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Chehade M, Jensen ET, Wright BL. Addressing health disparities and transitions of care in eosinophilic gastrointestinal diseases. J Allergy Clin Immunol 2024:S0091-6749(24)00333-6. [PMID: 38593869 DOI: 10.1016/j.jaci.2024.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 04/04/2024] [Indexed: 04/11/2024]
Affiliation(s)
- Mirna Chehade
- Mount Sinai Center for Eosinophilic Disorders, Departments of Pediatrics and Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Elizabeth T Jensen
- Departments of Epidemiology and Prevention and Internal Medicine, Gastroenterology Section, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Benjamin L Wright
- Division of Allergy, Asthma, and Clinical Immunology, Department of Medicine, Mayo Clinic Arizona, Scottsdale, Ariz; Division of Allergy and Immunology, Phoenix Children's Hospital, Phoenix, Ariz
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2
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Jones SM, Anvari S, Coleman A, Pesek RD, Kloepfer KM, Perry TT, Jefferson AA, Doan D, Andres A, Doderer M, Hilbun A, Solomon R, Scurlock AM. Food insecurity and allergic diseases: A call to collective action. J Allergy Clin Immunol 2024; 153:359-367. [PMID: 37926122 DOI: 10.1016/j.jaci.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/13/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
Food security encompassess the concept of access by all people at all times to enough food for an active, healthy life. Conversely, food insecurity (FI) refers to household-level economic and social conditions of limited or uncertain access to adequate food. FI is a key social determinant of health that can negatively affect nutrition and health outcomes, as it is estimated that 10.2% of the US population meets criteria for FI. Recognizing the impact of FI on our patients and families is critical to promote health equity and optimize health outcomes. This review focuses on FI and allergic disease from the perspective of key multisector stakeholders within the field of allergy and immunology as well as from the larger health care arena, highlighting key resources and initiatives important to patients. Collectively, as specialists in allergy and immunology, and within the medical field more broadly, we must leverage our unique roles as we interface with patients and families and serve as committed advocates for change. Developing innovative strategies to promote health equity can provide a pathway forward for all children, adults, and families to gain access to healthy, nutritious food as part of their routine lifestyle. This is a call to action.
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Affiliation(s)
- Stacie M Jones
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark.
| | - Sara Anvari
- Baylor College of Medicine and Texas Children's Hospital, Houston, Tex
| | - Amaziah Coleman
- National Institutes of Health, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Robert D Pesek
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Kirsten M Kloepfer
- Indiana University School of Medicine and Riley Children's Hospital at IU Health, Indianapolis, Ind
| | - Tamara T Perry
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Akilah A Jefferson
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Dieu Doan
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
| | - Aline Andres
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Nutrition Center, Little Rock, Ark
| | - Marcy Doderer
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ashlie Hilbun
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Ryan Solomon
- Arkansas Children's Hospital, Little Rock, Ark; Arkansas Children's Health System, Little Rock, Ark
| | - Amy M Scurlock
- University of Arkansas for Medical Sciences, Little Rock, Ark; Arkansas Children's Hospital, Little Rock, Ark
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3
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Atuiri C, Zhang W, Cronin C. Eosinophilic Enteritis Causing Recurrent Small Bowel Obstruction: A Case Report. Cureus 2024; 16:e54355. [PMID: 38500945 PMCID: PMC10946293 DOI: 10.7759/cureus.54355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2024] [Indexed: 03/20/2024] Open
Abstract
Eosinophilic enteritis is an inflammatory condition characterized by eosinophilic infiltration of the gastrointestinal tract. This case report highlights a unique presentation of eosinophilic enteritis as a cause of recurrent small bowel obstruction. The diagnosis was elusive despite extensive abdominal imaging. A histopathologic examination of a full-thickness bowel segment showing extensive eosinophilic infiltration in the muscularis propria was vital in establishing the diagnosis. This report underscores the diagnostic complexities associated with eosinophilic enteritis and the need to consider this condition as a potential cause of recurrent abdominal pain and small bowel obstruction.
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Affiliation(s)
| | - Wei Zhang
- Internal Medicine, St. Luke's Hospital, St. Louis, USA
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4
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Tanaka F, Kanamori A, Sawada A, Ominami M, Nadatani Y, Fukunaga S, Otani K, Hosomi S, Kamata N, Nagami Y, Taira K, Fujiwara Y. Correlation between anxiety and decreased quality of life in patients with non-esophageal eosinophilic gastrointestinal diseases. JGH Open 2024; 8:e13025. [PMID: 38268958 PMCID: PMC10805507 DOI: 10.1002/jgh3.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Background and Aim Mental status such as anxiety and depression in patients with non-esophageal eosinophilic gastrointestinal diseases (non-EoE EGIDs) has not been studied. The aim of this study was to evaluate whether patients with non-EoE EGIDs had mental disorders and decreased mental-health-related quality of life (QOL) similar to those in patients with disorders of gut-brain interaction (DGBI). Methods We enrolled patients with non-EoE EGIDs and DGBI visiting the Osaka Metropolitan University Hospital, and the measures listed below were compared between the groups. We collected data using the following questionnaires: hospital anxiety and depression scale, and short form (SF)-8 including mental component summary (MCS)-8. Results We evaluated 21 and 17 patients with non-EoE EGIDs and DGBI, respectively. The anxiety score was not significantly different between the groups. The proportion of patients with possible anxiety was not significantly different between the groups (19.0% vs 33.3%). These results show that patients with non-EoE EGIDs had anxiety that might be equivalent to that of patients with DGBI. The depression score and proportion of patients with possible depression in the non-EoE EGID group tended to be lower than those in the DGBI group. MCS-8 scores were not significantly different between the non-EoE EGID and DGBI groups, which might imply an equivalent decrease in mental-health-related QOL in both groups of patients. In patients with non-EoE EGIDs, the anxiety score had a significant inverse association with the MCS-8 score. Conclusions Patients with non-EoE EGIDs may have anxiety that correlates with decreased mental-health-related QOL.
