Document Type : original article

Authors

1 Department of Pediatrics, Clinical Research Development Unit ,Hajar Hospital, Shahrekord University of Medical Science, Shahrekord, Iran.

2 Department of Gastroenterology, Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Background: Eosinophilic gastrointestinal disorders (EGIDs) are a group of uncommon inflammatory diseases. In this study, we aimed to evaluate the prevalence of EGIDs, clinical manifestation and their response to treatment in a Children Medical Center in Iran.
Method: Between 2011 and 2016, all patients, aged <18 years old, who had pathology-confirmed diagnosis of EGIDs and underwent endoscopy in our center, were included in the study. Patient demographics, clinical presentation, laboratory data, radiologic findings, endoscopic findings, histological findings and the results of treatment were retrieved from the participants’ medical records.
Results: The prevalence of EGIDs in children in the gastrointestinal unit of our hospital during these years was reported as 5 per 1000 children. The most reported clinical symptoms in patients with EoE were nausea (75%), vomiting (69%), and epigastric pain (62.5% each). All of the patients had a hypoallergenic diet. Seventy-five percent of the patients used fluticasone spray.  The most frequent symptom in the patients with EoC was rectal bleeding (100%), followed by diarrhea (73%), irritability (23%), and loss of weight gain (18%). All of the patients had a hypoallergenic diet. Twenty-seven percent of the patients used Neocate milk and the use of cetirizine and ketotifen were reported in 18% of patients. EoGE was reported in only two patients (mean age: 10.25 years).
Conclusion: During the 5-year period, most cases of EGIDs were related to EoC and EoE, and all cases improved in response to treatment. The hypoallergenic diet was identified as a common effective treatment for the studied patients.

