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Bennett Murphy LM, O’Gorman M, Fitzgerald S, Peterson K, Robson J. Quality of life in children and adolescents with eosinophilic esophagitis. CHILDRENS HEALTH CARE 2022. [DOI: 10.1080/02739615.2022.2079510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Laura M. Bennett Murphy
- Division of Psychiatry and Pediatric Behavioral Health, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Molly O’Gorman
- Division of Gastroenterology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Susan Fitzgerald
- Clinical Nutrition Services, Intermountain Health Care Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Kathryn Peterson
- Division of Gastroenterology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Jacob Robson
- Division of Gastroenterology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
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Chen CB, Barry J, Conjeevaram Selvakumar PK, Hong S, Mahajan L, Worley S, Patel SA. Measurement of Quality-of-Life Outcomes in Pediatric and Young Adult Patients Treated for Eosinophilic Esophagitis. Cureus 2022; 14:e21675. [PMID: 35237474 PMCID: PMC8882214 DOI: 10.7759/cureus.21675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2022] [Indexed: 11/06/2022] Open
Abstract
Eosinophilic esophagitis is a chronic, immune-mediated esophageal condition that may lead to impairment of quality of life in pediatric and young adult patients. We performed a prospective, cross-sectional study on 40 patients between the ages of 2-21 years with an established diagnosis of eosinophilic esophagitis. The study evaluated physical, emotional, social, and school functioning in patients undergoing treatment with proton pump inhibitors, dietary elimination, or swallowed corticosteroids. There were no statistically significant differences in total or domain-specific quality of life scores between proton pump inhibitors, dietary elimination, and swallowed corticosteroid therapy. Overall, total and domain-specific quality of life were well-preserved in patients with eosinophilic esophagitis, with the highest scores reported in social functioning. There were also no statistically significant associations between clinical, endoscopic, and histologic features and quality-of-life measures.
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Skypala I, Bauer M, DunnGalvin A, Venter C. The Challenges of Managing Multiple Food Allergies and Consequent Food Aversions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 10:35-44. [PMID: 34757065 DOI: 10.1016/j.jaip.2021.10.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/15/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022]
Abstract
The allergic march can often result in children with one food allergy phenotype developing other allergic manifestations as they grow older. In this grand round, we describe the case of a child with a diagnosis of eosinophilic esophagitis at an early age, who subsequently developed IgE-mediated allergy to milk and egg. Because of the onset of allergic rhinitis, an additional complication of the teenage years was the development of pollen food syndrome, which further affected the already complex dietary management. These multiple allergies had a consequent effect on nutritional status and provoked considerable psychosocial issues, which greatly affected the patient's relationship with food. This case illustrates that for complex patients, a cohesive approach and shared decision-making are essential for diagnosis and management. Working with the patient and also the whole family, and considering how best to support them, necessitates a flexible approach. Regular follow-up is important to address changing psychosocial and dietary needs and monitor the resolution of allergies and response to pharmacotherapy. Complex patients need the input of a comprehensive multidisciplinary team, with good access to dietetic and psychological support, to optimize quality of life for these individuals and their families.
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Affiliation(s)
- Isabel Skypala
- Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom; Department of Allergy & Clinical Immunology, Imperial College London, London, United Kingdom.
| | - Maureen Bauer
- Children's Hospital Colorado Section of Pediatric Allergy and Immunology, University of Colorado School of Medicine, Denver, Colo
| | - Audrey DunnGalvin
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Carina Venter
- Children's Hospital Colorado Section of Pediatric Allergy and Immunology, University of Colorado School of Medicine, Denver, Colo
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Votto M, Castagnoli R, De Filippo M, Brambilla I, Cuppari C, Marseglia GL, Licari A. Behavioral issues and quality of life in children with eosinophilic esophagitis. Minerva Pediatr 2020; 72:424-432. [DOI: 10.23736/s0026-4946.20.05913-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Taft TH, Guadagnoli L, Edlynn E. Anxiety and Depression in Eosinophilic Esophagitis: A Scoping Review and Recommendations for Future Research. J Asthma Allergy 2019; 12:389-399. [PMID: 31849499 PMCID: PMC6910091 DOI: 10.2147/jaa.s193045] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/27/2019] [Indexed: 12/29/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is a rapidly emerging chronic disease with limited treatments. Impacting both children and adults, EoE and its treatments have the potential to significantly reduce psychological functioning, including increasing anxiety and depression. In this paper, we provide a scoping review of the scientific literature on anxiety and depression in both pediatric and adult patients. We aim to document the current state of research, identify knowledge gaps, recognize unique challenges that EoE patients may face as they relate to psychosocial function, and offer suggestions for future research directions. Based on the current review, both adult and pediatric patients with EoE are at risk for anxiety and depression symptoms, both due to the disease process and the prevailing dietary treatments. Significant gaps exist in the current understanding of anxiety and depression in EoE, providing ample opportunity for future studies to address this important issue.
