A Practical Update on Pediatric Eosinophilic Esophagitis

被引:11
作者
Votto, Martina [1 ,2 ]
De Filippo, Maria [1 ,2 ]
Caimmi, Silvia [2 ]
Indolfi, Cristiana [3 ]
Raffaele, Alessandro [4 ]
Tosca, Maria Angela [5 ]
Marseglia, Gian Luigi [1 ,2 ]
Licari, Amelia [1 ,2 ]
机构
[1] Univ Pavia, Dept Clin Surg Diagnost & Pediat Sci, Pediat Unit, I-27100 Pavia, Italy
[2] Fdn IRCCS Policlin San Matteo, Pediat Clin, I-27100 Pavia, Italy
[3] Univ Campania Luigi Vanvitelli, Dept Woman Child & Gen & Specialized Surg, I-80138 Naples, Italy
[4] Fdn IRCCS Policlin San Matteo, Pediat Surg Unit, I-27100 Pavia, Italy
[5] IRCCS Giannina Gaslini, Allergy Ctr, I-16147 Genoa, Italy
来源
CHILDREN-BASEL | 2023年 / 10卷 / 10期
关键词
adolescents; allergy; children; eosinophilic esophagitis; food elimination diet; proton pump inhibitor; quality of life; topical steroids; ELIMINATION DIET; ELEMENTAL DIET; GASTROINTESTINAL DISORDERS; GASTROESOPHAGEAL-REFLUX; HISTOLOGIC REMISSION; CHILDREN; DIAGNOSIS; THERAPY; PREVALENCE; MANAGEMENT;
D O I
10.3390/children10101620
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Eosinophilic esophagitis (EoE) is an emerging atopic disease of unknown etiology limited to the esophagus. The pathogenesis is still understood and is likely characterized by type 2 inflammation. Food allergens are the primary triggers of EoE that stimulate inflammatory cells through an impaired esophageal barrier. In children and adolescents, clinical presentation varies with age and mainly includes food refusal, recurrent vomiting, failure to thrive, abdominal/epigastric pain, dysphagia, and food impaction. Upper-gastrointestinal endoscopy is the gold standard for diagnosing and monitoring EoE. EoE therapy aims to achieve clinical, endoscopic, and histological ("deep") remission; prevent esophageal fibrosis; and improve quality of life. In pediatrics, the cornerstones of therapy are proton pump inhibitors, topical steroids (swallowed fluticasone and viscous budesonide), and food elimination diets. In recent years, much progress has been made in understanding EoE pathogenesis, characterizing the clinical and molecular heterogeneity, and identifying new therapeutic approaches. Notably, clinical, molecular, endoscopic, and histological features reflect and influence the evolution of inflammation over time and the response to currently available treatments. Therefore, different EoE phenotypes and endotypes have recently been recognized. Dupilumab recently was approved by FDA and EMA as the first biological therapy for adolescents (>= 12 years) and adults with active EoE, but other biologics are still under consideration. Due to its chronic course, EoE management requires long-term therapy, a multidisciplinary approach, and regular follow-ups.
引用
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页数:17
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