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Kamat S, Yaworsky A, Guillemin I, Krohe M, Litcher-Kelly L, McLafferty M, Lamoureux RE, Lowe C, Chehade M, Spergel JM, Weinfurt K, Turner-Bowker DM. Novel Questionnaires for Assessing Signs and Symptoms of Eosinophilic Esophagitis in Children. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:1856-1863.e3. [PMID: 35398552 DOI: 10.1016/j.jaip.2022.02.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pediatric patients with eosinophilic esophagitis (EoE) experience heterogeneous symptoms and the patient's age may preclude reliable self-report of symptoms. OBJECTIVE The goal of this study was to develop a patient-reported outcome and an observer-reported outcome questionnaire to evaluate the signs and symptoms of EoE in pediatric patients (≥1 to <12 y of age) in a clinical trial setting. METHODS A concept-focused literature review, expert advice meetings, and concept elicitation interviews with pediatric EoE patients and their caregivers were conducted to identify disease-related signs and symptoms. Instructions, items, and response options were drafted. Cognitive debriefing interviews were conducted to evaluate children's and caregivers' ability to understand and respond to the questionnaires and to evaluate the comprehensiveness of the concepts measured. RESULTS Results from the literature review, expert advice meetings (n = 6), and concept elicitation interviews (n = 24) informed the development of the Pediatric Eosinophilic Esophagitis Sign/Symptom Questionnaire intended for use by patients (PESQ-P) with EoE 8 years or older to younger than 12 years and an observer-reported outcome questionnaire planned for use by caregivers of patients (PESQ-C) 1 year old or older to younger than 12 years. Both questionnaires measure the same concepts; the PESQ-P assesses the frequency, duration, and/or severity of symptoms and the PESQ-C assesses the presence/absence of the signs/symptoms. The cognitive debriefing interviews (n = 17) demonstrated that participants were able to comprehend and complete the questionnaires as intended. CONCLUSIONS This study provides evidence of the content validity of 2 novel questionnaires, PESQ-P and PESQ-C, designed to evaluate the symptom experience of pediatric EoE patients in a clinical trial setting.
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Affiliation(s)
- Siddhesh Kamat
- Regeneron Pharmaceuticals, Health Economics and Outcomes Research, Medical Affairs, Tarrytown, NY
| | | | | | - Meaghan Krohe
- Adelphi Values, Patient-centered Outcomes, Boston, Mass
| | | | | | | | - Caitlyn Lowe
- Adelphi Values, Patient-centered Outcomes, Boston, Mass
| | - Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jonathan M Spergel
- Division of Allergy-Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pa
| | - Kevin Weinfurt
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC
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Breathing freely is possible! How to help patients with bronchial asthma and polyposis rhinosinusitis? TERAPEVT ARKH 2021; 93:991-998. [DOI: 10.26442/00403660.2021.08.201050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 09/04/2021] [Indexed: 11/22/2022]
Abstract
On June 2325, under the auspices of the Year of Science and Technology in Russia, the 17th International Interdisciplinary Congress of Allergology and Rhinosinusitis was held in Moscow. The 17th International Interdisciplinary Congress of Allergology and Immunology, where the results of current research, approaches to therapy and prevention of diseases based on modern clinical guidelines were presented. The event included a symposium "Breathe freely it is possible! How to help patients with bronchial asthma and polyposis rhinosinusitis?" with the participation of leading Russian specialists.