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Affiliation(s)
- Fumio Tanaka
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Atsushi Kanamori
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
- Department of Premier Preventive MedicineGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Akinari Sawada
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Masaki Ominami
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Yuji Nadatani
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
- Department of Premier Preventive MedicineGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Shusei Fukunaga
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Koji Otani
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Shuhei Hosomi
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Noriko Kamata
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Yasuaki Nagami
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Koichi Taira
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Yasuhiro Fujiwara
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
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5
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Ito K, Shibuya T, Nomura K, Haraikawa M, Kurosawa T, Haga K, Akazawa Y, Murakami T, Nomura O, Hojo M, Yao T, Nagahara A. Successful Treatment of Steroid-resistant Eosinophilic Gastrointestinal Disease with Mepolizumab. Intern Med 2023; 62:3461-3467. [PMID: 37081676 PMCID: PMC10749822 DOI: 10.2169/internalmedicine.0801-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/10/2023] [Indexed: 04/22/2023] Open
Abstract
We experienced a case of treatment-resistant eosinophilic gastrointestinal disease (EGID). The patient, a 46-year-old man, presented with a fever, persistent abdominal pain, and an elevated peripheral eosinophil count. Eosinophil infiltration of the intestinal mucosa was also observed, and EGID was diagnosed. Corticosteroid therapy was initiated, but no improvement was seen. However, after mepolizumab (anti-interleukin 5 antibody) was administered, the patient's disease was controlled. Currently, the indications for mepolizumab are limited to bronchial asthma and paraneoplastic eosinophilic polyangiitis, but the experience herein reported suggests its usefulness in the treatment of EGID.
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Affiliation(s)
- Kentaro Ito
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Tomoyoshi Shibuya
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Kei Nomura
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Mayuko Haraikawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Taro Kurosawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Keiichi Haga
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Yoichi Akazawa
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Takashi Murakami
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Osamu Nomura
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Mariko Hojo
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
| | - Takashi Yao
- Department of Human Pathology, Juntendo University School of Medicine, Japan
| | - Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Japan
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6
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Nguyen PV, Quach DT, Bui MH, Dang TP, Talley NJ. A Clinicopathologic Continuum of Eosinophilic Gastrointestinal Diseases in an Adult With Tuberculosis and Latent Hepatitis B Virus Infection. ACG Case Rep J 2023; 10:e01176. [PMID: 37829167 PMCID: PMC10567028 DOI: 10.14309/crj.0000000000001176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/13/2023] [Indexed: 10/14/2023] Open
Abstract
Eosinophilic gastroenteritis (EGE) is considered distinct from eosinophilic colitis (EC). A 59-year-old man presented with a colonic tumor, who had resolution of pain and diarrhea after surgery, then 7 months later developed proton-pump inhibitor-responsive dysphagia with esophagitis, and 9 months later presented again with pain and diarrhea where EGE with concurrent eosinophilic esophagitis was diagnosed. Review of the resected tumor specimen identified EC with an adenoma. Workup revealed tuberculosis and latent hepatitis B virus requiring treatment before commencing immunosuppressive therapy plus a 6-food elimination diet that led to complete resolution within 3 weeks. EC may precede EGE and eosinophilic esophagitis.
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Affiliation(s)
- Phong V. Nguyen
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam
| | - Duc T. Quach
- Department of Gastroenterology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam
- Department of Internal Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
| | - Minh H.Q. Bui
- Laboratory Department, Vinmec Central Park International Hospital, Ho Chi Minh, Vietnam
- Department of Pathology, Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam
| | - Thinh P. Dang
- Department of Endoscopy, Nhan Dan Gia Dinh Hospital, Ho Chi Minh, Vietnam
| | - Nicholas J. Talley
- Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health and NHMRC Centre of Research Excellence Digestive Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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7
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Djahandideh Sheijani S, Calabrese F, Pasta A, Marabotto E, Bodini G, Furnari M, Grillo F, Mastracci L, Savarino EV, Savarino V, Giannini EG. Clopidogrel-Induced Eosinophilic Colitis. ACG Case Rep J 2023; 10:e01118. [PMID: 37547482 PMCID: PMC10400044 DOI: 10.14309/crj.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/21/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
Eosinophilic colitis is a rare condition characterized by histologic findings of high eosinophilic infiltrate in the gut wall, typically presenting with diarrhea and abdominal pain. The etiology of this entity remains unclear because it can be primary or can occur secondarily to infections, drugs, or even in association with immune-mediated diseases. We present the case of a woman referred to our outpatient clinic for chronic diarrhea that had been worsening for months. Colonoscopy with biopsies was performed, and eosinophilic colitis associated with the use of clopidogrel was diagnosed. After clopidogrel discontinuation, a complete remission of the clinical and histological picture was observed.
