Elizabeth T Jensen1,2, Kevin Z Huang2, Hannah X Chen2, Lisa E Landes3, Kristen A McConnell3, Mary Angie Almond3, Anca M Safta3, Douglas T Johnston4, Raquel Durban4, Laura Jobe5,6, Carrie Frost6, Sarah Donnelly7, Brady Antonio7, Antonio Quiros7, Jonathan E Markowitz5,6, Evan S Dellon2,8. 1. Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem. 2. Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill. 3. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Wake Forest Baptist Medical Center, Winston-Salem. 4. Asthma and Allergy Specialists, Charlotte. 5. University of South Carolina School of Medicine. 6. Greenvile Children's Hospital, Greenville. 7. Pediatric Gastroenterology and Nutrition, MUSC Children's Hospital, Charleston. 8. Center for Esophageal Diseases and Swallowing, University of North Carolina School of Medicine, Chapel Hill, NC.
Abstract
OBJECTIVES: No formal comparative effectiveness studies have been conducted to evaluate the effect of eosinophilic esophagitis (EoE) treatment choice on long-term growth in pediatric patients. Long-term studies of inhaled corticoid steroids in asthma, however, suggest possible effects on linear growth. The aim of this study was to compare longitudinal, anthropometric growth in children with EoE according to treatment approach. METHODS: We conducted a retrospective, multicenter cohort study of anthropometric growth (height and body mass index [BMI] z scores) in pediatric (<18 years of age) patients newly diagnosed with EoE across 5 clinical sites between 2005 and 2014. We compared differences in growth according to treatment approach over a 12-month period. Modification by sex and age was examined and sensitivity analyses were conducted to assess robustness of results given study assumptions. RESULTS: In the 409 patients identified, the mean age and proportion male differed by treatment (P = < 0.01 and P = 0.04, respectively). Baseline growth measures were associated with slight impairment of height at diagnosis (median baseline height z score of -0.1 [interquartile range -0.9, 0.8]). In general, treatment approach was not associated with any significant increase or decrease in expected growth over a 12-month period. Subtle decrease in linear growth was observed with treatment using a combined elemental and topical steroid (Δ height z score [adjusted]: -0.04; 95% confidence interval [CI]: -0.08, -0.01). Differences in linear growth differed by sex (P for interaction <0.01). For elemental formula in combination with topical steroids, only girls exhibited a significant decline in linear growth (Δ height z score [adjusted]: -0.24; 95% CI: -0.32, -0.17). A slight reduction in BMI was observed for patients treated with a combination of elemental diet and dietary elimination (Δ BMI z score [adjusted]: -0.07; 95% CI: -0.13, -0.01). CONCLUSIONS: Treatment of EoE, in general, is not associated with major anthropometric growth changes in most pediatric patients. Slight linear growth impairment was observed for topical steroid treatment, and sex differences in growth by treatment approach were observed. Future prospective studies should evaluate the effect of treatment on optimal growth and development and over a longer period of follow-up.
OBJECTIVES: No formal comparative effectiveness studies have been conducted to evaluate the effect of eosinophilic esophagitis (EoE) treatment choice on long-term growth in pediatric patients. Long-term studies of inhaled corticoid steroids in asthma, however, suggest possible effects on linear growth. The aim of this study was to compare longitudinal, anthropometric growth in children with EoE according to treatment approach. METHODS: We conducted a retrospective, multicenter cohort study of anthropometric growth (height and body mass index [BMI] z scores) in pediatric (<18 years of age) patients newly diagnosed with EoE across 5 clinical sites between 2005 and 2014. We compared differences in growth according to treatment approach over a 12-month period. Modification by sex and age was examined and sensitivity analyses were conducted to assess robustness of results given study assumptions. RESULTS: In the 409 patients identified, the mean age and proportion male differed by treatment (P = < 0.01 and P = 0.04, respectively). Baseline growth measures were associated with slight impairment of height at diagnosis (median baseline height z score of -0.1 [interquartile range -0.9, 0.8]). In general, treatment approach was not associated with any significant increase or decrease in expected growth over a 12-month period. Subtle decrease in linear growth was observed with treatment using a combined elemental and topical steroid (Δ height z score [adjusted]: -0.04; 95% confidence interval [CI]: -0.08, -0.01). Differences in linear growth differed by sex (P for interaction <0.01). For elemental formula in combination with topical steroids, only girls exhibited a significant decline in linear growth (Δ height z score [adjusted]: -0.24; 95% CI: -0.32, -0.17). A slight reduction in BMI was observed for patients treated with a combination of elemental diet and dietary elimination (Δ BMI z score [adjusted]: -0.07; 95% CI: -0.13, -0.01). CONCLUSIONS: Treatment of EoE, in general, is not associated with major anthropometric growth changes in most pediatric patients. Slight linear growth impairment was observed for topical steroid treatment, and sex differences in growth by treatment approach were observed. Future prospective studies should evaluate the effect of treatment on optimal growth and development and over a longer period of follow-up.