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Mari A, Tsoukali E, Yaccob A. Eosinophilic Esophagitis in Adults: A Concise Overview of an Evolving Disease. Korean J Fam Med 2020; 41:75-83. [PMID: 32062959 PMCID: PMC7093678 DOI: 10.4082/kjfm.18.0162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 10/15/2018] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that encompasses esophageal symptoms along with eosinophilic infiltration of the esophageal epithelium. EoE is an evolving disease that has been a subject of interest to many researchers since the first studies recognized this condition as a new and distinct clinicopathological entity 25 years ago. Clinical presentation in adult patients may include dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis of EoE is based on the combination of clinical history suggestive of esophageal dysfunction, endoscopic features indicative of the disease, and histology revealing eosinophilic infiltration of the esophageal epithelium that persists after a trial of proton pump inhibitor therapy along with the exclusion of other disorders that may be associated with esophageal tissue eosinophilia. The interplay between EoE and gastroesophageal reflux disease (GERD) is complex, and differentiating these two conditions continues to be difficult and challenging in clinical practice. The mainstay treatment includes dietary modification, topical steroids, and/or endoscopic dilation. The primary care physician (PCP) plays an important role in improving patient care and quality of life by ensuring early referral and participating in management and follow-up. This article provides an overview of the current knowledge base regarding the disease including epidemiology, genetics, pathogenesis, common clinical presentations, the interplay between EoE and GERD, diagnostic approaches, and therapeutic options available to the PCP.
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Affiliation(s)
- Amir Mari
- Gastroenterology Institute, Nazareth EMMS Hospital, Nazareth, Israel.,The Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
| | - Emmanouela Tsoukali
- Gastroenterology and Hepatology Department, Evangelismos General Hospital of Athens, Athens, Greece
| | - Afif Yaccob
- Gastroenterology and Liver Disease Department, Rambam Healthcare Campus, Haifa, Israel
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Kiely K. Eosinophilic Esophagitis: A Case Study of a 12-Year-Old Boy. J Pediatr Health Care 2017; 31:618-622. [PMID: 28396105 DOI: 10.1016/j.pedhc.2017.02.001] [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: 11/16/2016] [Revised: 01/12/2017] [Accepted: 02/08/2017] [Indexed: 11/24/2022]
Abstract
Eosinophilic esophagitis is an underrecognized chronic condition in which symptoms of gastroesophageal reflux are accompanied by eosinophilia in the esophagus. This disorder affects both children and adults and is associated with a history of other atopic disorders, particularly food allergies. This case study discusses the epidemiology of eosinophilic esophagitis and the proper procedures for diagnosis, referral, and management using the dietary restrictions and pharmacologic treatment included in the clinical recommendations issued by the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition; the American Academy of Allergy, Asthma, and Immunology; and the American College of Gastroenterologists.
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de Bortoli N, Penagini R, Savarino E, Marchi S. Eosinophilic esophagitis: Update in diagnosis and management. Position paper by the Italian Society of Gastroenterology and Gastrointestinal Endoscopy (SIGE). Dig Liver Dis 2017; 49:254-260. [PMID: 27979389 DOI: 10.1016/j.dld.2016.11.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 11/21/2016] [Accepted: 11/24/2016] [Indexed: 12/11/2022]
Abstract
Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. The entity exists worldwide but has been most extensively studied in Western countries. However, a wide range of symptoms has been noticed such as chest pain or gastro-esophageal reflux disease-like symptoms. Upper gastro-intestinal endoscopy and esophageal biopsies are crucial for the diagnosis. Endoscopy might be normal or reveal typical patterns such as rings, furrows, exudates, edema, and stricture. Two to four biopsies should be performed both in the distal and in the proximal esophagus, and 15 eosinophils per high power field within the esophageal epithelium are the minimal threshold to diagnose eosinophilic esophagitis. Allergy testing is recommended, although its impact to orient treatment remains to be demonstrated. Eosinophilic esophagitis treatment includes medical treatment, diet and endoscopic dilation. Proton pump inhibitors are the first-line therapy as up to 50% of patients respond well to proton pump inhibitors irrespective of objective evidence of GERD. Topical viscous corticosteroids or elimination diet are the treatment of choice in case of unresponsiveness to proton pump inhibitors.
