Niyada Vithayasai1, Siriluck Jennuvat, Anchaleerat Lertsatit. 1. Gastroenterology and Nutrition Unit, Department of Pediatrics, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand. niyada-v@hotmail.com
Abstract
OBJECTIVE: To study eosinophilic gastrointestinal disease (EGIDs) in children concerning the clinical presentations, diagnostic methods and results of treatment. MATERIAL AND METHOD: A retrospective study of EGIDs was done from January 2000 to December 2009. All patients diagnosed as EGIDs according to gastrointestinal symptoms combined with eosinophilic infiltration in mucosal, muscular or serosal layer of involvement. Exclusion of extraintestinal eosinophilic involvement and parasitic infestations were done. Analysis of clinical presentations, diagnostic methods and results of treatment were reviewed. RESULTS: Sixteen children fulfilled criteria of EGIDs. Mucosal type was the most common finding type (12 out of 16 cases) (75%). Muscular and serosal type was found in equal numbers (2 of each in 16 cases) (12.5% each). Ages ranged from 6 months to 13 years. The male: female ratio was 1: 1.2. Abdominal pain was the most common presenting symptom followed by diarrhea. Allergic history was detected in 68.75% of all patients. Peripheral eosinophilia was found in only 37.5% of all cases. Radiographic findings showed non-specific findings. Endoscopy was performed in 14 out of 16 cases (87.5%). Lymphoid hyperplasia was the most common endoscopic finding especially in mucosal type. Eosinophil (more than 20 per high power field) was found from biopsied tissues obtained from the esophagus, stomach, colon or from ascitic fluid. Prednisolone was used in 13 out of 16 cases with satisfactory results in 11 cases. The two resisted cases responded to ketotifen in one and the other in combination with montelukast. One out of 16 cases subsided with only proton pump inhibitor The last two cases improved by allergic food elimination. CONCLUSION: Eosinophilic gastrointestinal disease in children presents with varieties of gastrointestinal symptoms. Biopsied tissues or ascitic fluid are required to demonstrate significant eosinophilic infiltration or presence of eosinophil. Allergic history seems to play an important role in more than half of the patients. Specific dietary elimination is the most important treatment in allergic cases. Corticosteroid is the treatment of choice in the non-allergic group or for those who did not improve with food elimination.
OBJECTIVE: To study eosinophilic gastrointestinal disease (EGIDs) in children concerning the clinical presentations, diagnostic methods and results of treatment. MATERIAL AND METHOD: A retrospective study of EGIDs was done from January 2000 to December 2009. All patients diagnosed as EGIDs according to gastrointestinal symptoms combined with eosinophilic infiltration in mucosal, muscular or serosal layer of involvement. Exclusion of extraintestinal eosinophilic involvement and parasitic infestations were done. Analysis of clinical presentations, diagnostic methods and results of treatment were reviewed. RESULTS: Sixteen children fulfilled criteria of EGIDs. Mucosal type was the most common finding type (12 out of 16 cases) (75%). Muscular and serosal type was found in equal numbers (2 of each in 16 cases) (12.5% each). Ages ranged from 6 months to 13 years. The male: female ratio was 1: 1.2. Abdominal pain was the most common presenting symptom followed by diarrhea. Allergic history was detected in 68.75% of all patients. Peripheral eosinophilia was found in only 37.5% of all cases. Radiographic findings showed non-specific findings. Endoscopy was performed in 14 out of 16 cases (87.5%). Lymphoid hyperplasia was the most common endoscopic finding especially in mucosal type. Eosinophil (more than 20 per high power field) was found from biopsied tissues obtained from the esophagus, stomach, colon or from ascitic fluid. Prednisolone was used in 13 out of 16 cases with satisfactory results in 11 cases. The two resisted cases responded to ketotifen in one and the other in combination with montelukast. One out of 16 cases subsided with only proton pump inhibitor The last two cases improved by allergic food elimination. CONCLUSION:Eosinophilic gastrointestinal disease in children presents with varieties of gastrointestinal symptoms. Biopsied tissues or ascitic fluid are required to demonstrate significant eosinophilic infiltration or presence of eosinophil. Allergic history seems to play an important role in more than half of the patients. Specific dietary elimination is the most important treatment in allergic cases. Corticosteroid is the treatment of choice in the non-allergic group or for those who did not improve with food elimination.
Authors: Li Nien Michelle Tan; Supriya Srivastava; Ming Teh; Seng Hock Quak; Marion M Aw Journal: Singapore Med J Date: 2016-03-15 Impact factor: 1.858