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Di Chio T, Sokollik C, Peroni DG, Hart L, Simonetti G, Righini-Grunder F, Borrelli O. Nutritional Aspects of Pediatric Gastrointestinal Diseases. Nutrients 2021; 13:nu13062109. [PMID: 34205445 PMCID: PMC8235230 DOI: 10.3390/nu13062109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022] Open
Abstract
In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively “harmless” nature. Apart from a diet’s therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical “side effects”, however, it should be emphasized that any dietary modification might have negative consequences on children’s growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.
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Affiliation(s)
- Teresa Di Chio
- Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland;
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Christiane Sokollik
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital, Inselspital, University of Bern, 3010 Bern, Switzerland
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Diego G. Peroni
- Department of Clinical and Experimental Medicine, Section of Pediatrics, University of Pisa, 56126 Pisa, Italy;
| | - Lara Hart
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, McMaster University, Hamilton, ON L8N 3Z5, Canada;
| | - Giacomo Simonetti
- Pediatric Institute of Southern Switzerland, Ospedale Regionale di Bellinzona e Valli, Via Ospedale 12, 6500 Bellinzona, Switzerland;
- Università della Svizzera Italiana, 6900 Lugano, Switzerland
| | - Franziska Righini-Grunder
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Lucerne Children’s Hospital, Cantonal Hospital Lucerne, 6000 Lucerne, Switzerland
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
| | - Osvaldo Borrelli
- Division of Neurogastroenterology and Motility, Department of Pediatric Gastroenterology, University College London (UCL) Institute of Child Health and Great Ormond Street, London WC1N 3JH, UK
- Correspondence: (T.D.C.); (C.S.); (F.R.-G.); (O.B.)
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Huang X, Liao X, Xiao Z, Huang Z. Halo sign and araneid limb-like sign in eosinophilic enteritis. Lancet Gastroenterol Hepatol 2020; 5:954. [PMID: 32941835 DOI: 10.1016/s2468-1253(20)30115-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Xing Huang
- First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China.
| | - Xiangqi Liao
- First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Zhigang Xiao
- First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
| | - Zhongcheng Huang
- First Department of General Surgery (Department of Colorectal and Anal Surgery), Hunan Provincial People's Hospital (First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
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Abstract
PURPOSE OF REVIEW To provide an overview of recent developments on dietary treatment of eosinophilic gastrointestinal disorders (EGID) in children. RECENT FINDINGS Food antigens are the main triggers of eosinophilic esophagitis (EoE); however, currently available allergy tests cannot reliably identify eliciting antigens. Studies evaluating the six-food empiric elimination diet (6FED-milk, wheat/gluten, egg, soy/legumes, nuts and fish/seafood) have shown histological remission rates of 72%. Milk, egg, wheat/gluten, and, to a lesser extent, soy/legumes were the most frequent food triggers with only one or two culprit foods identified for most patients. A 4-food elimination strategy afforded a 64% remission rate. A step-up two-four-six food elimination diet generated a 43% remission rate at the two-food elimination stage, and similar reported rates for 4FED and 6FED. Endoscopic procedures were reduced by a 20% compared with 6FED. In a prospective study including 63 children, exclusive milk elimination has been effective in 44% of them. Controlled elimination and reintroduction with histological assessment is necessary. SUMMARY Dietary therapy of EoE has evolved from more restrictive to less restrictive diets to provide better balance between efficacy vs. nutritional deficiencies and quality of life. Data on efficacy of dietary therapy in other EGIDs are very scarce.
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Affiliation(s)
- Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, University Hospital Puerta de Hierro Majadahonda, Autonomous University of Madrid, Madrid, Spain
| | - Noam Zevit
- Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Petah Tikva
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Madison JM, Bhardwaj V, Braskett M. Strategy for Food Reintroduction Following Empiric Elimination and Elemental Dietary Therapy in the Treatment of Eosinophilic Gastrointestinal Disorders. Curr Gastroenterol Rep 2020; 22:25. [PMID: 32222940 DOI: 10.1007/s11894-020-00758-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 06/10/2023]
Abstract
PURPOSE OF REVIEW This review presents the available data regarding efficacy of nutritional therapy, highlighting clinical decision points and a strategy for reintroduction of foods following an elemental diet for treatment of eosinophilic gastrointestinal disorders. RECENT FINDINGS Elemental and empiric elimination diets are highly effective treatments for eosinophilic gastrointestinal diseases. Standardization in the reintroduction phase, after utilizing the diet for disease remission, is lacking. Clinicians are confronted with multiple challenges regarding the best practice for food reintroduction and identification of potential dietary triggers including order of foods being challenged and duration between endoscopic procedures. Individualization is required for preference and adherence to optimize quality of life and treatment success for this burdensome and life altering immune driven gastrointestinal disorder. Age specific concerns for children, teenagers, and adults should be assessed using a patient centric approach.
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Affiliation(s)
- Jill M Madison
- Division of Clinical Immunology & Allergy, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Vrinda Bhardwaj
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Melinda Braskett
- Division of Clinical Immunology & Allergy, Children's Hospital Los Angeles, Los Angeles, CA, USA.