Authors: Amir F Kagalwalla; Timothy A Sentongo; Sally Ritz; Therese Hess; Suzanne P Nelson; Karan M Emerick; Hector Melin-Aldana; B U K Li Journal: Clin Gastroenterol Hepatol Date: 2006-07-21 Impact factor: 11.382
Authors: Bridget K Butz; Ting Wen; Gerald J Gleich; Glenn T Furuta; Jonathan Spergel; Eileen King; Robert E Kramer; Margaret H Collins; Emily Stucke; Colleen Mangeot; W Daniel Jackson; Molly O'Gorman; J Pablo Abonia; Scott Pentiuk; Philip E Putnam; Marc E Rothenberg Journal: Gastroenterology Date: 2014-04-22 Impact factor: 22.682
Authors: Jeffrey A Alexander; Kee Wook Jung; Amindra S Arora; Felicity Enders; David A Katzka; Gail M Kephardt; Hirohito Kita; Lori A Kryzer; Yvonne Romero; Thomas C Smyrk; Nicholas J Talley Journal: Clin Gastroenterol Hepatol Date: 2012-04-01 Impact factor: 11.382
Authors: Elizabeth T Jensen; Michael D Kappelman; Christopher F Martin; Evan S Dellon Journal: Am J Gastroenterol Date: 2014-09-30 Impact factor: 10.864
Authors: Jesús González-Cervera; Ángel Arias; Olga Redondo-González; María M Cano-Mollinedo; Ingrid Terreehorst; Alfredo J Lucendo Journal: Ann Allergy Asthma Immunol Date: 2017-03-30 Impact factor: 6.347
Authors: Chris A Liacouras; Glenn T Furuta; Ikuo Hirano; Dan Atkins; Stephen E Attwood; Peter A Bonis; A Wesley Burks; Mirna Chehade; Margaret H Collins; Evan S Dellon; Ranjan Dohil; Gary W Falk; Nirmala Gonsalves; Sandeep K Gupta; David A Katzka; Alfredo J Lucendo; Jonathan E Markowitz; Richard J Noel; Robert D Odze; Philip E Putnam; Joel E Richter; Yvonne Romero; Eduardo Ruchelli; Hugh A Sampson; Alain Schoepfer; Nicholas J Shaheen; Scott H Sicherer; Stuart Spechler; Jonathan M Spergel; Alex Straumann; Barry K Wershil; Marc E Rothenberg; Seema S Aceves Journal: J Allergy Clin Immunol Date: 2011-04-07 Impact factor: 10.793
Authors: Cathleen A Collins; Jacob Palmquist; James A Proudfoot; Alex Qian; Hannah Wangberg; Emad Khosh-Hemmat; Ranjan Dohil; Seema S Aceves Journal: J Allergy Clin Immunol Date: 2019-06-28 Impact factor: 10.793
Authors: Anna F Henderson; Soofia M Khan; Lindsey N Hornung; Vincent A Mukkada; Heidi J Kalkwarf Journal: J Pediatr Gastroenterol Nutr Date: 2020-12 Impact factor: 3.288