology, The Children’s Hospital of Philadelphia, 3550 Market St., Philadelphia, PA 19104, USA,Department of Pediatrics, Perelman School of Medicine of University of Pennsylvania, 3550 Market St., Philadelphia, PA 19104, USA
| | - Sandeep K. Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Illinois and the University of Illinois College of Medicine, 800 NE Glen Oak Ave, Peoria, IL 61603, USA
| | - Glenn T. Furuta
- Division of Gastroenterology, Department of Pediatrics, Children’s Hospital Colorado, 13123 E 16th Avenue #B361, Aurora, CO 80045, USA
| | - Marc E. Rothenberg
- Division of Allergy/Immunology, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7028, Cincinnati, OH 45229, USA
| | - Evan S. Dellon
- Center for Esophageal Diseases and Swallowing and Center for Gastrointestinal Biology and Disease, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, CB #7080, Chapel Hill, NC 27599, USA
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11
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Groft SC, Gopal-Srivastava R, Dellon ES, Gupta SK. How to Advance Research, Education, and Training in the Study of Rare Diseases. Gastroenterology 2019; 157:917-921. [PMID: 31401141 PMCID: PMC8034804 DOI: 10.1053/j.gastro.2019.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Stephen C. Groft
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
| | - Rashmi Gopal-Srivastava
- Division of Clinical Innovation, National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, Maryland
| | - Evan S. Dellon
- Department of Medicine, Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Sandeep K. Gupta
- Department of Pediatrics and Internal Medicine, Division of Pediatric Gastroenterology/Hepatology/Nutrition, University of Illinois College of Medicine/Children’s Hospital of Illinois, Peoria, Illinois
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12
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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; 114:984-994. [PMID: 31008735 PMCID: PMC6554065 DOI: 10.14309/ajg.0000000000000228] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The literature related to eosinophilic gastritis (EG), gastroenteritis (EGE), and colitis (EC) is limited. We aimed to characterize rates of diagnosis, clinical features, and initial treatments for patients with EG, EGE, and EC. METHODS In this retrospective study, data were collected from 6 centers in the Consortium of Eosinophilic Gastrointestinal Researchers from 2005 to 2016. We analyzed demographics, time trends in diagnosis, medical history, presenting symptoms, disease overlap, and initial treatment patterns/responses. RESULTS Of 373 subjects (317 children and 56 adults), 38% had EG, 33% EGE, and 29% EC. Rates of diagnosis of all diseases increased over time. There was no male predominance, and the majority of subjects had atopy. Presenting symptoms were similar between diseases with nausea/vomiting and abdominal pain, the most common. One hundred fifty-four subjects (41%) had eosinophilic inflammation outside of their primary disease location with the esophagus the second most common gastrointestinal (GI) segment involved. Multisite inflammation was more common in children than in adults (68% vs 37%; P < 0.001). Initial treatment patterns varied highly between centers. One hundred-nine subjects (29%) had follow-up within 6 months, and the majority had clinical, endoscopic, and histologic improvements. CONCLUSIONS In this cohort, EG, EGE, and EC were diagnosed more frequently over time, and inflammation of GI segments outside the primary disease site co-occurrence of atopy was common with a lack of male predominance. Symptoms were similar between diseases, and initial treatment strategies were highly variable. Future investigation should assess the cause of the increased prevalence of eosinophilic GI disorders and prospectively assess outcomes to establish treatment algorithms.
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13
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Huang KZ, Jensen ET, Chen HX, Landes LE, McConnell KA, Almond MA, Johnston DT, Durban R, Jobe L, Frost C, Donnelly S, Antonio B, Safta AM, Quiros JA, Markowitz JE, Dellon ES. Practice Pattern Variation in Pediatric Eosinophilic Esophagitis in the Carolinas EoE Collaborative: A Research Model in Community and Academic Practices. South Med J 2018; 111:328-332. [PMID: 29863219 DOI: 10.14423/smj.0000000000000817] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Differences in the initial management of pediatric eosinophilic esophagitis (EoE) by practice setting have not been well characterized. We aimed to characterize these differences for sites in the Carolinas EoE Collaborative (CEoEC), a multicenter network of academic and community practices. METHODS We performed a retrospective cohort study of pediatric EoE patients at five CEoEC sites: University of North Carolina (UNC) Hospital, Charlotte Asthma and Allergy Specialists, Greenville Health Systems, Wake Forest Baptist Medical Center, and the Medical University of South Carolina Hospital. Cases of EoE were defined by consensus guidelines. Data were extracted from electronic medical records. We tested for differences among sites and used a multinomial model (polytomous regression) to assess associations between treatment and site, adjusting on patient factors. RESULTS We identified 464 children with EoE across the CEoEC sites. The median age was highest at Wake Forest (11.4 years), the median eosinophil count was highest at UNC (69 eos/hpf), and UNC had the most male patients (82%). UNC used topical steroids for initial treatment in 86% of cases, compared with <1% in Greenville (P < 0.01). Greenville used dietary elimination more frequently than UNC (81% vs 2%, P < 0.01). Differences in treatment approach held after adjusting for potential baseline confounders. There was no significant association between patient factors and initial treatment approach. CONCLUSIONS Significant differences in EoE patient factors and treatment approaches were identified across CEoEC sites and were not explained by patient or practice factors. This suggests that institutional or provider preferences drive initial treatment approaches, and that more data are needed to drive best practice decisions.