- Clinical Pediatrics, Keck School of Medicine of USC, Los Angeles, CA, USA.
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Wilechansky RM, Spring M, Huang Q, Zullow S. Eosinophilic esophagitis, gastroenteritis, and colitis in a patient with prior parasite exposure. Clin J Gastroenterol 2019; 12:530-533. [PMID: 31077082 DOI: 10.1007/s12328-019-00988-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 03/20/2019] [Accepted: 04/22/2019] [Indexed: 10/26/2022]
Abstract
Eosinophilic gastrointestinal disorders (EGID) comprise a spectrum of inflammatory diseases that can affect any segment of the gastrointestinal tract. The pathogenesis of these conditions is complex; differentiating between primary and secondary forms of these disorders can be clinically challenging. We report a case of primary EGID in a patient with remote parasite exposure, whose symptoms were initially attributed to irritable bowel syndrome. Endoscopy revealed the rare finding of EGID involving the entire gastrointestinal tract; symptoms improved with an elimination diet. This case raises the possibility of a link between prior parasite exposure and development of EGID, and underscores the necessity of exploring alternative diagnoses in patients with presumed IBS who present with severe symptoms.
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Affiliation(s)
| | - Matthew Spring
- Department of Internal Medicine, Boston Medical Center, Boston, MA, USA
| | - Qin Huang
- Department of Pathology, VA Boston Healthcare System, West Roxbury Division, West Roxbury, MA, USA
| | - Samantha Zullow
- Division of Gastroenterology and Hepatology, Department of Medicine, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
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Sylva D, Tamayo L, Mosquera-Klinger G, Carvajal JJ, Pérez JC. Eosinophilic gastroenteritis: An unusual presentation of a rare disease. Rev Gastroenterol Mex (Engl Ed) 2019; 84:116-118. [PMID: 29555104 DOI: 10.1016/j.rgmx.2018.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/19/2017] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Affiliation(s)
- D Sylva
- Medicina Interna, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - L Tamayo
- Medicina Interna, Universidad Pontificia Bolivariana, Medellín, Colombia
| | | | - J J Carvajal
- Gastroenterología, Hospital Pablo Tobón Uribe, Medellín, Colombia
| | - J C Pérez
- Patología, Hospital Pablo Tobón Uribe; Universidad Pontificia Bolivariana, Medellín, Colombia
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Barros KV, Flor Silveira VL, Laranjeira MS, Wandalsen NF, Passeti S, de Oliveira R, Munekata RV, Noakes PS, Miles EA, Calder PC. Evidence for Involvement of IL-9 and IL-22 in Cows' Milk Allergy in Infants. Nutrients 2017; 9:E1048. [PMID: 28934137 PMCID: PMC5691665 DOI: 10.3390/nu9101048] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/07/2017] [Accepted: 09/18/2017] [Indexed: 12/13/2022] Open
Abstract
Although allergic inflammation is characterized by a T helper (Th) 2-dominant immune response, the discovery of a role for new T cell subsets in inflammatory diseases has added an additional layer of complexity to the understanding of the pathogeneses of allergic diseases. We evaluated plasma cytokine profiles in infants with cows' milk allergy (CMA), who were being treated with an elimination diet. In a prospective, randomized and controlled study, infants (aged 8.4 ± 3.9 months) with CMA were treated with an elimination diet for 120 days, which replaced cows' milk with a hydrolysed soy protein formula (n = 26) or a free amino acid formula (n = 20). Blood samples were collected before treatment during active disease (T0) and after 120 days, when symptoms were absent (T1). Plasma cytokine concentrations were measured. Infants with CMA had higher plasma concentrations of interleukin (IL)-4 and IL-13 and lower concentrations of IL-9, IL-17A and interferon-γ, compared with healthy breast-fed infants. At T0, there was a positive correlation between blood eosinophil numbers and plasma concentrations of IL-4, IL-9, IL-17A and IL-22. Treatment with a cows' milk elimination diet resulted in a decrease in plasma IL-4, IL-9, IL-13 and IL-22 and an increase in plasma IL-17A. We conclude that IL-4 and IL-13 are elevated in active CMA. The association of IL-9 and IL-22 with eosinophilia, and the decrease in these two cytokines with cows' milk elimination, suggests that they both play a role in the symptoms observed in CMA and may be important targets for future interventions.
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Affiliation(s)
- Karina V Barros
- Department of Physiology, Federal University of São Paulo, São Paulo SP CEP 04023-900, Brazil.
| | - Vera L Flor Silveira
- Department of Biological Sciences, Federal University of São Paulo, Diadema SP CEP 09972-270, Brazil.
| | - Marisa S Laranjeira
- Department of Pediatrics, Faculty of Medicine, Federal University of ABC, Santo André SP CEP 09210-580, Brazil.
| | - Neusa F Wandalsen
- Department of Pediatrics, Faculty of Medicine, Federal University of ABC, Santo André SP CEP 09210-580, Brazil.
| | - Susana Passeti
- Department of Pediatrics, Faculty of Medicine, Federal University of ABC, Santo André SP CEP 09210-580, Brazil.
| | - Roberta de Oliveira
- Department of Pediatrics, Faculty of Medicine, Federal University of ABC, Santo André SP CEP 09210-580, Brazil.
| | - Regina V Munekata
- Department of Pediatrics, Faculty of Medicine, Federal University of ABC, Santo André SP CEP 09210-580, Brazil.
| | - Paul S Noakes
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Elizabeth A Miles
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
| | - Philip C Calder
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
- National Institute for Health Research Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton SO16 6YD, UK.