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Affiliation(s)
- Tiffany H Taft
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, IL, USA
| | - Livia Guadagnoli
- Northwestern University Feinberg School of Medicine, Division of Gastroenterology & Hepatology, Chicago, IL, USA
| | - Emily Edlynn
- Oak Park Behavioral Medicine LLC, Oak Park, IL, USA
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Abstract
OBJECTIVE The aim of the study was to evaluate whether children with eosinophilic esophagitis (EoE) demonstrated an association between health-related quality of life (HRQoL) improvements and symptom reduction during 12 months of treatment; to examine age-related EoE discrete symptom presentation; and to describe residual symptom and HRQoL burden. METHODS Children ages 2 to 18 years with EoE were assessed at the onset of treatment and 12 months later at 4 tertiary care centers. Continuous measures of symptoms and symptom severity were based on 8 discrete EoE symptoms. HRQoL was measured with the Pediatric Quality of Life (PedsQL) parent-proxy (PR) report, child self-report (CR), and Family Impact Module. Mixed-effects modeling was used to test changes over time for symptom burden and child and family HRQoL. RESULTS One hundred nine children were followed (ages 2-18 years, mean age 7.6 [4.6] years, 77% boys, 87% white). Baseline symptom number mean was 3.5 (standard deviation = 2.3, range 0-8) and symptom severity mean was 5.5 (standard deviation = 4.3, range 0-24). EoE symptom number and symptom severity decreased significantly over the 12 months (P = 0.013, P < 0.001, respectively). PedsQL PR Total, Physical, Psychosocial, and Family Impact scores all improved significantly (P = 0.001, 0.012, 0.012, 0.015, respectively) but PedsQL child self-report scores did not. Symptom reduction correlated with PR PedsQL improvement (P = 0.01). Few discrete symptoms completely remitted, but lowered severity ratings indicated clinically significant improvement. CONCLUSIONS Year-long treatment in multidisciplinary tertiary centers reduced most symptoms and improved parent-reported HRQoL in children with EoE. The frequency of residual symptoms and persistently lower HRQoL, however, underscore the chronic nature of pediatric EoE.
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Bashaw H, Schwartz S, Kagalwalla AF, Wechsler JB. Tutorial: Nutrition Therapy in Eosinophilic Esophagitis—Outcomes and Deficiencies. JPEN J Parenter Enteral Nutr 2019; 44:600-609. [DOI: 10.1002/jpen.1738] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 01/02/2023]
Affiliation(s)
- Hillary Bashaw
- Division of Gastroenterology Hepatology & Nutrition Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Sally Schwartz
- Division of Gastroenterology Hepatology & Nutrition Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
| | - Amir F. Kagalwalla
- Division of Gastroenterology Hepatology & Nutrition Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Pediatrics John H. Stroger Hospital of Cook County Chicago Illinois USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago Illinois USA
| | - Joshua B. Wechsler
- Division of Gastroenterology Hepatology & Nutrition Department of Pediatrics Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois USA
- Department of Pediatrics Northwestern University Feinberg School of Medicine Chicago Illinois USA
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Lynch MK, Dimmitt RA, Goodin BR. Evidence of Disturbed Sleep in Children With Eosinophilic Esophagitis and Persistent Epigastric Pain. J Pediatr Psychol 2019; 43:331-341. [PMID: 29048495 DOI: 10.1093/jpepsy/jsx117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 08/29/2017] [Indexed: 12/21/2022] Open
Abstract
Objective To determine whether the experience of persistent epigastric pain is associated with sleep disturbances in children with eosinophilic esophagitis (EoE). We hypothesized that children with EoE and persistent epigastric pain would (1) self-report greater current and worst pain severity, and (2) experience more disturbed sleep on objective and subjective measures in comparison with children with EoE but no persistent pain and healthy children. Methods Fifty children with EoE were recruited for this cross-sectional study, of which 24 (48%) reported experiencing persistent epigastric pain. The remaining 26 (52%) children with EoE denied experiencing persistent pain. An additional 25 healthy children without EoE or persistent pain were included. All children provided severity ratings of current pain and worst pain experienced over the past week. Children then completed 12 consecutive nights of ambulatory sleep monitoring via actigraphy in the home. Caregivers provided information regarding their child's sleep patterns and internalizing symptoms. Results Children with EoE and persistent pain reported significantly greater severity of current pain (p < .001) and worst pain over the past week (p < .001) compared with EoE without persistent pain and healthy children. Compared with the other groups, children with EoE and persistent pain also demonstrated greater actigraphic sleep disturbances, lower sleep efficiency (p = .004) and greater wake after sleep onset (p = .034). Conclusions This study provides novel evidence that a significant proportion of children with EoE experience persistent symptoms of epigastric pain. Persistent pain was associated with significant sleep disturbances in children with EoE.