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Affiliation(s)
- Nicola de Bortoli
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
| | - Roberto Penagini
- Gastroenterology Unit, Foundation IRCCS Ca' Granda, Ospedale Maggiore, Policlinic, Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
| | - Santino Marchi
- Gastroenterology Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
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Imam T, Gupta SK. Topical glucocorticoid vs. diet therapy in eosinophilic esophagitis: the need for better treatment options. Expert Rev Clin Immunol 2016; 12:797-9. [PMID: 27206496 DOI: 10.1080/1744666x.2016.1191947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Tanbeena Imam
- a Riley Hospital for Children , Indiana University Health , Indianapolis , IN , USA
| | - Sandeep K Gupta
- a Riley Hospital for Children , Indiana University Health , Indianapolis , IN , USA
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Ahmed M. Eosinophilic esophagitis in adults: An update. World J Gastrointest Pharmacol Ther 2016; 7:207-213. [PMID: 27158535 PMCID: PMC4848242 DOI: 10.4292/wjgpt.v7.i2.207] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 01/10/2016] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic esophagitis is a worldwide chronic allergic disease of the esophagus. In the last decade, there is an epidemic of this entity in the western world. Mostly seen in children and young adults, patients present with dysphagia or food impaction in the emergency room. Characteristic endoscopic findings, esophageal eosinophilia and non-responsiveness to proton pump inhibitors help make the diagnosis. Avoidance of food allergens, administration of steroidal anti-inflammatory medications and dilation of the esophagus are the mainstays of treatment. Investigations are ongoing for mucosal healing and optimum maintenance treatment.
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Teoh T, Chan ES, Avinashi V, Ko HH, Goldman RD. Diagnosis and management of eosinophilic esophagitis in children. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2015; 61:687-690. [PMID: 26505065 PMCID: PMC4541432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
QUESTION After a few years of difficulty swallowing solids and feeling like food was getting stuck, a 13-year-old boy in my practice with peanut allergy and asthma was recently diagnosed with eosinophilic esophagitis (EoE). What is EoE and how is it diagnosed and managed? ANSWER Eosinophilic esophagitis is an immune-mediated disease resulting in inflammation of the esophagus. It is increasing in prevalence and incidence in countries like Canada, and frequently occurs in children with other allergic conditions. Unexplained feeding difficulties, vomiting, and solid-food dysphagia, especially in boys with atopy, supports the possibility of having EoE. A formal diagnosis is obtained by reviewing esophageal biopsies obtained through upper endoscopy performed while the patient is taking a proton pump inhibitor. Once EoE has been established, management should involve working collaboratively with gastroenterology and allergy specialists. Medical or dietary treatments are acceptable therapeutic approaches.
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Syrigou E, Angelakopoulou A, Zande M, Panagiotou I, Roma E, Pitsios C. Allergy-test-driven elimination diet is useful in children with eosinophilic esophagitis, regardless of the severity of symptoms. Pediatr Allergy Immunol 2015; 26:323-9. [PMID: 25845555 DOI: 10.1111/pai.12389] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2015] [Indexed: 01/07/2023]
Abstract
BACKGROUND A combination of PPIs and corticosteroids is the pharmacotherapy mostly used to treat eosinophilic esophagitis (EoE), while dietetic manipulations consist also an efficient option. The aim of this study was to compare the efficacy of allergy-test-driven elimination diet in children with mild symptoms of EoE to a group of children with moderate/severe symptoms. METHODS Thirty-five children, aged 7 months to 12 yr, with EoE were enrolled in the study. They had a clinical history of GERD-like (21 children, Group A) or more severe symptoms (14 children, Group B). The diagnosis had been confirmed after two preliminary months of therapy with PPIs and an esophagogastroduodenoscopy. Soon after diagnosis, they were allergy-tested, using IgE detection (SPT and serum-specific IgE) and atopy patch tests (APTs). A 12-month tailor-made diet was prescribed according to the tests. Patients of Group B continued PPIs for two more months, while swallowed topical steroids were also prescribed to them for the first 5 months after diagnosis, followed by an 'as-needed' use of them for the rest of the study. Endoscopy was repeated at the end of the study. RESULTS Milk and egg were the most common APT-positive allergens. Thirty-two patients were instructed to follow an elimination diet, which was completed by 15/18 of Group A and 12/14 of Group B. An improvement of symptoms was reported by 26/27 patients that completed the study. The use of swallowed corticosteroids was noticeably decreased during the as-needed period, in Group B. A remarkable reduce of eosinophils was noticed in biopsies; from 42.84 ± 18.08, they decreased to 6.41 ± 3.20, a year after. CONCLUSION All children with EoE and mild symptoms had resolution of symptoms and normal eosinophils in the esophageal mucosa a year after an allergy-driven elimination diet. Patients with moderate/severe EoE symptoms had the same improvement, indicating that an elimination diet is an efficient complementary treatment to corticosteroids.