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8
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Riggle KM, Wahbeh G, Williams EM, Riehle KJ. Perforated duodenal ulcer: An unusual manifestation of allergic eosinophilic gastroenteritis. World J Gastroenterol 2015; 21:12709-12712. [PMID: 26640348 PMCID: PMC4658626 DOI: 10.3748/wjg.v21.i44.12709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/04/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis (EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.
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9
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Yang M, Geng L, Chen P, Wang F, Xu Z, Liang C, Li H, Fang T, Friesen CA, Gong S, Li D. Effectiveness of dietary allergen exclusion therapy on eosinophilic colitis in Chinese infants and young children ≤ 3 years of age. Nutrients 2015; 7:1817-27. [PMID: 25768952 PMCID: PMC4377883 DOI: 10.3390/nu7031817] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/06/2015] [Accepted: 02/16/2015] [Indexed: 12/19/2022] Open
Abstract
Eosinophilic colitis is a well recognized clinical entity mainly associated with food allergies. Empiric treatment options include dietary allergen exclusion (extensively hydrolyzed protein formula and elimination diet), anti-allergy medications (antihistamines and leukotriene receptor antagonists) and corticosteroids. We evaluated the effectiveness of dietary antigen exclusion on clinical remission of eosinophilic colitis in infants and young children. We retrospectively reviewed charts of all infants and children ≤3 years of age who were diagnosed with eosinophilic colitis (defined as mucosal eosinophilia ≥20 hpf−1) from 1 January 2011 to 31 December 2013 at a tertiary children’s hospital in China. Forty-nine children were identified with eosinophilic colitis. Elemental formula, simple elimination diet or combination therapy resulted in clinical improvement in 75%, 88.2% and 80% of patients, respectively. In conclusion, eosinophilic colitis in infants and children ≤3 years of age responded well to dietary allergen exclusion.
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Affiliation(s)
- Min Yang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Lanlan Geng
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Peiyu Chen
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Fenghua Wang
- Department of Pathology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Zhaohui Xu
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Cuiping Liang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Huiwen Li
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Tiefu Fang
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Craig A Friesen
- Division of Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City 64108, MO, USA.
| | - Sitang Gong
- Department of Gastroenterology, Guangzhou Women and Children's Medical Center of Guangzhou Medical University, Guangzhou 510623, China.
| | - Dingyou Li
- Division of Gastroenterology, Children's Mercy Hospitals and Clinics, Kansas City 64108, MO, USA.
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Mutalib M, Blackstock S, Evans V, Huggett B, Chadokufa S, Kiparissi F, Elawad M. Eosinophilic gastrointestinal disease and inflammatory bowel disease in children: is it a disease continuum? Eur J Gastroenterol Hepatol 2015; 27:20-3. [PMID: 25358014 DOI: 10.1097/meg.0000000000000230] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Eosinophilic gastrointestinal disease (EGID) and inflammatory bowel disease (IBD) are two distinct disorders that share some clinical manifestations but have different diagnostic criteria. In this article, we reviewed the clinical data of three children with EGID who later developed IBD. This study is a retrospective case note review that was conducted between 2007 and 2012. EGID seems to precede IBD in some subsets of children in whom the diagnosis of IBD may take a few years to fully develop.
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Affiliation(s)
- Mohamed Mutalib
- Department of Paediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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11
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Affiliation(s)
- Yoshiyuki Yamada
- Division of Allergy and Immunology, Gunma Children's Medical Center, Gunma, Japan
| | - Masahiko Kato
- Division of Allergy and Immunology, Gunma Children's Medical Center, Gunma, Japan
| | - Yuka Isoda
- Division of Nutrition and Cooking, Gunma Children's Medical Center, Gunma, Japan
| | - Akira Nishi
- Division of Surgery, Gunma Children's Medical Center, Gunma, Japan
| | - Yuko Jinbo
- Division of Nutrition and Cooking, Gunma Children's Medical Center, Gunma, Japan
| | - Yasuhide Hayashi
- Division of Hematology and Oncology, Gunma Children's Medical Center, Gunma, Japan
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13
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Abstract
A number of recent studies have demonstrated that a variety of treatments effectively improve symptoms and histology in the majority of patients with eosinophilic esophagitis. Therapeutic options include pharmacologic treatments, such as oral and topical corticosteroids and leukotriene-receptor antagonists. In children, the high response rates to dietary modification and elimination suggest that certain foods may serve as environmental triggers for the eosinophilic infiltration. Because many adults present with strictures, endoscopic esophageal dilation is another management modality. Despite these treatment options, several controversies exist in the recommended treatment strategy. Whether the goal of therapy is resolution of symptoms, tissue eosinophilia, or both remains uncertain owing to the paucity of data on the natural history of the condition. Furthermore, important differences in the clinical presentations of eosinophilic esophagitis in children and adults point toward the possible need for different treatment approaches in the two patient populations.
