EoE ToT Module 3 References-De Matteis et al Curr Pediatr Rev 2020 EoE in children Clinical findings and diagnostic approach

De Matteis et al Curr Pediatr Rev 2020 EoE in children Clinical findings and diagnostic approach

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The document is a comprehensive review article on Eosinophilic Esophagitis (EoE) in children, focusing on its epidemiology, pathophysiology, clinical presentation, and diagnostic approaches. EoE is described as an emerging chronic immune and antigen-mediated condition with increasing incidence in children over the past two decades. The condition is characterized by chronic esophageal dysfunction and significant eosinophilic infiltration of the esophageal mucosa.<br /><br />**Key Content Highlights:**<br /><br />1. **Epidemiology and Incidence:**<br />   - There has been a significant increase in the incidence and prevalence of EoE in both children and adults, partly due to increased awareness and utilization of diagnostic endoscopy.<br />   - Population-based studies show varying prevalence rates, with a male predominance (3:1 ratio).<br /><br />2. **Pathophysiology:**<br />   - EoE involves a Th2-type immune response, including both IgE and non-IgE-mediated reactions to food and environmental allergens.<br />   - Genetic predisposition plays a substantial role, with specific genes and polymorphisms associated with EoE.<br />   - Environmental factors and changes in the microbiome also contribute to the disease's development.<br /><br />3. **Clinical Presentation:**<br />   - Symptoms range by age:<br />     - Infants/toddlers: feeding difficulties, vomiting, regurgitation, failure to thrive.<br />     - School-aged children: abdominal pain, dysphagia, nausea.<br />     - Adolescents: dysphagia, food impaction, heartburn, chest pain.<br />   - Many children have associated atopic conditions like asthma, allergic rhinitis, and atopic dermatitis.<br /><br />4. **Diagnosis:**<br />   - Diagnosis is based on the presence of chronic esophageal symptoms and significant eosinophilic infiltration detected via esophageal biopsies.<br />   - Relevant histological features include a density of at least 15 eosinophils per high-power field, eosinophil microabscesses, basal zone hyperplasia, and others.<br />   - Endoscopic features include fixed rings, exudates, furrows, edema, and strictures, which are graded using the EoE Endoscopic Reference Score (EREFS).<br /><br />5. **Differential Diagnosis:**<br />   - EoE must be distinguished from conditions like GERD, infections, Crohn’s disease, and more, with GERD being the primary differential diagnosis.<br />   - Proton Pump Inhibitor (PPI)-responsive esophageal eosinophilia (PPI-REE) is discussed as a distinct but related condition, leading to a proposed new diagnostic algorithm.<br /><br />The review emphasizes the increasing recognition of EoE, its multifactorial etiology involving genetic, immune, and environmental factors, and the importance of thorough clinical and endoscopic assessment for accurate diagnosis and management.

Keywords

Eosinophilic Esophagitis

EoE

children

epidemiology

pathophysiology

clinical presentation

diagnosis

eosinophilic infiltration

endoscopy

immune response