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Affiliation(s)
| | | | - Maria Zande
- Allergy Department, 'Sotiria' General Hospital, Athens, Greece
| | - Ioanna Panagiotou
- First Department of Paediatrics, University of Athens, Athens, Greece
| | - Eleftheria Roma
- First Department of Paediatrics, University of Athens, Athens, Greece
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Oh JY, Min KH, Park HS, Hur GY. Eosinophilic esophagitis associated with Cynanchum wilfordii. Ann Allergy Asthma Immunol 2015; 114:257-9. [PMID: 25648564 DOI: 10.1016/j.anai.2014.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 11/25/2014] [Accepted: 12/12/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Jee Youn Oh
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Kyung Hoon Min
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Seoul, Korea
| | - Gyu-Young Hur
- Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
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11
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Scott GD, Blum ED, Fryer AD, Jacoby DB. Tissue optical clearing, three-dimensional imaging, and computer morphometry in whole mouse lungs and human airways. Am J Respir Cell Mol Biol 2014; 51:43-55. [PMID: 24471696 DOI: 10.1165/rcmb.2013-0284oc] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In whole adult mouse lung, full identification of airway nerves (or other cellular/subcellular objects) has not been possible due to patchy distribution and micron-scale size. Here we describe a method using tissue clearing to acquire the first complete image of three-dimensional (3D) innervation in the lung. We then created a method to pair analysis of nerve (or any other colabeled epitope) images with identification of 3D tissue compartments and airway morphometry by using fluorescent casting and morphometry software (which we designed and are making available as open-source). We then tested our method to quantify a sparse heterogeneous nerve population by examining visceral pleural nerves. Finally, we demonstrate the utility of our method in human tissue to image full thickness innervation in irregular 3D tissue compartments and to quantify sparse objects (intrinsic airway ganglia). Overall, this method can uniquely pair the advantages of whole tissue imaging and cellular/subcellular fluorescence microscopy.
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Affiliation(s)
- Gregory D Scott
- Division of Pulmonary and Critical Care, Oregon Health and Sciences University, Portland, Oregon
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Lavin JM, Tieu D, Maddalozzo J. Complementary and integrative treatments: swallowing disorders. Otolaryngol Clin North Am 2013; 46:447-60. [PMID: 23764821 DOI: 10.1016/j.otc.2013.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Swallowing disorders are associated with many disease processes and are associated with significant morbidity and mortality. This article provides information regarding the various causes of swallowing disorders as well as medical, surgical, and integrative approaches to their management.
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Affiliation(s)
- Jennifer M Lavin
- Department of Otolaryngology-Head and Neck Surgery, Northwestern, University Feinberg School of Medicine, Chicago, IL 60611, USA.
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13
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Pan XP, Wang W. Eosinophilic esophagitis. Shijie Huaren Xiaohua Zazhi 2013; 21:403-408. [DOI: 10.11569/wcjd.v21.i5.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated inflammatory esophageal disease characterized clinicopathologically by symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. The pathogenesis of EoE is incompletely understood but is generally considered to be related to IgE- and non-IgE-mediated hypersensitivity. The diagnosis of EoE relies mainly on typical clinical presentations, esophageal pathological changes, and exclusion of gastroesophageal reflux disease (GRED) and other conditions that cause esophageal eosinophilia. Management options include dietary modifications, pharmacological therapy, and endoscopic dilation.
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Jo Y. Eosinophilic Esophagitis: Update 2012. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2012; 60:3-12. [DOI: 10.4166/kjg.2012.60.1.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Yunju Jo
- Department of Internal Medicine, Eulji University School of Medicine, Seoul, Korea
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