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Affiliation(s)
- Ameesh Shah
- Division of Gastroenterology and Hepatology, Northwestern University Feinberg School of Medicine, 676 North St. Clair Street, Suite 1400, Chicago, IL 60611-2951, USA
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14
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Abstract
Eosinophilic esophagitis (EE) is an increasingly recognized disorder in the adult population, most often manifested by symptoms of dysphagia and food impaction. Mechanisms involving eotaxin-3, interleukin 5, and signal transducer and activator of transcription 6 have been studied and may represent future therapeutic targets. Patients commonly have a personal and family history of atopy, and both food allergies and aeroallergens have also been investigated as triggers of EE. Traditional allergy-testing methods, including skin prick testing and specific IgE testing, have been used to identify food and environmental allergies. However, new studies suggest that patch testing could add to diagnostic accuracy in EE because the disorder might not be a classic type I allergic response. Although studies of treatment of adults with EE have thus far focused on swallowed fluticasone proprionate, many trials in children have assessed the efficacy of food elimination and elemental diets. These diets, which have been extremely successful in reducing symptoms, have also been shown to induce histological improvement and remission. No similar studies have been conducted in adults; the tolerability of such an intervention may prove more difficult in this population. This article reviews the underlying pathophysiology of EE and describes evolving options for more accurately identifying food and environmental allergies. We also discuss the pediatric trials using food elimination and avoidance diets and suggest that this type of intervention may be an important area of future research in the adult population.
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Affiliation(s)
- Jason M Swoger
- Miles and Shirley Fiterman Center for Digestive Diseases, Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Chehade M, Sicherer SH, Magid MS, Rosenberg HK, Morotti RA. Multiple exudative ulcers and pseudopolyps in allergic eosinophilic gastroenteritis that responded to dietary therapy. J Pediatr Gastroenterol Nutr 2007; 45:354-7. [PMID: 17873749 DOI: 10.1097/mpg.0b013e31803219d5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mirna Chehade
- Department of Pediatric Gastroenterology, Mount Sinai School of Medicine, New York, NY 10029, USA.
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16
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Spergel JM, Brown-Whitehorn T, Beausoleil JL, Shuker M, Liacouras CA. Predictive values for skin prick test and atopy patch test for eosinophilic esophagitis. J Allergy Clin Immunol 2007; 119:509-11. [PMID: 17291865 DOI: 10.1016/j.jaci.2006.11.016] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2006] [Revised: 10/16/2006] [Accepted: 11/14/2006] [Indexed: 02/08/2023]
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17
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Watanabe H, Sonoyama K, Watanabe J, Yamaguchi N, Kikuchi H, Nagura T, Aritsuka T, Fukumoto K, Kasai T. Reduction of allergic airway eosinophilia by dietary raffinose in Brown Norway rats. Br J Nutr 2007; 92:247-55. [PMID: 15333156 DOI: 10.1079/bjn20041179] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Oral administration of raffinose, a naturally occurring indigestible oligosaccharide, has reportedly ameliorated atopic dermatitis in human subjects although the mechanism is unknown. The present study investigated the effect of dietary raffinose on allergen-induced airway eosinophilia in ovalbumin-sensitised Brown Norway rats as an atopic disease model. Brown Norway rats were immunised by subcutaneous injection with ovalbumin on day 0 and fed either a control diet or the diet supplemented with raffinose (50 g/kg diet). The rats were exposed to aerosolised ovalbumin on day 20, and broncho-alveolar lavage fluid was obtained on the next day. The number of eosinophils in the fluid was significantly lower in the rats fed the raffinose diet than in those fed the control diet. Dietary raffinose significantly reduced IL-4 and IL-5 mRNA levels in lung tissue and tended to lower ovalbumin-specific Ig E levels. Suppression of eosinophilia by dietary raffinose was still observed in caecectomised and neomycin-administered rats, suggesting little contribution by the colonic bacteria to the effect of raffinose. Intraperitoneal administration of raffinose also suppressed eosinophilia. Significant concentrations of raffinose were detected in portal venous and abdominal arterial plasma after the intragastric administration of raffinose. Overall, the findings suggest that dietary raffinose ameliorates allergic airway eosinophilia at least partly via post-absorptive mechanisms in Brown Norway rats.