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Affiliation(s)
- Shirin Djahandideh Sheijani
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Calabrese
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Andrea Pasta
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Elisa Marabotto
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Giorgia Bodini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Manuele Furnari
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federica Grillo
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, Pathological Anatomy Unit, University of Genoa, Genoa, Italy
| | - Luca Mastracci
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics, Pathological Anatomy Unit, University of Genoa, Genoa, Italy
| | - Edoardo V. Savarino
- Department of Surgery, Oncology, and Gastroenterology, University of Padua, Padua, Italy
- Gastroenterology Unit, Azienda Ospedale Università Padova, Padua, Italy
| | | | - Edoardo G. Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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8
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Huang J. Becoming the Patient. Gastroenterology 2023:S0016-5085(23)00585-1. [PMID: 37031911 DOI: 10.1053/j.gastro.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/11/2023]
Affiliation(s)
- Jenny Huang
- Division of Allergy, Asthma, and Immunology, Scripps Clinic.
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Abstract
The eosinophilic gastrointestinal diseases (EGIDs) are chronic, immune-mediated conditions characterized clinically by GI symptoms and histologically by pathologic infiltration of the GI tract by eosinophils. The most well-studied is eosinophilic esophagitis (EoE), but non-EoE EGIDs are becoming more frequently encountered. These have traditionally been classified by the predominant location inflammation, including eosinophilic gastritis (EoG; stomach only), eosinophilic enteritis (EoN; small bowel only), and eosinophilic colitis (EoC; colon only).(1 , 2 ) However, multiple locations can be involved (e.g. gastric and small bowel involvement), specific segments of the small bowel can be named (e.g. eosinophilic duodenitis; EoD), and efforts are underway to standardize this nomenclature. The non-EoE EGIDs are considered rare diseases, with studies of administrative databases estimating the prevalence to be approximately 3–8/100,000, or ~50,000 cases in the United States.(3 ) However, recent data suggest these conditions may be under diagnosed.(4 ) In this paper, I will review my approach to the diagnosis and management of the non-EoE EGIDs, highlighting a number of principles that can be applied in most settings.
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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, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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10
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Hirano I, Collins MH, King E, Sun Q, Chehade M, Abonia JP, Bonis PA, Capocelli KE, Dellon ES, Falk GW, Gonsalves N, Gupta SK, Leung J, Katzka D, Menard-Katcher P, Khoury P, Klion A, Mukkada VA, Peterson K, Shoda T, Rudman-Spergel AK, Spergel JA, Yang GY, Rothenberg ME, Aceves SS, Furuta GT; CEGIR investigators. Prospective Endoscopic Activity Assessment for Eosinophilic Gastritis in a Multisite Cohort. Am J Gastroenterol 2022; 117:413-23. [PMID: 35080202 DOI: 10.14309/ajg.0000000000001625] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 12/27/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Eosinophilic gastritis (EG) is a chronic inflammatory disease of the stomach characterized by eosinophil-predominant gastric mucosal inflammation and gastrointestinal symptoms. The aim of this study was to prospectively evaluate endoscopic features in a large series of children and adults with EG to better understand the endoscopic manifestations and develop a standardized instrument for investigations. METHODS Data were prospectively collected as part of the Consortium for Eosinophilic Gastrointestinal Disease Researchers, a national collaborative network. Endoscopic features were prospectively recorded using a system specifically developed for EG, the EG Endoscopic Reference System (EG-REFS). Correlations were made between EG-REFS and clinical and histologic features. RESULTS Of 98 patients with EG, 65 underwent assessments using EG-REFS. The most common findings were erythema (72%), raised lesions (49%), erosions (46%), and granularity (35%); only 8% of patients with active histology (≥30 eosinophils/high-power field) exhibited no endoscopic findings. A strong correlation between EG-REFS scores and physician global assessment of endoscopy severity was demonstrated (Spearman r = 0.84, P < 0.0001). The overall score and specific components of EG-REFS were more common in the antrum than in the fundus or body. EG-REFS severity was significantly correlated with active histology, defined by a threshold of ≥30 eosinophils/high-power field (P = 0.0002). DISCUSSION Prospective application of EG-REFS identified gastric features with a strong correlation with physician global assessment of endoscopic activity in EG. Endoscopic features demonstrated greater severity in patients with active histology and a predilection for the gastric antrum. Further development of EG-REFS should improve its utility in clinical studies.