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Affiliation(s)
- Kevin Z Huang
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Elizabeth T Jensen
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Hannah X Chen
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Lisa E Landes
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Kristen A McConnell
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - M Angie Almond
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Douglas T Johnston
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Raquel Durban
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Laura Jobe
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Carrie Frost
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Sarah Donnelly
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Brady Antonio
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Anca M Safta
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - J Antonio Quiros
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Jonathan E Markowitz
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
| | - Evan S Dellon
- From the Department of Medicine, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, the Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Wake Forest Baptist Medical Center, Winston-Salem, North Carolina, Asthma and Allergy Specialists, Charlotte, North Carolina, the University of South Carolina School of Medicine, Greenville, Greenville Children's Hospital, Greenville, South Carolina, and the Division of Pediatric Gastroenterology and Nutrition, Medical University of South Carolina Children's Hospital, Charleston, South Carolina
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Hiremath G, Kodroff E, Strobel MJ, Scott M, Book W, Reidy C, Kyle S, Mack D, Sable K, Abonia P, Spergel J, Gupta SK, Furuta TG, Rothenberg ME, Dellon ES. Individuals affected by eosinophilic gastrointestinal disorders have complex unmet needs and frequently experience unique barriers to care. Clin Res Hepatol Gastroenterol 2018; 42:483-493. [PMID: 29615329 PMCID: PMC6167209 DOI: 10.1016/j.clinre.2018.03.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/08/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Eosinophilic gastrointestinal disorders (EGIDs) are a rare but emerging healthcare problem. Patient advocacy groups (PAGs) have an important role in representing the EGID community, and serve as valuable research partners. By leveraging the partnership between medical researchers and PAGs, we examined the unmet needs and barriers to care perceived by individuals affected by EGIDs. Next, we examined if these varied between adult EGID patients and adult caregivers of children with EGID. METHODS Adult EGID patients and adult caregivers of children (<18 years) with EGIDs participated in this study. PAGs conducted focus groups comprised of individuals affected by EGIDs to identify domains and questions meaningful to the EGID community and this information was used to develop an online REDCap survey. The survey consisted of 58 questions across medical, healthcare, social, and emotional impact domains. It was distributed via the PAGs' web-based platforms. Demographic data, and responses to questions on a six-point Likert scale were collected and analyzed. RESULTS Of the 361 responses analyzed, 90 (25%) were from adult EGID patients and 271 (75%) were from adult caregivers. Of the applicable responses, in the medical domain only 19% of participants indicated that repeated endoscopies to monitor response to treatment was convenient. In the healthcare domain, 67% indicated that lack of insurance coverage for elemental formula was a barrier. In the social domain, only 5% of respondents reported adequate awareness of EGIDs in schools. In the emotional domain, 64% had experienced significant stress due to EGID related out-of-pocket costs. Multivariate logistic regression revealed that some of these responses varied between adult EGID patients and adult caregivers of children with EGID. The respondents indicated highest priority for improvement in the medical domain compared to other domains. CONCLUSIONS Individuals affected by EGIDs have a constellation of complex unmet needs and perceived barriers across medical, healthcare, social and emotional domains. Addressing unmet needs in the medical domain is relatively more important for the EGID community. Understanding unmet needs and barriers will likely help design improved patient-centered EGID care paradigms.
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Affiliation(s)
- Girish Hiremath
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Monroe Carell Jr Children's Hospital at Vanderbilt, DOT Suite 10226, 2200 Children's Way, Nashville, TN 37232, USA.