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Affiliation(s)
- Hiroshi Watanabe
- Laboratory of Food Biochemistry, Division of Applied Bioscience, Graduate School of Agriculture, Hokkaido University, Sapporo 060-8589, Japan
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Abstract
BACKGROUND Eosinophilic esophagitis (EE) is often associated with concomitant atopic diseases. In children with EE in whom food allergens have been identified as causative factors, elemental and elimination diets result in an improvement or resolution of symptoms. Most adult EE patients are sensitized to aeroallergens, which cross-react with plant-derived food allergens, most commonly to grass pollen and cereals. AIMS OF THE STUDY To investigate the clinical relevance of the sensitization to wheat and rye, and the efficacy of an allergen-specific elimination diet in adult EE patients. METHODS Six patients (five men, one women) with permanently active EE sensitized to grass pollen and the cereals wheat and rye underwent a double-blind placebo-controlled food challenge and were kept on an elimination diet avoiding wheat and rye for 6 weeks. RESULTS The challenge tests with wheat and rye did not provoke any EE symptoms in all patients. The elimination diet failed in reducing disease activity. Although one patient noticed an improvement of symptoms, endoscopic and histopathologic findings remained unchanged. CONCLUSIONS In adult EE patients, sensitization to wheat and rye does not seem causative for EE. Elimination diet is not a reliable and efficient therapeutic measure in EE patients sensitized to wheat and rye. Low specific immunoglobulin-E levels to wheat and rye may be a consequence of the underlying grass pollen allergy.
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Affiliation(s)
- D Simon
- Department of Dermatology, University of Bern, Bern, Switzerland
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Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, Melin-Aldana H, Li BUK. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol 2006; 4:1097-102. [PMID: 16860614 DOI: 10.1016/j.cgh.2006.05.026] [Citation(s) in RCA: 472] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS In children, eosinophilic esophagitis (EE) is predominantly, but not exclusively, a food-hypersensitivity disorder. A crystalline amino acid-based elemental diet (ELED) formula currently remains the most effective nutritional treatment in inducing clinical and histologic remission. However, compliance with an exclusive, poor-tasting liquid formulation is difficult. METHODS This retrospective observational study assessed the short-term clinical and histologic responses of 2 cohorts of children with EE evaluated during 2 different time periods: one was treated with the standard 6-food elimination diet (SFED) and the other was treated with ELED. Of the 60 children who met the inclusion criteria and were compliant with the dietary protocol, 35 were treated with a diet excluding cow-milk protein, soy, wheat, egg, peanut, and seafood while allowing all other table foods and 25 were treated exclusively with ELED. Repeat esophageal biopsy specimens were obtained at least 6 weeks later. RESULTS Twenty-six of 35 (74%) in the SFED group and 22 of 25 (88%) in the ELED group achieved significant improvement of esophageal inflammation (</=10 eosinophils/high-power field). The pretreatment and posttreatment peak eosinophil counts for the SFED were 80.2 +/- 44.0 and 13.6 +/- 23.8 (P < .0001) and 58.8 +/- 31.9 and 3.7 +/- 6.5 (P < .001) for the ELED group, respectively. CONCLUSIONS SFED treatment was associated with clinical and histologic improvement in EE in an observational study. It offers advantages of better acceptance, cost, and compliance than ELED and should be considered as an option in the initial management of children with EE.
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Affiliation(s)
- Amir F Kagalwalla
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
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Spergel JM, Beausoleil J, Brown-Whitehorn T, Liacouras CA. Authors' response to detection of causative foods by skin prick and atopy patch tests in patients with eosinophilic esophagitis: things are not what they seem. Ann Allergy Asthma Immunol 2006; 96:376-8. [PMID: 16498864 DOI: 10.1016/s1081-1206(10)61252-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Abstract
BACKGROUND Esophagitis is an increasingly diagnosed disease. Patients with gastroesophagic reflux, dysphagia, vomiting or abdominal pain, with a torpid response to the treatment, could be suffering from it. MATERIAL AND METHODS A 37 year-old male patient with background of gastroesophagic reflux and dysphagia for solids since 2002, self-limited diarrhea episodes and intolerance to alcoholic drinks due to epigastric pain. Skin prick tests, specific IgE, histamine release test and basophil activation test were carried out. RESULTS Skin prick test to the usual allergens with negative result; prick-prick tests to egg white and yolk, milk and apple with positive result to egg white; total serum IgE within normal levels, specific IgE to egg white with positive result; histamine release test (HRT) and basophil activation test (BAT) with positive result to egg white and yolk. CONCLUSION The patient was diagnosed eosinophilic esophagitis. The commercial food extracts have a great variability in their allergenic composition, which could result in false negative results in the prick test. Prick-prick with the natural food is a more sensitive technique than prick in the diagnosis of food allergy. There are other useful in vitro techniques, apart from specific IgE, in the diagnosis of food allergy. In our case, an exclusion diet of the involved food was more effective than other treatments for remission of the symptoms.
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Affiliation(s)
- Judith Antón Remírez
- Department of Allergology and Clinical Immunology, Clínica Universitaria, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain.