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Neely JL, Reimers A, Taylor S, Garg S, Masuda MY, Schroeder S, Wright BL, Doyle AD. GATA-3 and T-bet as diagnostic markers of non-esophageal eosinophilic gastrointestinal disease. Allergy 2022; 77:1042-1044. [PMID: 34735725 DOI: 10.1111/all.15171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/19/2021] [Accepted: 10/31/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Joseph L. Neely
- University of Arizona College of Medicine –Phoenix Phoenix Arizona USA
| | - Annika Reimers
- Division of Allergy, Asthma, and Clinical Immunology Department of Medicine Mayo Clinic Arizona Scottsdale Arizona USA
| | - Steve Taylor
- Division of Laboratory Medicine and Pathology Phoenix Children’s Hospital Phoenix Arizona USA
| | - Shipra Garg
- Division of Laboratory Medicine and Pathology Phoenix Children’s Hospital Phoenix Arizona USA
| | - Mia Y. Masuda
- Division of Allergy, Asthma, and Clinical Immunology Department of Medicine Mayo Clinic Arizona Scottsdale Arizona USA
| | - Shauna Schroeder
- Division of Gastroenterology Phoenix Children’s Hospital Phoenix Arizona USA
| | - Benjamin L. Wright
- Division of Allergy, Asthma, and Clinical Immunology Department of Medicine Mayo Clinic Arizona Scottsdale Arizona USA
- Section of Allergy and Immunology Division of Pulmonology Phoenix Children’s Hospital Phoenix Arizona USA
| | - Alfred D. Doyle
- Division of Allergy, Asthma, and Clinical Immunology Department of Medicine Mayo Clinic Arizona Scottsdale Arizona USA
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12
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Hoofien A, Oliva S, Karl-Heinz Auth M, Brook E, Giordano C, Zouzo V, Simmons W, Rossetti D, Shukla R, Marderfeld L, Zevit N. A Quantitative Assessment of Mucosal Eosinophils in the Gastrointestinal Tract of Children Without Detectable Organic Disease. Pediatr Dev Pathol 2022; 25:99-106. [PMID: 34492208 DOI: 10.1177/10935266211039474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Accurate measurements of mucosal eosinophil concentrations in gastrointestinal tracts of healthy children are necessary to differentiate health and disease states in general, and better define eosinophilic gastrointestinal diseases. STUDY We retrospectively reviewed gastrointestinal biopsies from children with macroscopically normal endoscopies, who, after a minimal follow-up of one year, were not diagnosed with any organic disease. Peak eosinophil concentrations and distributions were assessed from each segment of the gastrointestinal tract. RESULTS Three centers (Italy, United Kingdom, and Israel) contributed 202 patients (median age 13 years IQR 9.5-15.5, range 1-18 years). Median (IQR, range) eosinophil concentrations (eos/mm2) were: esophagus 0 (0-0, 0-84), stomach 0 (0-4, 0-84), duodenal bulb 20 (13-30, 7-67), second part of duodenum 20 (13-29, 0-105), terminal ileum 29 (14-51, 0-247), cecum 53 (37-89, 10-232), ascending colon 55 (25-84, 0-236), transverse colon 38 (21-67, 4-181), descending colon 29 (17-59, 0-114), sigmoid colon 25 (13-40, 0-215) and rectum 13 (4-28, 0-152). Significant geographical variance was present, however, no differences in eosinophil concentrations were identified between children with resolving symptoms vs. those with functional diagnoses, nor across age groups. CONCLUSIONS Standardized eosinophil concentrations from the gastrointestinal tracts of children without organic disease will serve to better define both health and disease states. No differences were found between resolved symptoms vs. functional diagnoses nor between age groups in this pediatric cohort.
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Affiliation(s)
- Assaf Hoofien
- Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Salvatore Oliva
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza-University of Rome, Italy
| | - Marcus Karl-Heinz Auth
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Elena Brook
- Department of Pathology, Rabin Medical Center-Beilinson Campus, Petach Tikva, Israel
| | - Carla Giordano
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Vaia Zouzo
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - William Simmons
- Department of Histopathology, Cellular Pathology Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Danilo Rossetti
- Pediatric Gastroenterology and Liver Unit, Maternal and Child Health Department, Sapienza-University of Rome, Italy
| | - Rajeev Shukla
- Department of Histopathology, Cellular Pathology Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Luba Marderfeld
- Division of Gastroenterology, The Ottawa Hospital IBD Centre, Ottawa, Ontario, Canada
| | - Noam Zevit
- Institute of Gastroenterology, Nutrition, and Liver Diseases, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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13
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Salman H, Akçam M. Familial Mediterranean fever presenting with eosinophilic gastritis. Pediatr Int 2022; 64:e14744. [PMID: 34724289 DOI: 10.1111/ped.14744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/30/2021] [Accepted: 04/09/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Hakan Salman
- Department of Pediatric Gastroenterology Hepatology & Nutrition, Suleyman Demirel University, Isparta, Turkey
| | - Mustafa Akçam
- Department of Pediatric Gastroenterology Hepatology & Nutrition, Suleyman Demirel University, Isparta, Turkey
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14
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Abstract
Eosinophilic esophagitis (EoE) is a relatively recently identified but now frequently encountered antigen/immune-mediated disease which places significant burden on patients and the healthcare system. With its growing prevalence and recognition by healthcare providers in multiple disciplines, substantial progress has been made regarding the diagnostic criteria, clinical evaluation, tools for disease assessment, and immune pathways related to pathogenesis. Current treatment goals focus on the amelioration of inflammation and prevention of remodeling consequences using proton pump inhibitors, swallowed topical steroids, elimination diets, and esophageal dilation. Ongoing research holds promise for more efficacious and targeted therapies as well as a personalized approach to the care of patients with EoE.
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Affiliation(s)
- Ronak V Patel
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; , ,
| | - Ikuo Hirano
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; , ,
| | - Nirmala Gonsalves
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA; , ,
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Devi S, Kar N, Sahoo D, Dey A, Das DS. Eosinophilic Ascites: A Rare Case Report With Diagnostic and Therapeutic Challenges. Cureus 2020; 12:e11362. [PMID: 33304695 PMCID: PMC7720916 DOI: 10.7759/cureus.11362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Eosinophilic ascites is a manifestation of serosal eosinophilic gastrointestinal disease. We present a 44-year-old male with low serum ascites albumin gradient with high eosinophil count and contrast-enhanced computed tomography of the abdomen showing circumferential wall thickening of the esophagus, mid to distal ileal loops, and ascending colon. The patient was managed with tablet prednisolone 20 mg twice daily for two weeks, then gradual tapering over one month. The patient responded to treatment. Awareness of the condition, timely diagnosis, and early treatment carries excellent responses.