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Affiliation(s)
| | - Reed A Dimmitt
- Division of Gastroenterology, Hepatology, & Nutrition, Department of Pediatrics
| | - Burel R Goodin
- Department of Psychology.,Division of Pain Medicine, Department of Anesthesiology & Perioperative Medicine, University of Alabama at Birmingham
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Lynch MK, Barnes MJ, Dimmitt RA, Martin L, Rothenberg ME, Goodin BR. Disease-Related Predictors of Health-Related Quality of Life in Youth With Eosinophilic Esophagitis. J Pediatr Psychol 2019; 43:464-471. [PMID: 29048518 DOI: 10.1093/jpepsy/jsx128] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Accepted: 09/30/2017] [Indexed: 01/07/2023] Open
Abstract
Objective To evaluate relations between health-related quality of life (HRQoL) and clinical symptom presentation in youth with eosinophilic esophagitis (EoE). We hypothesized that presence of dysphagia, reflux, nausea/vomiting, and epigastric pain would be related to poorer HRQoL. In predictive models, it was hypothesized that dysphagia, reflux, nausea/vomiting, and epigastric pain would each significantly and uniquely predict poorer HRQoL. Methods This cross-sectional, two-study design included 91 dyads comprised children with EoE and their respective caregivers across two tertiary children's hospitals, Site 1 in the Midwest (N = 47) and Site 2 in the Deep South (N = 44). Youth and their caregivers both completed questionnaires addressing HRQoL and EoE symptoms during clinic visits. Results Per youth self-report, epigastric pain was found to be a significant predictor of poor physical and psychosocial HRQoL. Per caregiver-proxy reports, epigastric pain was found to be a significant predictor of poor physical HRQoL. Conclusions The clinical symptoms of EoE, specifically epigastric pain, were found to be predictive of the youth's HRQoL. Targeted interventions to help youth with EoE better manage their specific symptom experiences could ultimately improve HRQoL.
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Affiliation(s)
| | | | - Reed A Dimmitt
- Department of Pediatrics, University of Alabama at Birmingham
| | - Lisa Martin
- Department of Pediatrics, University of Cincinnati School of Medicine.,Division of Human Genetics
| | - Marc E Rothenberg
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center
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Muir AB, Brown-Whitehorn T, Godwin B, Cianferoni A. Eosinophilic esophagitis: early diagnosis is the key. Clin Exp Gastroenterol 2019; 12:391-399. [PMID: 31616174 PMCID: PMC6699505 DOI: 10.2147/ceg.s175061] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is a disorder which affects all ages, from infancy through adulthood. It typically affects atopic individuals (Table 1) and is a chronic allergic disorder, with foods ubiquitous in the diet being the most described trigger of this isolated eosinophilic inflammation of the esophagus in both adults and children. This inflammatory process leads to esophageal symptoms such as dysphagia and feeding intolerance. In this review, we provide a brief overview of the current state of EoE therapy and symptomatology and then try to make the case for early diagnosis and treatment to prevent some of the long-term consequences of esophageal inflammation.