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Assa'ad A. Detection of causative foods by skin prick and atopy patch tests in patients with eosinophilic esophagitis: things are not what they seem. Ann Allergy Asthma Immunol 2005; 95:309-11. [PMID: 16279557 DOI: 10.1016/s1081-1206(10)61145-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Spergel JM, Andrews T, Brown-Whitehorn TF, Beausoleil JL, Liacouras CA. Treatment of eosinophilic esophagitis with specific food elimination diet directed by a combination of skin prick and patch tests. Ann Allergy Asthma Immunol 2005; 95:336-43. [PMID: 16279563 DOI: 10.1016/s1081-1206(10)61151-9] [Citation(s) in RCA: 356] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Eosinophilic esophagitis (EE) is a recently described disorder identified in patients with symptoms suggestive of gastroesophageal reflux disease (GERD) but unresponsive to conventional reflux therapies. Therapies have included corticosteroids, elemental diet, and diet restriction. We report our experience with skin prick and atopy patch testing and food elimination diets in patients diagnosed as having EE. OBJECTIVE To identify food antigens that cause EE and the characteristics of patients who respond to food elimination vs those who are unresponsive. METHODS Patients diagnosed as having EE had restricted diets based on skin prick and atopy patch testing results. Additional biopsies were performed after 4 to 8 weeks of restricted diet. Demographics, atopic tendencies, and food antigens were identified retrospectively in our food allergy database. RESULTS A total of 146 patients diagnosed as having EE were evaluated with skin prick and atopy patch testing. Thirty-nine patients had unequivocal demonstration of food causing EE, with normalization of biopsy results on elimination and reoccurrence on reintroduction. An additional 73 patients, for a total 112 (77%) of 146 patients, had resolution of their EE as demonstrated by biopsy results. Fifteen (10%) of 146 patients were nonresponders manifested by no significant reduction in esophageal eosinophils despite restricted diet based on skin prick and atopy patch testing. Egg, milk, and soy were identified most frequently with skin prick testing, whereas corn, soy, and wheat were identified most frequently with atopy patch testing. CONCLUSION In more than 75% of patients with EE, both symptoms and esophageal inflammation can be significantly improved with dietary elimination of foods. Skin prick and atopy patch testing can help identify foods in most patients.
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Affiliation(s)
- Jonathan M Spergel
- Division of Allergy and Immunology, The Children's Hospital of Philadelphia, Pennsylvania 19104-4399, USA.
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24
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Liacouras CA, Spergel JM, Ruchelli E, Verma R, Mascarenhas M, Semeao E, Flick J, Kelly J, Brown-Whitehorn T, Mamula P, Markowitz JE. Eosinophilic esophagitis: a 10-year experience in 381 children. Clin Gastroenterol Hepatol 2005; 3:1198-206. [PMID: 16361045 DOI: 10.1016/s1542-3565(05)00885-2] [Citation(s) in RCA: 570] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Eosinophilic esophagitis (EoE) is a disorder characterized by a severe, isolated eosinophilic infiltration of the esophagus unresponsive to aggressive acid blockade but responsive to the removal of dietary antigens. We present information relating to our 10-year experience in children diagnosed with EoE. METHODS We conducted a retrospective study between January 1, 1994, and January 1, 2004, to evaluate all patients diagnosed with EoE. Clinical symptoms, demographic data, endoscopic findings, and the results of various treatment regimens were collected and evaluated. RESULTS A total of 381 patients (66% male, age 9.1 +/- 3.1 years) were diagnosed with EoE: 312 presented with symptoms of gastroesophageal reflux; 69 presented with dysphagia. Endoscopically, 68% of patients had a visually abnormal esophagus; 32% had a normal-appearing esophagus despite a severe histologic esophageal eosinophilia. The average number of esophageal eosinophils (per 400 x high power field) proximally and distally were 23.3 +/- 10.5 and 38.7 +/- 13.3, respectively. Corticosteroids significantly improved clinical symptoms and esophageal histology; however, upon their withdrawal, the symptoms and esophageal eosinophilia recurred. Dietary restriction or complete dietary elimination using an amino acid-based formula significantly improved both the clinical symptoms and esophageal histology in 75 and 172 patients, respectively. CONCLUSIONS Medications such as corticosteroids are effective; however, upon withdrawal, EoE recurs. The removal of dietary antigens significantly improved clinical symptoms and esophageal histology in 98% of patients.
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Affiliation(s)
- Chris A Liacouras
- Division of Gastroenterology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
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25
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Rosas Vargas MA, Moncayo Coello V, García Cárdenas E, Valencia Mayoral P, Sienra Monge JJL, del Río Navarro BE. [Eosinophilic colitis. A report of two cases with non conventional treatment]. Rev Alerg Mex 2004; 51:231-5. [PMID: 15794416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
Eosinophilic colitis is a rare entity of unknown etiology characterized by diarrhea, abdominal pain, and gastrointestinal bleeding. Diagnosis includes histopathological infiltration of more than 20 eosinophils in colon. It is frequently associated with milk hypersensitivity and, less usual, with other foods and increased IgE. Histopthological appearance of eosinophil mediators has been observed in the gut. It is sometimes related to the degree of infiltration of eosinophils in the gut as well as to the disease severity. There is not an established treatment for this entity, although systemic steroids have been used with certain efficacy. However, there is a recurrence of the symptoms when the therapy stops, besides the well known side effects of the long-term use of steroids. Cromolyn inhibits mast cell degranulation and prevents liberation of mediators. It is successful in certain cases, specially the severe ones. However, it is not available for its use in our country. Ketotifen, as last resource in our patients with bad response to habitual treatment and restriction diet, was used. Although its use is controversial, we consider that stabilizing mast cell membrane with subsequent inhibition of degranulation and recruitment of eosinophils to sites of inflammation, would also restrain histamine liberation and blockage of H1 receptors, which would diminish local damage induced by eosinophils. Nonetheless ketotifen mechanism of action is unknown, our patients improved after treatment with this drug.