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Affiliation(s)
- Sujata Devi
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Nilanjan Kar
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Debananda Sahoo
- Internal Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Anupam Dey
- General Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Dhriti Sundar Das
- General Medicine, All India Institute of Medical Sciences, Bhubaneswar, IND
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16
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Jensen ET, Aceves SS, Bonis PA, Bray K, Book W, Chehade M, Collins MH, Dellon ES, Falk GW, Gonsalves N, Gupta SK, Hirano I, Katzka DA, Kyle S, Mack D, Kodroff E, Leung J, Mukkada VA, Scott M, Paliana A, Sable K, Spergel JM, Strobel MJ, Krischer J, Rothenberg ME, Abonia P; CEGIR Investigator group. High Patient Disease Burden in a Cross-sectional, Multicenter Contact Registry Study of Eosinophilic Gastrointestinal Diseases. J Pediatr Gastroenterol Nutr 2020; 71:524-9. [PMID: 32541201 DOI: 10.1097/MPG.0000000000002817] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Clinical features of eosinophilic esophagitis (EoE) have been well-described in the literature, however, characterization of features experienced by patients with other eosinophilic gastrointestinal diseases (EGIDs) is lacking. Using data collected from a patient contact registry, we sought to characterize and contrast patient-reported gastrointestinal and extragastrointestinal symptoms and comorbidities in non-EoE EGIDs, including eosinophilic gastritis, gastroenteritis and colitis, relative to EoE. METHODS We conducted a cross-sectional study of contact registry data collected from 2015 to 2018. Statistical comparisons were made using chi-square (categorical measures) and the Mann-Whitney U test (continuous measures). Multivariable analyses were used to evaluate associations between treatment and feelings of isolation. RESULTS Of the 715 reporting an EGID diagnosis (n = 525 EoE; n = 190 non-EoE EGID), a higher proportion of those with a non-EoE EGID reported more frequent specific and nonspecific gastrointestinal symptoms, including nausea, abdominal pain, diarrhea, constipation, and bloating (P < 0.01 for all). Participants with a non-EoE EGID were more likely to report higher frequency of fatigue, isolation, and deep muscle or joint pain (P < 0.01 for all). Specific food elimination and elemental formula treatments were associated with increased odds of more frequent (at least weekly) feelings of isolation for participants with EoE (adjusted odds rtaio [aOR]: 2.4; 95% confidence interval [CI]: 1.5--4.1 for specific food elimination and adjusted OR: 1.9; 95% CI: 1.2--3.3 for elemental formula). CONCLUSIONS Significant differences exist in the symptoms and comorbidities experienced between those with EoE versus non-EoE EGIDs. Additional investigation is needed to elucidate the factors that may contribute to the high disease burden of these poorly understood conditions.
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Abstract
Primary atopic disorders can be classified as heritable genetic disorders presenting with deregulated pathogenic allergic effector responses irrespective of sensitization. In the last decade, there are parallel rises in the burden of atopic and gastrointestinal (GI) diseases. Areas covered: There is increasing recognition of an association between atopy and GI disease through immune dysregulation, the microbiome and shared genetic pathways. Since the first article on atopy and the GI tract in 2014 in this journal, many more studies have shed light on the shared pathways in these diseases, particularly in the field of eosinophilic GI disease, functional GI disorders, and inflammatory bowel disease. Expert opinion: Understanding the links with common mechanisms in atopy and GI diseases that may lead to better targeting of treatment through manipulation of immune mechanisms, the microbiome, genetics, food allergens and specific GI diseases such as inflammatory bowel disease, functional GI disorders.
