Assaf Hoofien1, Jorge A Dias2, Monica Malamisura3, Francesca Rea4, Sonny Chong5, Johanna Oudshoorn6, Danielle Nijenhuis-Hendriks7, Sebastian Otte8, Alexandra Papadopoulou9, Claudio Romano10, Frederic Gottrand11, Victor V Miravet12, Rok Orel13, Salvatore Oliva14, Carolina G Junquera15, Andrzej Załęski16, Vaidotas Urbonas17, Roger Garcia-Puig18, Maria J M Gomez19, Gloria Dominguez-Ortega19, Marcus K-H Auth20, Michal Kori21, Amir Ben Tov22,23, Nicolas Kalach24, Saskia V Velde25, Mark Furman26, Erasmo Miele27, Luba Marderfeld1,28, Eleftheria Roma29, Noam Zevit1,23. 1. Institute of Gastroenterology, Nutrition, and Liver Disease, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. 2. Pediatric Gastroenterology Unit, Centro Hospitalar São João, Porto, Portugal. 3. Universitary Pediatric Department (DPUO) in Bambino Gesù Children's Hospital, IRCCS, University of Rome "Tor Vergata". 4. Bambino Gesù Children's Hospital, Sant'Onofrio Square, 4, Rome, Italy. 5. Queen Mary's Hospital for Children, Epsom and St Helier University NHS Trust, Carshalton, United Kingdom. 6. Gelre Hospitals, Pediatrics, Apeldoorn, The Netherlands. 7. Pediatrics Department, Juliana Children's Hospital, The Hague, The Netherlands. 8. Dr Von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany. 9. Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's Hospital 'agia Sofia', Athens, Greece. 10. Pediatrics Department, University of Messina, Messina, Italy. 11. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, and Reference Center for Congenital and Malformative Esophageal Diseases, CHU Lille, University Lille, Lille, France. 12. Pediatric Gastroenterology Unit, Hospital Sant Joan de Déu, Barcelona. Spain. 13. Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia. 14. Department of Pediatrics, Sapienza - University of Rome, Rome, Italy. 15. Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain. 16. Department of Pediatric Gastroenterology and Nutrition, Paediatrics with Clinical Assessment Unit, Warsaw Medical University, Warsaw, Poland. 17. Vilnius University Clinic for Children's Diseases, Vilnius, Lithuania. 18. Hospital Universitari MútuaTerrassa, Terrassa, Spain. 19. Gastroenterology and Nutrition Department, Niño Jesús University Children Hospital, Madrid, Spain. 20. Department of Paediatric Gastroenterology, Hepatology and Nutrition (GHN), Alder Hey Children's NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom. 21. Kaplan Medical Center, Rehovot, Israel. 22. Gastroenterology Unit, Dana-Dewk Children's Hospital, Tel Aviv Sourasky Medical Center. 23. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. 24. St Vincent de Paul Hospital, Lille, France. 25. Pediatric Gastroenterology and Hepatology, Ghent University Hospital, Ghent, Belgium. 26. Royal Free Hospital, London, United Kingdom. 27. Department of Translational Medical Science, Section of Paediatrics, University of Naples "Federico II", Naples, Italy. 28. Nutrition and Dietetics Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel. 29. First Department of Pediatrics and Mitera Children's Hospital, University of Athens School of Medicine, Athens, Greece.
Abstract
OBJECTIVES: Recommendations for diagnosing and treating eosinophilic esophagitis (EoE) are evolving; however, information on real world clinical practice is lacking. To assess the practices of pediatric gastroenterologists diagnosing and treating EoE and to identify the triggering allergens in European children. METHODS: Retrospective anonymized data were collected from 26 European pediatric gastroenterology centers in 13 countries. Inclusion criteria were: Patients diagnosis with EoE, completed investigations prescribed by the treating physician, and were on stable medical or dietary interventions. RESULTS: In total, 410 patients diagnosed between December 1999 and June 2016 were analyzed, 76.3% boys. The time from symptoms to diagnosis was 12 ± 33.5 months and age at diagnosis was 8.9 ± 4.75 years. The most frequent indications for endoscopy were: dysphagia (38%), gastroesophageal reflux (31.2%), bolus impaction (24.4%), and failure to thrive (10.5%). Approximately 70.3% had failed proton pump inhibitor treatment. The foods found to be causative of EoE by elimination and rechallenge were milk (42%), egg (21.5%), wheat/gluten (10.9%), and peanut (9.9%). Elimination diets were used exclusively in 154 of 410 (37.5%), topical steroids without elimination diets in 52 of 410 (12.6%), both diet and steroids in 183 of 410 (44.6%), systemic steroids in 22 of 410 (5.3%), and esophageal dilation in 7 of 410 (1.7%). Patient refusal, shortage of endoscopy time, and reluctance to perform multiple endoscopies per patient were noted as factors justifying deviation from guidelines. CONCLUSIONS: In this "real world" pediatric European cohort, milk and egg were the most common allergens triggering EoE. Although high-dose proton pump inhibitor trials have increased, attempted PPI treatment is not universal.
OBJECTIVES: Recommendations for diagnosing and treating eosinophilic esophagitis (EoE) are evolving; however, information on real world clinical practice is lacking. To assess the practices of pediatric gastroenterologists diagnosing and treating EoE and to identify the triggering allergens in European children. METHODS: Retrospective anonymized data were collected from 26 European pediatric gastroenterology centers in 13 countries. Inclusion criteria were: Patients diagnosis with EoE, completed investigations prescribed by the treating physician, and were on stable medical or dietary interventions. RESULTS: In total, 410 patients diagnosed between December 1999 and June 2016 were analyzed, 76.3% boys. The time from symptoms to diagnosis was 12 ± 33.5 months and age at diagnosis was 8.9 ± 4.75 years. The most frequent indications for endoscopy were: dysphagia (38%), gastroesophageal reflux (31.2%), bolus impaction (24.4%), and failure to thrive (10.5%). Approximately 70.3% had failed proton pump inhibitor treatment. The foods found to be causative of EoE by elimination and rechallenge were milk (42%), egg (21.5%), wheat/gluten (10.9%), and peanut (9.9%). Elimination diets were used exclusively in 154 of 410 (37.5%), topical steroids without elimination diets in 52 of 410 (12.6%), both diet and steroids in 183 of 410 (44.6%), systemic steroids in 22 of 410 (5.3%), and esophageal dilation in 7 of 410 (1.7%). Patient refusal, shortage of endoscopy time, and reluctance to perform multiple endoscopies per patient were noted as factors justifying deviation from guidelines. CONCLUSIONS: In this "real world" pediatric European cohort, milk and egg were the most common allergens triggering EoE. Although high-dose proton pump inhibitor trials have increased, attempted PPI treatment is not universal.
Authors: Anjan Dhar; Hasan N Haboubi; Stephen E Attwood; Marcus K H Auth; Jason M Dunn; Rami Sweis; Danielle Morris; Jenny Epstein; Marco R Novelli; Hannah Hunter; Amanda Cordell; Sharon Hall; Jamal O Hayat; Kapil Kapur; Andrew Robert Moore; Carol Read; Sarmed S Sami; Paul J Turner; Nigel J Trudgill Journal: Gut Date: 2022-05-23 Impact factor: 31.793
Authors: Arianna De Matteis; Giuseppe Pagliaro; Vito Domenico Corleto; Claudia Pacchiarotti; Emilio Di Giulio; Maria Pia Villa; Pasquale Parisi; Francesca Vassallo; Chiara Ziparo; Giovanni Di Nardo Journal: Curr Pediatr Rev Date: 2020