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Affiliation(s)
- Miguel A Rosas Vargas
- Departamento de alergia e inmunología clínica, Hospital Infantil de México Federico Gómez, México, D F
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26
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Abstract
Children with eosinophilic esophagitis, an isolated, severe esophageal eosinophilia, present with symptoms similar to gastroesophageal reflux but do not experience response to aggressive antireflux therapy. Increasingly, eosinophilic esophagitis is considered to be a separate entity from reflux disease. Current theory suggests that the former may be caused by cell-mediated food hypersensitivity or may be a subset of eosinophilic gastroenteritis. Reports support the efficacy of dietary restriction or corticosteroid therapy. Additional research is needed to determine etiology, allow earlier clinical recognition, and improve treatment.
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Affiliation(s)
- Chris A Liacouras
- Division of Gastroenterology and Nutrition, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
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27
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De Agustin JC, Sanz N, Canals MJ, Alvarez E, Morales JL, Soler J, Ollero JC, Vazquez J. Successful medical treatment of two patients with eosinophilic oesophagitis. J Pediatr Surg 2002; 37:207-13. [PMID: 11819200 DOI: 10.1053/jpsu.2002.30256] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND/PURPOSE Significant oesophageal eosinophilia is associated with oesophagitis and gastroesophageal reflux (GER). Eosinophilic oesophagitis is a rare disease that causes thickening of the oesophageal wall, narrowing of the oesophageal lumen, and severe motor disturbance. METHODS AND RESULTS Two 12 yr-old patients with eosinophilic oesophagitis were studied prospectively. Clinical and investigation details are presented. Elemental formula was administered until complete remission of disease. Final outcome was assessed after 3 months on regular diet with exclusion of specific allergic components. Both patients responded to the dietary manipulation. CONCLUSIONS Eosinophilic oesophagitis must be included in the differential diagnosis when dealing with oesophageal strictures of unknown or unclear aetiology. Elimination diet therapy plays a crucial role in ameliorating the course of the illness. Blood eosinophilia correlates with therapeutic response and with improvement of the disease.
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Pumberger W, Pomberger G, Geissler W. Proctocolitis in breast fed infants: a contribution to differential diagnosis of haematochezia in early childhood. Postgrad Med J 2001; 77:252-4. [PMID: 11264489 PMCID: PMC1741985 DOI: 10.1136/pmj.77.906.252] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Dietary protein induced proctocolitis in exclusively breast fed infants is rarely taken into consideration as a cause of rectal bleeding or blood streaked stool in the neonatal period and early infancy. Eleven babies are presented in whom it is believed that bleeding through the rectum was due to proctocolitis as a result of allergy triggered by cows' milk protein transferred to the infants via the breast milk. Colonoscopy was performed in five infants, revealing benign eosinophilic proctocolitis. Standard treatment was the exclusion of the allergen from the mother's diet. Resolution of visible rectal bleeding took place within 72 to 96 hours after elimination of the offending protein from the mother's diet.
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Affiliation(s)
- W Pumberger
- Division of Paediatric Surgery, University of Vienna, Austria.
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29
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Abstract
Esophagitis may present endoscopically with erythema, edema, loss of vascular pattern, friability, and ulceration of the esophageal mucosa. Left untreated, chronic esophagitis may result in stricture formation. The presence of multiple concentric rings involving the entire esophagus has been cited as a chronic form of esophagitis. We present a case of an 8-yr-old boy with multiple concentric esophageal rings and histological evidence of eosinophilic esophagitis, who failed medical antireflux treatment and responded to an elimination diet.
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Affiliation(s)
- C G Siafakas
- Division of Pediatric Gastroenterology and Nutrition, Children's Hospital at Strong, Strong Children's Research Center, Rochester, New York, USA
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30
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Rossel M, Ceresa S, Las Heras J, Araya M. [Eosinophilic colitis caused by allergy to cow's milk protein]. Rev Med Chil 2000; 128:167-75. [PMID: 10962885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Eosinophilic colitis is one of the clinical manifestations of allergy to cow's milk during the first year of life. We report a series of 9 infants who, under 9 months of age and while clinically well, presented rectal bleeding of variable magnitude, with or without diarrhea, shortly after a cow's milk-based formula was initiated (n = 6); yet, 3 cases received only breast feeding. Bleeding disappeared in all patients after milk withdrawal from the diet. Challenges were planned after 12 months of treatment; three patients have not yet reached this moment, 3 had a negative challenge at 12, 18 and 28 months of age and are on a complete diet, and 3 are still on cow's milk free diet because ingestion of milk at 12, 18 and 25 months still induced rectal bleeding. This series of patients gathered in 3 years, follows the trend reported in many countries that there is a relative increase of patients diagnosed with allergy conditions early in life.