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Affiliation(s)
- Marjorie M Walker
- a Faculty of Medicine & Health University of Newcastle , School of Medicine & Public Health , Callaghan , NSW , Australia.,b School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine , University of Newcastle , Newcastle , NSW , Australia.,c Priority Research Centre for Digestive Health and Neurogastroenterology , University of Newcastle , Newcastle , NSW , Australia
| | - Nicholas J Talley
- c Priority Research Centre for Digestive Health and Neurogastroenterology , University of Newcastle , Newcastle , NSW , Australia.,d Priority Research Centre for Digestive Health & Neurogastroenterology , Hunter Medical Research Institute, New Lambton Heights , Newcastle , NSW , Australia
| | - Simon Keely
- b School of Biomedical Sciences & Pharmacy, Faculty of Health & Medicine , University of Newcastle , Newcastle , NSW , Australia.,c Priority Research Centre for Digestive Health and Neurogastroenterology , University of Newcastle , Newcastle , NSW , Australia.,d Priority Research Centre for Digestive Health & Neurogastroenterology , Hunter Medical Research Institute, New Lambton Heights , Newcastle , NSW , Australia
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18
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Legrand F, Cao Y, Wechsler JB, Zhu X, Zimmermann N, Rampertaap S, Monsale J, Romito K, Youngblood BA, Brock EC, Makiya MA, Tomasevic N, Bebbington C, Maric I, Metcalfe DD, Bochner BS, Klion AD. Sialic acid-binding immunoglobulin-like lectin (Siglec) 8 in patients with eosinophilic disorders: Receptor expression and targeting using chimeric antibodies. J Allergy Clin Immunol 2018; 143:2227-2237.e10. [PMID: 30543818 DOI: 10.1016/j.jaci.2018.10.066] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 09/19/2018] [Accepted: 10/26/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sialic acid-binding immunoglobulin-like lectin (Siglec) 8 is selectively expressed on eosinophils, mast cells, and basophils and, when engaged on eosinophils, can cause cell death. OBJECTIVE We sought to characterize surface and soluble Siglec-8 (sSiglec-8) levels in normal donors (NDs) and eosinophilic donors (EOs) and assess the efficacy of anti-Siglec-8 antibodies in inducing eosinophil cell death in vitro. METHODS Eosinophil expression of Siglec-8 was assessed by using flow cytometry and quantitative PCR. Serum sSiglec-8 levels were measured by means of ELISA. Induction of eosinophil death by IgG4 (chimeric 2E2 IgG4) and afucosylated IgG1 (chimeric 2E2 IgG1 [c2E2 IgG1]) anti-Siglec-8 antibodies was evaluated in vitro by using flow cytometry and in vivo in humanized mice. RESULTS Siglec-8 was consistently expressed on eosinophils from NDs and EOs and did not correlate with absolute eosinophil count or disease activity. sSiglec-8 levels were measurable in sera from most donors unrelated to absolute eosinophil counts or Siglec-8 surface expression. c2E2 IgG1 and chimeric 2E2 IgG4 were equally effective at inducing cell death (Annexin-V positivity) of purified eosinophils from NDs and EOs after overnight IL-5 priming. In contrast, killing of purified eosinophils without IL-5 was only seen in EOs, and natural killer cell-mediated eosinophil killing was seen only with c2E2 IgG1. Finally, treatment of humanized mice with anti-Siglec antibody led to robust depletion of IL-5-induced eosinophilia in vivo. CONCLUSIONS Siglec-8 is highly expressed on blood eosinophils from EOs and NDs and represents a potential therapeutic target for eosinophilic disorders. Enhanced killing of eosinophils in the presence of IL-5 might lead to increased efficacy in patients with IL-5-driven eosinophilia.
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MESH Headings
- Animals
- Antibodies, Blocking/genetics
- Antigens, CD/genetics
- Antigens, CD/immunology
- Antigens, CD/metabolism
- Antigens, Differentiation, B-Lymphocyte/genetics
- Antigens, Differentiation, B-Lymphocyte/immunology
- Antigens, Differentiation, B-Lymphocyte/metabolism
- Cell Death
- Cells, Cultured
- Cytotoxicity, Immunologic
- Eosinophilia/immunology
- Eosinophilia/therapy
- Eosinophils/immunology
- Humans
- Immunoglobulin G/genetics
- Interleukin-5/metabolism
- Killer Cells, Natural/immunology
- Lectins/genetics
- Lectins/immunology
- Lectins/metabolism
- Leukocyte Count
- Mice
- Mice, SCID
- Molecular Targeted Therapy
- Recombinant Fusion Proteins/genetics
- Transcriptome
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Affiliation(s)
- Fanny Legrand
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md.
| | - Yun Cao
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Joshua B Wechsler
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill
| | - Xiang Zhu
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nives Zimmermann
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Shakuntala Rampertaap
- Department of Laboratory Medicine, Warren Magnusson Clinical Center, National Institutes of Health, Bethesda
| | - Joseph Monsale
- Department of Laboratory Medicine, Warren Magnusson Clinical Center, National Institutes of Health, Bethesda
| | - Kimberly Romito
- Department of Laboratory Medicine, Warren Magnusson Clinical Center, National Institutes of Health, Bethesda
| | | | | | - Michelle A Makiya
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | | | | | - Irina Maric
- Hematology Section, Department of Laboratory Medicine, Clinical Center, National Institutes of Health, Bethesda
| | - Dean D Metcalfe
- Mast Cell Biology Section, Laboratory of Allergic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md
| | - Bruce S Bochner
- Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Amy D Klion
- Human Eosinophil Section, Laboratory of Parasitic Diseases, National Institute of Allergy and Infectious Diseases, Bethesda, Md.
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19
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Mitson-Salazar A, Prussin C. Pathogenic Effector Th2 Cells in Allergic Eosinophilic Inflammatory Disease. Front Med (Lausanne) 2017; 4:165. [PMID: 29057225 PMCID: PMC5635264 DOI: 10.3389/fmed.2017.00165] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022] Open
Abstract
There is an absolute requirement for Th2 cells in the pathogenesis of allergen-driven eosinophil-rich type 2 inflammation. Although Th2 cells are generally regarded as a homogeneous population, in the past decade there has been increasing evidence for a minority subpopulation of IL-5+ Th2 cells that have enhanced effector function. This IL-5+ Th2 subpopulation has been termed pathogenic effector Th2 (peTh2), as it exhibits greater effector function and disease association than conventional Th2 cells. peTh2 cells have a different expression profile, differentially express transcription factors, and preferentially use specific signaling pathways. As such, peTh2 cells are a potential target in the treatment of allergic eosinophilic inflammation. This review examines peTh2 cells, both in mouse models and human disease, with an emphasis on their role in the pathogenesis of allergic eosinophilic inflammation.