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Affiliation(s)
- Amanda B Muir
- Gastroenterology Division, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Bridget Godwin
- Gastroenterology Division, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Antonella Cianferoni
- Gastroenterology Division, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Psychosocial Mediators of Change and Patient Selection Factors in Oral Immunotherapy Trials. Clin Rev Allergy Immunol 2018; 55:217-236. [PMID: 30284193 DOI: 10.1007/s12016-018-8700-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Health-related quality of life (HRQL) is influenced by physiological, psychological, and environmental variables and can be best understood by considering the interactions of factors that cut across multiple levels. One of the most important issues relating to treatment in food allergy is to identify, describe, and define predictors that may contribute to modify HRQL outcomes. The research presented demonstrates that measures of HRQL are able to distinguish key features of known groups (e.g. relating to reaction severity, treatment, allergen type/number, expectation of outcome) and delineate impact on hitherto unknown groups (e.g. relating to personality types and coping styles). This heterogeneity may explain why HRQL or other patient-related outcomes may differ in individuals during, or following any treatment or intervention. Patient-reported outcomes are relatively poorly defined to date. Since HRQL has only been studied in relatively few oral immunotherapy trials to date, primarily looking at caregiver HRQL, it is unclear which factors, measures, or subscales are most predictive of short- and/or long-term treatment outcomes for which type of patient, and which time points for measurement are most informative. A standardised protocol that incorporates HRQL and other relevant patient-related outcome measures and agreed definitions of outcomes would allow for the comparison of efficacy of food allergy treatments between centres, trials, or countries. Further evidence-based research aimed at exploring the effects of interventions on outcomes in food allergy is needed, including the influence of patient and parent factors on protocol design. To this end, it is vital that patient-related outcomes such as improved HRQL are seen as a primary outcome and are measured at multiple intervals during the trial duration and beyond. The creative use of methods and designs (both qualitative and quantitative) to better understand the role of HRQL in immunotherapy treatment trials will enable improved modelling of the costs, risks, and benefits of any treatment. Systematic analysis and modelling of antecedent factors, mediators, and outcomes will be important to boost intervention effects and to maximise the overall benefits of treatment.
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Leigh LY, Spergel JM. An in-depth characterization of a large cohort of adult patients with eosinophilic esophagitis. Ann Allergy Asthma Immunol 2018; 122:65-72.e1. [PMID: 30223114 DOI: 10.1016/j.anai.2018.09.452] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/21/2018] [Accepted: 09/11/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic, allergic, immune-mediated disease associated with increased risk of comorbid atopic conditions. OBJECTIVE To perform an in-depth characterization of a large cohort of manually verified adult patients with EoE, including evaluation of less studied associations, such as pollen food allergy syndrome, anaphylaxis, autoimmunity, and psychiatric comorbidities. METHODS We performed a manual retrospective electronic medical record review of 1,218 patients with EoE identified by International Classification of Diseases, Ninth Revision and International Classification of Disease, 10th Revision codes from the University of Pennsylvania Health Systems. Through manual medical record review, we evaluated patient demographics, family and smoking history, laboratory and endoscopic findings, treatment, and comorbid atopic, autoimmune, and psychiatric conditions. RESULTS A total of 950 of the 1,218 patients had biopsy-proven EoE. This cohort was predominantly male, white, and never-smokers who presented most commonly with dysphagia, with an initial biopsy results showing 49 eosinophils per high-powered field, a serum absolute eosinophilic count of 446,000/µL, and mean total IgE level of 243 IU/mL. Of the patients, 55% had impaction (of which 38% required endoscopic removal), and 56% had strictures or fibrosis (of which 56% underwent dilatation). Therapy used was predominantly (77%) medical only. Comorbid atopy, pollen food allergy syndrome, drug allergy, anaphylaxis, autoimmunity, and psychiatric illnesses were higher in the EoE cohort compared with the general University of Pennsylvania Health Systems population. CONCLUSION Our adult cohort of manually verified, biopsy-proven EoE had an increased risk of pollen food allergy syndrome, anaphylaxis, and comorbid autoimmune and psychiatric conditions compared with the University of Pennsylvania Health Systems population. There was also an increased prevalence of impaction and stricture or fibrosis requiring endoscopic intervention compared with the pediatric population.