| | - Ellyn Kodroff
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Mary J Strobel
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | | | - Wendy Book
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Cathy Reidy
- Eosinophilic Family Coalition, Cincinnati, OH, USA
| | - Shay Kyle
- Campaign Urging Research for Eosinophilic Diseases, Lincolnshire, IL, USA
| | - Denise Mack
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Kathleen Sable
- American Partnership for Eosinophilic Disorders, Atlanta, GA, USA
| | - Pablo Abonia
- Division of Allergy and Immunology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Jonathan Spergel
- Division of Allergy and Immunology, Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Sandeep K Gupta
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine, Peoria, IL, USA
| | - T Glenn Furuta
- Digestive Health Institute, Gastrointestinal Eosinophilic Diseases Program, Children's Hospital Colorado, Aurora, CO, USA
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, USA
| | - Evan S Dellon
- Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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15
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Practice Differences in the Diagnosis and Management of Eosinophilic Esophagitis Among Adult and Pediatric Gastroenterologists in Israel. J Pediatr Gastroenterol Nutr 2018; 67:34-39. [PMID: 29394215 DOI: 10.1097/mpg.0000000000001909] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Eosinophilic esophagitis (EoE) guidelines call for similar practices in adults and children with EoE. We compared the diagnostic and management practices of gastroenterologists treating adult and pediatric patients suspected of having, or diagnosed with, EoE. METHODS A 19-question multiple-choice questionnaire was given to gastroenterologists treating either adults or children. Questions explored 4 areas of interest: physician demographics, diagnosis and tissue sampling practices, management, and the need for societal publications on EoE. RESULTS Completed questionnaires were returned by 85/180 adult and 30/40 pediatric gastroenterologists (PGs). Compared to PGs, adult gastroenterologists (AGs) took esophageal biopsies significantly less frequently in the following scenarios: endoscopy without esophageal symptoms or macroscopic endoscopic findings (10% vs 57%; P < 0.001), dysphagia without macroscopic findings (83% vs 100%; P = 0.019), and gastroesophageal reflux symptoms with distal esophageal erythema (44% vs 100%; P < 0.001). Significantly fewer AGs reported taking gastric and duodenal biopsies when EoE was suspected (29% vs 90%; P < 0.001). AGs more often followed patients clinically (30% vs 0%; P < 0.001) rather than endoscopically, and were far less inclined to implement elimination diets compared to PGs (23% vs 68%; P < 0.001). CONCLUSIONS Significant disparities exist between gastroenterologists treating adult and pediatric patients with EoE. These findings may impact rates of diagnosis, appropriate treatment, monitoring, long-term outcomes, and may affect negatively transition from pediatric to adult care.
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16
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Armbruster-Lee J, Cavender CP, Lieberman JA, Samarasinghe AE. Understanding fibrosis in eosinophilic esophagitis: Are we there yet? J Leukoc Biol 2018; 104:31-40. [DOI: 10.1002/jlb.5mr1017-395r] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/20/2017] [Accepted: 12/20/2017] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jennifer Armbruster-Lee
- Department of Pediatrics; Division of Gastroenterology, University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Cary P. Cavender
- Department of Pediatrics; Division of Gastroenterology, University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Jay A. Lieberman
- Department of Pediatrics; Division of Allergy/Immunology, University of Tennessee Health Science Center; Memphis Tennessee USA
| | - Amali E. Samarasinghe
- Department of Pediatrics; Division of Pulmonology; University of Tennessee Health Science Center; Memphis Tennessee USA
- Children's Foundation Research Institute; Memphis Tennessee USA
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17
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Cheng K, Gupta SK, Kantor S, Kuhl JT, Aceves SS, Bonis PA, Capocelli KE, Carpenter C, Chehade M, Collins MH, Dellon ES, Falk GW, Gopal-Srivastava R, Gonsalves N, Hirano I, King EC, Leung J, Krischer JP, Mukkada VA, Schoepfer A, Spergel JM, Straumann A, Yang GY, Furuta GT, Rothenberg ME. Creating a multi-center rare disease consortium - the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR). TRANSLATIONAL SCIENCE OF RARE DISEASES 2017; 2:141-155. [PMID: 29333363 PMCID: PMC5757645 DOI: 10.3233/trd-170016] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Eosinophilic gastrointestinal disorders (EGIDs) affect various segments of the gastrointestinal tract. Since these disorders are rare, collaboration is essential to enroll subjects in clinical studies and study the broader population. The Rare Diseases Clinical Research Network (RDCRN), a program of the National Center for Advancing Translational Sciences (NCATS), funded the Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) in 2014 to advance the field of EGIDs. CEGIR facilitates collaboration among various centers, subspecialties, patients, professional organizations and patient-advocacy groups and includes 14 clinical sites. It has successfully initiated two large multi-center clinical studies looking to refine EGID diagnoses and management. Several pilot studies are underway that focus on various aspects of EGIDs including novel therapeutic interventions, diagnostic and monitoring methods, and the role of the microbiome in pathogenesis. CEGIR currently nurtures five physician-scholars through a career training development program and has published more than 40 manuscripts since its inception. This review focuses on CEGIR's operating model and progress and how it facilitates a framework for exchange of ideas and stimulates research and innovation. This consortium provides a model for progress on other potential clinical areas.