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Affiliation(s)
- Alyssa Mitson-Salazar
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT, United States
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20
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Nguyen N, Furuta GT, Menard-Katcher C. Recognition and Assessment of Eosinophilic Esophagitis: The Development of New Clinical Outcome Metrics. Gastroenterol Hepatol (N Y) 2015; 11:670-674. [PMID: 27330494 PMCID: PMC4849519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Eosinophilic esophagitis (EoE) is a chronic, food-allergic disease manifest by symptoms of esophageal dysfunction and dense esophageal eosinophilia in which other causes have been excluded. Treatments include dietary restriction of the offending allergens, topical corticosteroids, and dilation of strictures. EoE has become increasingly prevalent over the past decade and has been increasingly recognized as a major health concern. Advancements in research and clinical needs have led to the development of novel pediatric- and adult-specific clinical outcome metrics (COMs). These COMs provide ways to measure clinically relevant features in EoE and set the stage for measuring outcomes in future therapeutic trials. In this article, we review novel symptom measurement assessments, the use of radiographic imaging to serve as a metric for therapeutic interventions, recently developed standardized methods for endoscopic assessment, novel techniques to evaluate esophageal mucosal inflammation, and methods for functional assessment of the esophagus. These advancements, in conjunction with current consensus recommendations, will improve the clinical assessment of patients with EoE.
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Affiliation(s)
- Nathalie Nguyen
- Dr Nguyen is a pediatric gastroenterology and hepatology fellow, Dr Furuta is a professor of pediatrics, and Dr Menard-Katcher is an assistant professor of pediatrics at the Digestive Health Institute and the Section of Pediatric Gastroenterology, Hepatology and Nutrition at Children's Hospital Colorado in Aurora, Colorado. The authors are also affiliated with the Gastrointestinal Eosinophilic Diseases Program and the Mucosal Inflammation Program at the University of Colorado School of Medicine in Aurora, Colorado
| | - Glenn T Furuta
- Dr Nguyen is a pediatric gastroenterology and hepatology fellow, Dr Furuta is a professor of pediatrics, and Dr Menard-Katcher is an assistant professor of pediatrics at the Digestive Health Institute and the Section of Pediatric Gastroenterology, Hepatology and Nutrition at Children's Hospital Colorado in Aurora, Colorado. The authors are also affiliated with the Gastrointestinal Eosinophilic Diseases Program and the Mucosal Inflammation Program at the University of Colorado School of Medicine in Aurora, Colorado
| | - Calies Menard-Katcher
- Dr Nguyen is a pediatric gastroenterology and hepatology fellow, Dr Furuta is a professor of pediatrics, and Dr Menard-Katcher is an assistant professor of pediatrics at the Digestive Health Institute and the Section of Pediatric Gastroenterology, Hepatology and Nutrition at Children's Hospital Colorado in Aurora, Colorado. The authors are also affiliated with the Gastrointestinal Eosinophilic Diseases Program and the Mucosal Inflammation Program at the University of Colorado School of Medicine in Aurora, Colorado
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21
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Parashette KR, Zeytinoglu M, Kernek K, Molleston JP, Subbarao G. Clinical, endoscopic, and histologic features of eosinophilic inflammation of the gastrointestinal tract in pediatric liver transplant patients. Pediatr Transplant 2013; 17:737-43. [PMID: 24025083 DOI: 10.1111/petr.12143] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 01/21/2023]
Abstract
Immunosuppression during the post-transplantation period has led to dramatic outcome improvements in PLTR patients. There have been reports describing the development of food allergies and an increased predilection for development of EGI in PLTR. We aimed to identify the clinical, endoscopic and histologic features of EGI in PLTR patients. In this retrospective case series we analyzed medical record of all PLTR who underwent EGD and/or colonoscopy at our institution from 2000 to 2006. From 2000 to 2006, 32 PLTR patients underwent endoscopic evaluation. Seventeen (53%) of 32 patients were diagnosed with EGI. Endoscopic abnormalities were seen in the esophagus, stomach, and small intestine in 11 (65%), 11 (65%), and four (24%) patients, respectively. Eosinophilic inflammation was seen in the esophagus, stomach, and small intestine in 13 (76%), 10 (59%), and five (29%) patients, respectively. Nine of 17 patients underwent colonoscopy and endoscopic abnormalities were seen in four (44%) patients. Five patients (56%) had eosinophilic inflammation. In conclusion, we have characterized the clinical, endoscopic, and histologic features of EGI. Histologic and endoscopic examination reveals that, when present, EGI is often found at multiple segments along the gastrointestinal tract.
