Τίτλος:
Management guidelines of eosinophilic esophagitis in childhood
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives: Eosinophilic esophagitis (EoE) represents a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. With few exceptions, 15 eosinophils per high-power field (peak value) in ≥1 biopsy specimens are considered a minimum threshold for a diagnosis of EoE. The disease is restricted to the esophagus, and other causes of esophageal eosinophilia should be excluded, specifically proton pump inhibitor-responsive esophageal eosinophilia. This position paper aims at providing practical guidelines for the management of children and adolescents with EoE. METHODS: Relevant literature from searches of PubMed, CINAHL, and recent guidelines was reviewed. In the absence of an evidence base, recommendations reflect the expert opinion of the authors. Final consensus was obtained during 3 face-to-face meetings of the Gastroenterology Committee and 1 teleconference. RESULTS: The cornerstone of treatment is an elimination diet (targeted or empiric elimination diet, amino acid-based formula) and/or swallowed, topical corticosteroids. Systemic corticosteroids are reserved for severe symptoms requiring rapid relief or where other treatments have failed. Esophageal dilatation is an option in children with EoE who have esophageal stenosis unresponsive to drug therapy. Maintenance treatment may be required in case of frequent relapse, although an optimal regimen still needs to be determined. CONCLUSIONS: EoE is a chronic, relapsing inflammatory disease with largely unquantified long-term consequences. Investigations and treatment are tailored to the individual and must not create more morbidity for the patient and family than the disease itself. Better maintenance treatment as well as biomarkers for assessing treatment response and predicting long-term complications is urgently needed. © 2013 by European Society for Pediatric Gastroenterology,Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.
Συγγραφείς:
Papadopoulou, A.
Koletzko, S.
Heuschkel, R.
Dias, J.A.
Allen, K.J.
Murch, S.H.
Chong, S.
Gottrand, F.
Husby, S.
Lionetti, P.
Mearin, M.L.
Ruemmele, F.M.
Schäppi, M.G.
Staiano, A.
Wilschanski, M.
Vandenplas, Y.
Περιοδικό:
Journal of Pediatric Gastroenterology and Nutrition,
Λέξεις-κλειδιά:
amino acid; biological marker; budesonide; ciclesonide; corticosteroid; cromoglycate disodium; fluticasone propionate; infliximab; lansoprazole; mepolizumab; methylprednisolone; montelukast; omalizumab; omeprazole; prednisolone; prednisone; proton pump inhibitor; reslizumab, absence of side effects; article; childhood; chronic disease; clinical feature; corticosteroid therapy; diet restriction; diet therapy; differential diagnosis; disease severity; drug dose increase; drug megadose; drug withdrawal; eosinophil; eosinophilic esophagitis; esophageal eosinophilia; esophagus biopsy; esophagus candidiasis; esophagus dilatation; esophagus stenosis; gastroesophageal reflux; human; inflammatory disease; low drug dose; maintenance therapy; morbidity; nonhuman; patient compliance; practice guideline; priority journal; randomized controlled trial (topic); recommended drug dose; relapse; remission; treatment failure; treatment indication; treatment response; unspecified side effect, Adrenal Cortex Hormones; Child; Consensus; Eosinophilic Esophagitis; Eosinophils; Esophageal Stenosis; Esophagus; Humans; Recurrence
DOI:
10.1097/MPG.0b013e3182a80be1