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Affiliation(s)
- Lyvia Y Leigh
- Section of Allergy and Immunology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Santos T, de Matos MG, Simões C, Leal I, do Céu Machado M. (Health-related) quality of life and psychosocial factors in adolescents with chronic disease: a systematic literature review. Int J Adolesc Med Health 2017; 31:ijamh-2017-0037. [PMID: 29168956 DOI: 10.1515/ijamh-2017-0037] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 05/10/2017] [Indexed: 11/15/2022]
Abstract
Background Research on living with a chronic disease (CD) in adolescence is increasing. However, studies on the relevance of psychosocial factors are still needed. The present review, focuses on the impact of living with a CD in adolescence on on quality of life (QoL), health-related quality of life (HRQoL) and psychosocial factors. Methods A literature review of articles identified through PubMed, PsycINFO and PsycARTICLES (these last two ones comprise the Ebsco Host platform) and original peer-reviewed research papers, published between 2010 and 2015, with no restrictions regarding the format/source of interventions, randomized controlled trials (RCTs) or types of comparisons were included. Results Eighteen papers met the inclusion criteria and contradictory results were found: the majority showed a significantly higher risk of impairment on QoL/HRQoL and psychosocial factors, whereas others reported a significantly lower risk of impairment (highlighting possible protective factors), or no significant differences. Heterogeneity in the assessment procedures and substantial difficulties in considering adolescence as a single and independent age group, were also noted. Conclusion The higher risk of impairment and the heterogeneity observed between cohorts, reinforce the need to work towards consensual procedures, which allow for more accurate comparisons among studies. Additionally, it conveys the challenge to find more effective interventions. Furthermore, it is highly suggested to routinely assess HRQoL/psychosocial factors within an individualized framework, to considerer adolescents as a single/independent group, to emphasize potential protective factors, and, to increase youth's participation in their own adaptation process and in health promotion in general. These are possible future directions that could enable multidisciplinary responses to improve HRQoL and psychosocial care in adolescents with a CD.
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Affiliation(s)
- Teresa Santos
- William James Center of Research, ISPA-Instituto Universitário, Ciências Psicológicas, Sociais e da Vida, Rua Jardim do Tabaco, no 34, 1149-041 Lisboa, Portugal, Phone: +351 218811700; Mobile: +351 966142393.,FMH, Faculdade de Motricidade Humana (Projecto Aventura Social-Social Adventure Team)/Universidade de Lisboa, Lisboa, Portugal.,ISAMB, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Margarida Gaspar de Matos
- FMH, Faculdade de Motricidade Humana (Projecto Aventura Social-Social Adventure Team)/Universidade de Lisboa, Lisboa, Portugal.,ISAMB, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.,William James Center for Research, ISPA - Instituto Universitário, Lisboa, Portugal
| | - Celeste Simões
- FMH, Faculdade de Motricidade Humana (Projecto Aventura Social-Social Adventure Team)/Universidade de Lisboa, Lisboa, Portugal.,ISAMB, Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Isabel Leal
- William James Center for Research, ISPA - Instituto Universitário, Lisboa, Portugal
| | - Maria do Céu Machado
- FM, Faculdade de Medicina/Universidade de Lisboa, Lisboa, Portugal.,Departamento de Pediatria do Hospital de Santa Maria, CAML, Centro Académico de Medicina de Lisboa, Lisboa, Portugal
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Lucendo AJ, Arias-González L, Molina-Infante J, Arias Á. Systematic review: health-related quality of life in children and adults with eosinophilic oesophagitis-instruments for measurement and determinant factors. Aliment Pharmacol Ther 2017. [PMID: 28639700 DOI: 10.1111/apt.14194] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Several measures have been used to assess the health-related quality of life (HRQoL) of patients with eosinophilic oesophagitis (EoE). AIMS To systematically review these HRQoL measures, to appraise measurement properties of specific instruments and to evaluate determinant factors influencing HRQoL in paediatric and adult EoE patients. METHODS We searched the PubMed, Embase, Scopus, Web of Science (WOS) and PsycINFO databases for documents providing original information on the development of measurement tools and/or evaluation of HRQoL outcomes in EoE patients of all ages. RESULTS Of the 596 references identified, data was collected from 34 studies (with only 16 of them being published as full papers) including a total of 1,689 individual patients. Three disease-specific HRQoL measures in EoE covering different aspects of patients' lives and developed in English, were scored positive regarding measurement properties. The PedsQL inventory (including parent and child report forms) and the Peds-QoL EoE module were the generic and specific instruments respectively used in children, while the SF-36 and EoE-QoL-A were the most used questionnaires in adults. Patients with EoE show an impaired HRQoL compared to controls, which greatly depends on symptom severity and disease duration. Severity of endoscopic features and female gender may also determine an impaired HRQoL. The effect of treatments on HRQoL requires further assessment. CONCLUSIONS HRQoL is a relevant outcome that should be considered in clinical practice and research of EoE. Further validation studies in several languages and populations are required to support the use of disease-specific HRQoL measures.