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Affiliation(s)
- Kalyan Ray Parashette
- Indiana University School of Medicine, James Whitcomb Riley Hospital for Children, Pediatric Gastroenterology, Hepatology and Nutrition, Indianapolis, IN, USA
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22
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Brandon JL, Schroeder S, Furuta GT, Capocelli K, Masterson JC, Fenton LZ. CT imaging features of eosinophilic colitis in children. Pediatr Radiol 2013; 43:697-702. [PMID: 23361493 PMCID: PMC3816107 DOI: 10.1007/s00247-012-2615-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Revised: 10/31/2012] [Accepted: 11/09/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Eosinophilic colitis (EC) is a gastrointestinal disease of undetermined etiology whose clinical features overlap with those of the inflammatory bowel diseases. To the best of our knowledge, the CT imaging features of EC have not been described in children. OBJECTIVE To report and analyze the clinical, imaging and histological findings in seven children with EC. MATERIALS AND METHODS Children with EC were identified in a pediatric pathology database, and those with CT imaging within 2 months of diagnosis were included, totaling seven children. Clinical, imaging and pathological features were reviewed and analyzed. RESULTS The most common presenting symptoms were abdominal pain, bloody diarrhea and rectal bleeding. EC was characterized as a dense and predominantly eosinophilic inflammatory infiltrate in the lamina propria or epithelium without granulomas. CT scans were abnormal in six children (86%), demonstrating colonic wall thickening, predominantly cecal, in five (71%), mild to moderate terminal ileal thickening in two (29%), and pneumatosis in one (14%). Right colonic involvement was greater than terminal ileal involvement. CONCLUSION CT imaging findings in children with EC include right colonic wall thickening of variable extent downstream and absent or mild involvement of the terminal ileum. EC should be considered in the differential diagnosis in children presenting with abdominal pain and bloody diarrhea.
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Affiliation(s)
- Jonathan L. Brandon
- Department of Radiology, Children's Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
| | - Shauna Schroeder
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Glenn T. Furuta
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Kelley Capocelli
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Department of Pathology, Children's Hospital Colorado, Aurora, CO, USA
| | - Joanne C. Masterson
- Department of Pediatrics, Gastrointestinal Eosinophilic Diseases Program, University of Colorado Denver School of Medicine, Aurora, CO, USA; Digestive Health Institute, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital Colorado, Aurora, CO, USA; Department of Pediatrics, National Jewish Health, Denver, CO, USA
| | - Laura Z. Fenton
- Department of Radiology, Children's Hospital Colorado, 13123 E. 16th Ave., Aurora, CO 80045, USA
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23
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Abonia JP, Wen T, Stucke EM, Grotjan T, Griffith MS, Kemme KA, Collins MH, Putnam PE, Franciosi JP, von Tiehl KF. High prevalence of eosinophilic esophagitis in patients with inherited connective tissue disorders. J Allergy Clin Immunol. 2013;132:378-386. [PMID: 23608731 DOI: 10.1016/j.jaci.2013.02.030] [Citation(s) in RCA: 127] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 12/13/2022]
Abstract
BACKGROUND Eosinophilic esophagitis (EoE) is an emerging chronic inflammatory disease mediated by immune hypersensitization to multiple foods and strongly associated with atopy and esophageal remodeling. OBJECTIVE We provide clinical and molecular evidence indicating a high prevalence of EoE in patients with inherited connective tissue disorders (CTDs). METHODS We examined the rate of EoE among patients with CTDs and subsequently analyzed esophageal mRNA transcript profiles in patients with EoE with or without CTD features. RESULTS We report a cohort of 42 patients with EoE with a CTD-like syndrome, representing 0.8% of patients with CTDs and 1.3% of patients with EoE within our hospital-wide electronic medical record database and our EoE research registry, respectively. An 8-fold risk of EoE in patients with CTDs (relative risk, 8.1; 95% confidence limit, 5.1-12.9; χ(2)1 = 112.0; P < 10(-3)) was present compared with the general population. Esophageal transcript profiling identified a distinct subset of genes, including COL8A2, in patients with EoE and CTDs. CONCLUSION There is a remarkable association of EoE with CTDs and evidence for a differential expression of genes involved in connective tissue repair in this cohort. Thus, we propose stratification of patients with EoE and CTDs into a subset referred to as EoE-CTD.
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Spergel JM, Book WM, Mays E, Song L, Shah SS, Talley NJ, Bonis PA. Variation in prevalence, diagnostic criteria, and initial management options for eosinophilic gastrointestinal diseases in the United States. J Pediatr Gastroenterol Nutr 2011; 52:300-6. [PMID: 21057327 DOI: 10.1097/MPG.0b013e3181eb5a9f] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Variation in the prevalence of eosinophilic gastrointestinal diseases in different geographical regions has not been extensively studied. The aim of the present study was to define the regional and national prevalence of eosinophilic gastrointestinal diseases, and differences in practice approaches. PATIENTS AND METHODS We administered a survey electronically to members of the American College of Gastroenterology, the American Academy of Allergy, Asthma, and Immunology, and the North American Society Pediatric Gastroenterology, Hepatology, and Nutrition. Questions pertained to the number and proportion of patients seen with eosinophilic gastroenteritis or colitis and eosinophilic esophagitis (EoE), and methods used to diagnose and treat these conditions. RESULTS A total of 1836 physicians responded from 10,874 requests (17% response). Extrapolating responses from our US sample, we estimated an overall prevalence of 52 and 28/100,000 for EoE and eosinophilic gastroenteritis or colitis. The patient burden of EoE is higher in urban (0.58) and suburban (0.44) compared with rural settings (0.36, P < 0.0065), observations consistent with other allergic disorders. There was also increased prevalence in northeast region when calculated by prevalence per 100,000. There was considerable variability in criteria and initial treatment options used to diagnose EoE. Only one-third of respondents reported using diagnostic criteria proposed in a 2007 consensus document. Seventy-one and 35% of respondents reported treating some patients with EoE with a food elimination or elemental diet, respectively. CONCLUSIONS EoE is diagnosed more often in northeastern states and urban areas. There is considerable variability in diagnostic criteria and initial treatment approach supporting the need for additional clinical trials and consensus development.
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