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Affiliation(s)
- Katherine Cheng
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sandeep K. Gupta
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Illinois College of Medicine, Peoria, IL, USA
| | - Susanna Kantor
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital Colorado, Denver, CO, USA
| | - Jonathan T. Kuhl
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Seema S. Aceves
- Division of Allergy and Immunology, Department of Pediatrics and Medicine, University of California San Diego, CA, USA
| | - Peter A. Bonis
- Division of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | | | - Christina Carpenter
- Health Informatics Institute, Rare Diseases Clinical Research Network, Tampa, FL, USA
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret H. Collins
- Division of Pathology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Evan S. Dellon
- Department of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Gary W. Falk
- Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rashmi Gopal-Srivastava
- Office of Rare Diseases Research, National Center for Advancing Translational Sciences, National Institute of Health, Bethesda, MD, USA
| | - Nirmala Gonsalves
- Division of Gastroenterology & Hepatology, Northwestern University The Feinberg School of Medicine, Chicago, IL, USA
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern Medicine The Feinberg School of Medicine, Chicago, IL, USA
| | - Eileen C. King
- Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - John Leung
- Department of Gastroenterology, Tufts Medical Center, Boston, MA, USA
| | - Jeffrey P. Krischer
- Departments of Pediatrics and Medicine, Health Informatics Institute, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Vincent A. Mukkada
- Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Alain Schoepfer
- Department of Gastroenterology and Hepatology, University Hospital Lausanne/CHUV, Lausanne, Switzerland
| | - Jonathan M. Spergel
- Department of Allergy and Immunology, Children’s Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
| | - Alex Straumann
- Department of Gastroenterology and hepatology, University Hospital Zuerich, Switzerland
| | - Guang-Yu Yang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Glenn T. Furuta
- Gastrointestinal Eosinophilic Diseases Program, Children’s Hospital Colorado, Aurora, CO, USA
- Section of Gastroenterology, Hepatology, and Nutrition, Digestive Health Institute, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marc E. Rothenberg
- Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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18
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Sato M, Shoda T, Shimizu H, Orihara K, Futamura K, Matsuda A, Yamada Y, Irie R, Yoshioka T, Shimizu T, Ohya Y, Nomura I, Matsumoto K, Arai K. Gene Expression Patterns in Distinct Endoscopic Findings for Eosinophilic Gastritis in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1639-1649.e2. [PMID: 28526277 DOI: 10.1016/j.jaip.2017.03.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/21/2017] [Accepted: 03/17/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Eosinophilic gastritis (EG) is clinicopathologically characterized by both marked gastric eosinophilia and clinical symptoms. The endoscopic findings in EG vary among patients, leading to clinical confusion. However, little is known about the relationship between precise endoscopic findings and the pathophysiological process responsible for EG. OBJECTIVE We aimed to elucidate whether the gross endoscopic findings of EG can be classified into distinct gene expression profiles. METHODS We enrolled pediatric patients who underwent gastrointestinal endoscopy for clinical symptoms suggestive of eosinophilic gastrointestinal disorder between 2011 and 2016. EG was diagnosed when gastric eosinophilia was greater than or equal to 30 eosinophils/hpf. The gene expression profiles of gastric biopsies were assessed using microarray technology. RESULTS Patients with EG and control subjects (n = 8, each) were examined. On the microarray, 1,999 genes were differentially expressed between EG and the controls (≥2-fold difference, adjusted P value < .05), including significant upregulation of eotaxin-3 (C-C chemokine ligand 26). The endoscopic findings of patients with EG fell roughly into 2 types, namely, ulcerative and nodular lesions. Despite identifying distinct patterns of gene expression, most differentially regulated genes overlapped between the 2 endoscopic finding types. Several gene ontology terms were enriched in the substantially overlapped genes, but not in each of the distinct genes. CONCLUSIONS Our results strongly indicate that ulcerative and nodular lesions are a single disease, EG, or a variation thereof, in spite of morphological differences. Our findings may contribute to a better understanding of the pathogenesis of EG, as well as to more accurate diagnosis of this disease.
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Affiliation(s)
- Masamichi Sato
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuo Shoda
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Division of Allergy, National Center for Child Health and Development, Tokyo, Japan.
| | - Hirotaka Shimizu
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
| | - Kanami Orihara
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Waseda Institute for Advanced Study, Waseda University, Tokyo, Japan
| | - Kyoko Futamura
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Akio Matsuda
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Yoshiyuki Yamada
- Division of Allergy and Immunology, Gunma Children's Medical Center, Gunma, Japan
| | - Rie Irie
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Takako Yoshioka
- Department of Pathology, National Center for Child Health and Development, Tokyo, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yukihiro Ohya
- Division of Allergy, National Center for Child Health and Development, Tokyo, Japan
| | - Ichiro Nomura
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan; Division of Allergy, National Center for Child Health and Development, Tokyo, Japan
| | - Kenji Matsumoto
- Department of Allergy and Clinical Immunology, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Katsuhiro Arai
- Division of Gastroenterology, National Center for Child Health and Development, Tokyo, Japan
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