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Affiliation(s)
- A J Lucendo
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - L Arias-González
- Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain
| | - J Molina-Infante
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Department of Gastroenterology, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
| | - Á Arias
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Spain.,Research Support Unit, Complejo Hospitalario La Mancha Centro, Alcázar de San Juan, Spain
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Rajan J, Newbury RO, Anilkumar A, Dohil R, Broide DH, Aceves SS. Long-term assessment of esophageal remodeling in patients with pediatric eosinophilic esophagitis treated with topical corticosteroids. J Allergy Clin Immunol 2016; 137:147-156.e8. [PMID: 26233926 PMCID: PMC4715736 DOI: 10.1016/j.jaci.2015.05.045] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 04/15/2015] [Accepted: 05/14/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is a chronic TH2 inflammatory disease characterized by tissue remodeling that leads to esophageal strictures and food impactions. Effects of therapy on long-term remodeling in patients with pediatric eosinophil-associated diseases have not been previously described. OBJECTIVE We sought to understand the long-term control of esophageal remodeling in patients with EoE. METHODS We assessed endoscopic and histologic remodeling and TGF-β1 expression in esophageal biopsy specimens from children (n = 32) with EoE treated with topical corticosteroids (TCSs) over 10 years (mean, 4.5 years). We used standardized EoE scoring tools to gauge endoscopic and symptom features. RESULTS Seven hundred thirty-eight biopsy specimens from 246 endoscopic procedures were evaluated over 10 years. Four hundred eighty-six biopsy specimens had adequate lamina propria for evaluation of subepithelial remodeling. The severity of epithelial esophageal eosinophilia correlated with epithelial remodeling (basal zone hyperplasia, desquamation, and dilated intercellular spaces; P < .0001), lamina propria eosinophilia (P < .0001), and fibrosis (P < .0001). Sixteen subjects were initial responders (<15 eosinophils/high-power field) to TCSs. Responders and nonresponders spent 54% and 97% of their total disease duration with active EoE (P < .001) and 23% and 53% (P < .02) with maximal fibrosis scores, respectively. Responders had lower endoscopy scores during their disease duration (P = .013). Having less than 15 eosinophils/high-power field at any time correlated with lower fibrosis and endoscopic severity. TGF-β1(+) cell counts decreased in responders at the first biopsy, but this was not sustained. Symptoms did not correlate with other disease features. CONCLUSIONS Children with EoE have substantial esophageal remodeling, which associates with inflammation and can improve in a sustainable manner with TCSs. Although endoscopic features correspond to histologic features, symptoms did not correlate with inflammation or fibrosis.
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Affiliation(s)
- Jessica Rajan
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Center for Immunity, Infection, and Inflammation, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif
| | - Robert O Newbury
- Division of Pathology, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif
| | - Arjun Anilkumar
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Center for Immunity, Infection, and Inflammation, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Medicine, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif
| | - Ranjan Dohil
- Division of Gastroenterology, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Medicine, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif
| | - David H Broide
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Medicine, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif
| | - Seema S Aceves
- Division of Allergy and Immunology, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Center for Immunity, Infection, and Inflammation, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Pediatrics, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif; Department of Medicine, University of California, San Diego, La Jolla, Rady Children's Hospital San Diego, San Diego, Calif.
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Lynch MK, Avis KT, Dimmitt RA, Goodin BR. Topical Review: Eosinophilic Esophagitis in Children: Implications for Health-Related Quality of Life and Potential Avenues for Future Research. J Pediatr Psychol 2015; 40:727-32. [PMID: 25840445 DOI: 10.1093/jpepsy/jsv032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 03/12/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To characterize the health-related quality of life (HRQoL) of children with eosinophilic esophagitis (EoE) as well as generate novel hypotheses for future research in this pediatric population. METHOD A literature review was completed using PubMed and the keywords below. RESULTS Research has shown that for children with EoE and their parents, symptom experiences and recommended treatments can have a negative impact on HRQoL. However, studies have yet to adequately address mechanisms that may help explain why this is. Areas of interest include sleep quality and disturbances, the experience of pain, and the presence of internalizing symptoms, all of which have the potential to uniquely and synergistically impact HRQoL. CONCLUSION With greater understanding of the associations among sleep, pain, internalizing symptoms, and HRQoL in children with EoE may come enhanced therapies that substantially improve the quality of their health care.