Keywords

  1. Anuradha C, Mittal R, Yacob M, Manipadam M, Kurian S, Eapen A. Eosinophilic disorders of the gastrointestinal tract: imaging features. Diagn. Interv. Imaging. 2012; 18(2):183.
  2. Yan BM, Shaffer EA. Primary eosinophilic disorders of the gastrointestinal tract. Gut. 2009; 58(5):721-32.
  3. Gutiérrez-Junquera C, Zevit N. Dietary treatment of eosinophilic gastrointestinal disorders in children. Curr. Opin. Clin. Nutr. Metab. Care. 2020; 23(3):210-6.
  4. Charalabopoulos A, Charalabopoulos K, Avuzuklidou M, Charalabopoulos A, Ioachim E, Lebren F, et al. Eosinophilic gastroenteritis: presentation of two patients with unusual effect of terminal ileum and caecum with manifestations of acute abdomen and literature review. Int. J. Clin. Pract. 2004; 58(4):413-6.
  5. Lee C-M, Changehien C-S, Chen P-C, Lin D-Y, Sheen I-S, Wang C-S, Tai DI, Sheen-Chen SM, Chen WJ, Wu CS. Eosinophilic Gastroenteritis: 10 Years’ Experience. Am. J. Gastroenterol. Suppl. 1993; 88(1).
  6. Chen M-J, Chu C-H, Lin S-C, Shih S-C, Wang T-E. Eosinophilic gastroenteritis: clinical experience with 15 patients. World J. Gastroenterol. 2003; 9(12):2813.
  7. Zhang L, Duan L, Ding S, Lu J, Jin Z, Cui R, McNutt M, Wang A. Eosinophilic gastroenteritis: clinical manifestations and morphological characteristics, a retrospective study of 42 patients. Scand J Gastroenterol. 2011; 46(9):1074-80.
  8. Uppal V, Kreiger P, Kutsch E. Eosinophilic gastroenteritis and colitis: a comprehensive review. Clin Rev Allergy Immunol. 2016; 50(2):175-88.
  9. Luo J-Y, Niu C-Y, Wang X-Q, Zhu Y-L, Gong J. Effect of a single oral dose of rabeprazole on nocturnal acid breakthrough and nocturnal alkaline amplitude. World J. Gastroenterol. 2003; 9(11):2583.
  10. Licari A, Votto M, D'Auria E, Castagnoli R, Caimmi SM, Marseglia GL. Eosinophilic gastrointestinal diseases in children: a practical review. Curr. Pediatr. Rev. 2020; 16(2):106-14.
  11. Baek MS, Mok YM, Han W-C, Kim YS. A patient with eosinophilic gastroenteritis presenting with acute pancreatitis and ascites. Gut Liver. 2014; 8(2):224.
  12. Rothenberg ME. Eosinophilic gastrointestinal disorders (EGID). J. Allergy Clin. Immunol. 2004; 113(1):11-28.
  13. de Chambrun GP, Dufour G, Tassy B, Rivière B, Bouta N, Bismuth M, Panaro F, Funakoshi N, Ramos J, Valats JC, Blanc P. Diagnosis, natural history and treatment of eosinophilic enteritis: a review. Curr. Gastroenterol. Rep. 2018; 20(8):1-9.
  14. Reed C, Woosley JT, Dellon ES. Clinical characteristics, treatment outcomes, and resource utilization in children and adults with eosinophilic gastroenteritis. Dig Liver Dis. 2015; 47(3):197-201.
  15. Lucendo AJ, Serrano-Montalbán B, Arias Á, Redondo O, Tenias JM. Efficacy of dietary treatment for inducing disease remission in eosinophilic gastroenteritis. J Pediatr Gastroenterol Nutr. 2015; 61(1):56-64.
  16. Chehade M, Sicherer SH, Magid MS, Rosenberg HK, Morotti RA. Multiple exudative ulcers and pseudopolyps in allergic eosinophilic gastroenteritis that responded to dietary therapy. J. Pediatr. Gastroenterol. Nutr. 2007; 45(3):354-7.
  17. Shi YN, Sun SJ, Xiong LS, Cao QH, Cui Y, Chen MH. Prevalence, clinical manifestations and endoscopic features of eosinophilic esophagitis: a pathological review in China. J. Dig. Dis. 2012; 13(6):304-9.
  18. Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, Burks AW, Chehade M, Collins MH, Dellon ES, Dohil R, Falk GW, Gonsalves N, Gupta SK, Katzka DA, Lucendo AJ, Markowitz JE, Noel RJ, Odze RD, Putnam PE, Richter JE, Romero Y, Ruchelli E, Sampson HA, Schoepfer A, Shaheen NJ, Sicherer SH, Spechler S, Spergel JM, Straumann A, Wershil MK, Rothenberg ME, Aceves SS. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J. Allergy Clin. Immunol. 2011; 128(1):3-20. e6.
  19. Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am. J. Gastroenterol. 2013; 108(5):679-92.
  20. Lwin T, Melton SD, Genta RM. Eosinophilic gastritis: histopathological characterization and quantification of the normal gastric eosinophil content. J. Mod. Hum. Pathol. 2011; 24(4):556-63.
  21. Henderson CJ, Ngeow J, Collins MH, Martin LJ, Putnam PE, Abonia JP, Marsolo K, Eng C, Rothenberg ME. Increased prevalence of eosinophilic gastrointestinal disorders (EGID) in pediatric PTEN hamartoma tumor syndromes (PHTS). J. Pediatr. Gastroenterol. Nutr. 2014; 58(5):553.
  22. Kaijser R. Zur Kenntnis der allergisch en Affektionen des Verdauungskanals vom Standpunkt des Chirungen aus. Arch Klin Chir. 1937; 188:36-64.
  23. Klein NC, Hargrove RL, Sleisenger MH, Jeffries GH. Eosinophilic gastroenteritis. Medicine. 1970; 49(4):299-320.
  24. Jensen ET, Martin CF, Kappelman MD, Dellon ES. Prevalence of eosinophilic gastritis, gastroenteritis, and colitis: estimates from a national administrative database. J Pediatr Gastroenterol Nutr. 2016; 62(1):36.
  25. Hasosah MY, Sukkar GA, Alsahafi AF, Thabit AO, Fakeeh ME, Al-Zahrani DM, Satti MB. Eosinophilic esophagitis in Saudi children: symptoms, histology and endoscopy results. Saudi J Gastroenterol. 2011; 17(2):119.
  26. Hudson S, Sampson C, Muntz HR, Jackson WD, Smith ME. Foreign body impaction as presentation of eosinophilic esophagitis. Otolaryngol Head Neck Surg. 2013; 149(5):679-81.
  27. Cianferoni A, Spergel JM. Eosinophilic esophagitis and gastroenteritis.

Curr. Allergy Asthma Rep. 2015; 15(9):1-15.

  1. Kinoshita Y, Ishimura N, Oshima N, Ishihara S. Systematic review: eosinophilic esophagitis in Asian countries. World J. Gastroenterol. 2015; 21(27):8433.
  2. Kelly KJ, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995; 109(5):1503-12.
  3. DeBrosse CW, Case JW, Putnam PE, Collins MH, Rothenberg ME. Quantity and distribution of eosinophils in the gastrointestinal tract of children. Pediatric and developmental pathology. Pediatr Dev Pathol. 2006; 9(3):210-8.
  4. Iborra M, Álvarez-Sotomayor D, Nos P. Long-term safety and efficacy of budesonide in the treatment of ulcerative colitis. Clin. Exp. Gastroenterol. 2014; 7:39.
  5. Siewert E, Lammert F, Koppitz P, Schmidt T, Matern S. Eosinophilic gastroenteritis with severe protein-losing enteropathy: successful treatment with budesonide. Dig Liver Dis. 2006; 38(1):55-9.
  6. Tan AC, Kruimel JW, Naber TH. Eosinophilic gastroenteritis treated with non-enteric-coated budesonide tablets. Eur J Gastroenterol Hepatol. 2001; 13(4):425-7.