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Affiliation(s)
- M Rossel
- Departamento de Pediatría, Facultad de Medicina, Universidad de Chile
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31
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Pfaffenbach B, Adamek RJ, Bethke B, Stolte M, Wegener M. [Eosinophilic gastroenteritis in food allergy]. Z Gastroenterol 1996; 34:490-3. [PMID: 8967122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A 23-year-old woman suffered from chronic abdominal pain, nausea and diarrhea. The clinical symptoms particularly increased after ingestion of several foods. Laboratory investigation revealed a moderate eosinophilia in peripheral blood, elevated serum IgE-level and specific IgE against food allergens in radioallergosorbent testing. The patient exhibited exsudative ascites with eosinophiles. CT scan revealed a thickened wall of the small bowel. There was no evidence of a parasitic or extraintestinal disease. Endoscopically, the gastrointestinal tract appeared normal. Histological examinations of biopsies of the gastrointestinal tract led to the diagnosis of eosinophilic gastroenteritis. Under an elimination diet the patient is symptom-free since 16 months without ascites.
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Affiliation(s)
- B Pfaffenbach
- Medizinische Universitätsklinik, St. Josef-Hospital, Ruhr-Universität Bochum
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32
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Justinich C, Katz A, Gurbindo C, Lepage G, Chad Z, Bouthillier L, Seidman E. Elemental diet improves steroid-dependent eosinophilic gastroenteritis and reverses growth failure. J Pediatr Gastroenterol Nutr 1996; 23:81-5. [PMID: 8811528 DOI: 10.1097/00005176-199607000-00014] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- C Justinich
- Division of Gastroenterology and Nutrition, Ste-Justine, Montreal, Quebec, Canada
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Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995; 109:1503-12. [PMID: 7557132 DOI: 10.1016/0016-5085(95)90637-1] [Citation(s) in RCA: 720] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND & AIMS Treatment for gastroesophageal reflux may be ineffective in patients with an eosinophilic infiltration of the esophagus. The aim of this study was to investigate whether unremitting symptoms of gastroesophageal reflux and biopsy abnormalities of the esophagus may be associated with the ingestion of certain foods. METHODS Ten children previously diagnosed with gastroesophageal reflux by standard testing with long-standing symptoms (median, 34.3 months; range, 6-78 months) despite standard antireflux therapies, including Nissen fundoplication in 6 patients, were fed the elemental formulas Neocate or Neocate-1-Plus (Scientific Hospital Supplies Inc., Gaithersburg, MD) for a minimum of 6 weeks. Each child had repeat endoscopy followed by open food challenges. RESULTS While receiving the formulas, patients had either resolution (n = 8) or improvement (n = 2) of symptoms. On follow-up esophageal biopsy, the maximal intraepithelial eosinophil counts decreased significantly before (median, 41; range, 15-100) to after (median, 0.5; range, 0-22) the formula trial (P = 0.005). Other reactive epithelial changes of the esophageal mucosa also improved significantly. All patients redeveloped their previous symptoms on open food challenges. CONCLUSIONS Chronic gastrointestinal symptoms and histological changes of the esophagus unresponsive to standard treatments for gastroesophageal reflux were improved by the use of elemental formulas. Symptoms recurred when specific dietary proteins were reintroduced during open food challenges. The mechanism of these observations is unknown.
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Affiliation(s)
- K J Kelly
- Division of Pediatric Gastroenterology/Nutrition, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Longo G, Scornavacca G, Strinati R, Poli F. [Food allergy in asthma. Diagnostic significance of peripheral eosinophils]. Pediatr Med Chir 1987; 9:663-8. [PMID: 3444741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Thirty one patients with suspicion of asthma due to food allergy (lack of correlation between allergic sensitivity and asthmatic attacks, association of clinical features suggestive of food allergy, no response to the pharmacological treatment) received an elimination diet. A second group (control group) of 51 asthmatic patients were enrolled in the study for a better evaluation of the diagnostic significance of blood eosinophil counts in food-induced asthma. 29-31 patients who took a variable oligoallergenic diet had a baseline blood eosinophilia greater than 600/mm3 (range 600-2100/mm3). Eosinophil count after an appropriate diet showed an early significant fall which preceded the improvement of symptoms. Only 10 patients had not a valuable improvement from the diet. The post diet change of spirometric values was significant. There was no significant difference between subjects with an eosinophil count greater than 1000/mm3 vs. less than 1000/mm3 with regard to both inhalant and food skin prick tests. On the other hand, the group with blood eosinophilia greater than 1000/mm3 had a significant correlation with the presence of persistent asthma (persistent alteration of forced expiratory volumes verified in asymptomatic phases of the disease) as with the anamnestic or actual report of eczema or other clinical manifestations of food allergy. Blood eosinophil count showed to be essential in the management of patients with a suspicion of asthma due to food allergy.
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Affiliation(s)
- G Longo
- Clinica Pediatrica, Ospedale Infantile Burlo Garofolo, Trieste, Italia
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