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Affiliation(s)
| | - Kristin T Avis
- Department of Pediatrics, University of Alabama at Birmingham
| | - Reed A Dimmitt
- Department of Pediatrics, University of Alabama at Birmingham
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17
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Health-related quality of life over time in children with eosinophilic esophagitis and their families. J Pediatr Gastroenterol Nutr 2014; 59:308-16. [PMID: 24897164 PMCID: PMC4141021 DOI: 10.1097/mpg.0000000000000451] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Existing treatments for pediatric eosinophilic esophagitis (EoE) effectively reduce inflammation. The impact of treatment on health-related quality of life (HRQoL) over time for pediatric patients with EoE and their families, however, has not been systematically assessed. We hypothesized that individualized multidisciplinary treatment would improve both child and family HRQoL over time, with improvements associated with decreased symptom severity. METHODS Children with EoE treated in 4 tertiary care centers were enrolled. Baseline assessments occurred at the time of patients' first evaluation; follow-up assessments occurred at 2 and 6 months after baseline. Presence and severity of 8 EoE symptoms were measured. HRQoL was measured with the Pediatric Quality of Life Inventory parent proxy report, child self-report (CR), and Family Impact Module (FIM). Statistical analyses used mixed-effects modeling to test changes over time for child and family HRQoL. RESULTS Ninety-seven children were enrolled (ages 2-18 years, mean age 7.7 years ± 4.8, 78% boys, 80% white). Baseline mean symptom number was 3.5 (standard deviation 2.3), and symptom severity was 5.5 (standard deviation, 4.5). HRQoL scores were significantly related to symptom scores (P < 0.001). EoE symptom severity decreased during the study (P = 0.03). Pediatric Quality of Life Inventory parent proxy Total and FIM Total scores improved from baseline to 6 months (respectively, adjusted means 78.4 vs 81.0, P = 0.0006; 68.9 vs 70.1, P = 0.03). Interactions with baseline symptom severity revealed that subjects with lowest symptom severity showed the most improved HRQoL scores (P = 0.0013). CONCLUSIONS HRQoL improved during the course of evaluation and treatment, with positive changes being strongest for patients with less symptom severity at baseline.
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The clinical utility of health-related quality of life screening in a pediatric inflammatory bowel disease clinic. Inflamm Bowel Dis 2013; 19:2666-72. [PMID: 24051932 PMCID: PMC3863996 DOI: 10.1097/mib.0b013e3182a82b15] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Adjusting to symptom flares, treatment regimens, and side effects places youth with inflammatory bowel disease (IBD) at increased risk for emotional and behavioral problems and adverse disease outcomes. Implementation of psychosocial screening into clinical practice remains a challenge. This study examines the clinical utility of health-related quality of life (HRQOL) screening in predicting disease outcome and healthcare utilization. METHODS One hundred twelve youth of 7 to 18 years diagnosed with IBD and their parents. Youth completed standardized measures of HRQOL and depression. Parents completed a proxy report of HRQOL. Pediatric gastroenterologists provided the Physician Global Assessment. Families were recruited from a pediatric gastroenterology clinic. Retrospective chart reviews examined disease outcome and healthcare utilization for 12 months after baseline measurement. RESULTS Linear regressions, controlling for demographic and disease parameters, revealed that baseline measurement of youth and parent proxy-reported HRQOL predicted the number of IBD-related hospital admissions, gastroenterology clinic visits, emergency department visits, psychology clinic visits, telephone contacts, and pain management referrals over the next 12 months. Disease outcome was not significant. CONCLUSIONS Lower HRQOL was predictive of increased healthcare utilization among youth with IBD. Regular HRQOL screening may be the impetus to providing better case management and allocating resources based on ongoing care needs and costs. Proactive interventions focused on patients with poor HRQOL may be an efficient approach to saving on healthcare costs and resource utilization.
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Abstract
OBJECTIVE Children with eosinophilic esophagitis (EoE) experience daily challenges related to coping with symptoms and the psychosocial effect of this chronic disease. The aim of this study was to identify features of psychosocial dysfunction experienced by children with EoE who were evaluated in a tertiary care program. METHODS We performed a retrospective review of EoE patients and their families' psychosocial evaluations performed in a tertiary care EoE program. Consecutive evaluations were analyzed to document reports of patients' disease-related pain/discomfort; feeding/appetite symptoms; sleep, social, and school problems; depression, anxiety; and overall psychological adjustment. RESULTS Sixty-four patients received psychosocial evaluation during an 18-month period and were analyzed. Sixty-nine percent of children evaluated experienced some form of psychosocial problems, including social difficulties (64%), anxiety (41%), sleep difficulties (33%), depression (28%), and school problems (26%). Adjustment problems were identified in 44% of the sample. Older children experienced more adjustment difficulties than younger children (P = 0.05). Sleep disturbances and feeding problems predominated in the younger children. Anxious behavior and depressive feelings increased with age. Children with gastrostomy tubes (G-tubes) had more social, school, and psychological adjustment problems than those without. CONCLUSIONS The majority of children with EoE who underwent health and behavior evaluation in a tertiary care program experienced psychosocial adjustment and coping problems. Evaluation and management by mental health professionals would likely benefit a majority of patients with this chronic disease.
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Wu YP, Franciosi JP, Rothenberg ME, Hommel KA. Behavioral feeding problems and parenting stress in eosinophilic gastrointestinal disorders in children. Pediatr Allergy Immunol 2012; 23:730-5. [PMID: 22882380 DOI: 10.1111/j.1399-3038.2012.01340.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Children with eosinophilic gastrointestinal disorders (EGID) and their families are asked to adhere to dietary restrictions which can present significant daily challenges. However, little is known about child and family functioning and adaptation and the impact of psychosocial functioning (e.g., behavioral feeding problems) on adherence to dietary restrictions in this pediatric population. METHODS We conducted a gender- and age-matched case-control study wherein parents of children with EGID and healthy control children completed measures of behavioral feeding problems, parenting stress, and adherence to prescribed dietary restrictions. RESULTS Children with EGID (n = 92) have significantly higher levels of behavioral feeding problems than healthy controls (n = 89; t = 5.7, p < 0.001; t = 7.9, p < 0.001). In particular, younger children demonstrated higher levels of behavioral feeding problems than older children. While behavioral feeding problems were not predictive of adherence to dietary restriction recommendations, they were positively associated with parenting stress. CONCLUSIONS The study results indicate that, for families caring for a child with EGID, higher levels of behavioral feeding problems are associated with parent maladjustment or dysfunction. A multidisciplinary treatment team is needed to provide comprehensive psychosocial and feeding evaluations and treatment in EGID families.
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Affiliation(s)
- Yelena P Wu
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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Hommel KA, Franciosi JP, Gray WN, Hente EA, Ahrens A, Rothenberg ME. Behavioral functioning and treatment adherence in pediatric eosinophilic gastrointestinal disorders. Pediatr Allergy Immunol 2012; 23:494-9. [PMID: 22435992 DOI: 10.1111/j.1399-3038.2012.01297.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To examine behavioral predictors of treatment adherence in patients with eosinophilic gastrointestinal disorders (EGID). METHODS Participants were 96 patients 2.5-18 yr of age with eosinophilic esophagitis or eosinophilic gastroenteritis and their caregivers (mother, father). We assessed maternal and paternal report of child/adolescent internalizing symptoms (e.g., anxiety, depression) and externalizing symptoms (e.g., aggression, anger) using the Behavior assessment system for children, 2nd edition (BASC-2). A multi-informant adherence assessment approach and an 80% cut point were used to classify patients as adherent or non-adherent. RESULTS Sociodemographic predictors did not distinguish between adherent and non-adherent patients. Maternal report of internalizing symptoms significantly correlated with non-adherence (p < 0.001). Post hoc probing revealed a significant contribution of depression, with depressed patients being more likely (OR = 7.27; p < 0.05) to be non-adherent than non-depressed patients. Paternal report of internalizing and externalizing symptoms was not associated with non-adherence. CONCLUSIONS Maternal report of patient internalizing behavioral symptoms, particularly depression, is significantly associated with non-adherence in patients with EGID. These symptoms are potential risk factors and should be considered when assessing and treating non-adherence. Clinical care of patients with EGID should include routine screening for depression.
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Affiliation(s)
- Kevin A Hommel
- Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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