Sistema de Salut de Catalunya
Institut Català de la Salut
[Navarro P] Department of Gastroenterology, Hospital General de Tomelloso, Tomelloso, Spain. Instituto de Investigación Sanitaria de Castilla‐La Mancha (IDISCAM), Toledo, Spain. Instituto de Investigación Sanitaria La Princesa, Madrid, Spain. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain. [Feo‐Ortega S] Instituto de Investigación Sanitaria de Castilla‐La Mancha (IDISCAM), Toledo, Spain. Department of Pediatrics, Hospital General de Tomelloso, Tomelloso, Spain. [Casabona‐Francés S] Instituto de Investigación Sanitaria La Princesa, Madrid, Spain. Department of Gastroenterology, Hospital Universitario de La Princesa, Madrid, Spain. [Gutiérrez‐Junquera C] Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro, Majadahonda, Spain. Universidad Autónoma de Madrid, Madrid, Spain. [Savarino EV] Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy. Gastroenterology Unit, Azienza Ospedaliera di Padova, Padua, Italy. [Amorena E] Department of Gastroenterology, Hospital Universitario de Navarra, Pamplona, Spain. Masiques-Mas ML] Department of Pediatric Gastroenterology, Hospital General de Granollers, Granollers, Spain. [Guagnozzi D] Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, CIBERehd, Madrid, Spain. Servei d’Aparell Digestiu, Vall d’Hebron Hospital Universitari, Barcelona, Spain
Vall d'Hebron Barcelona Hospital Campus
2024-08-22T10:17:22Z
2024-08-22T10:17:22Z
2024-08
Dietary intervention; Eosinophilic esophagitis; Pediatrics
Intervención dietética; Esofagitis eosinofílica; Pediatría
intervenció dietètica; Esofagitis eosinofílica; Pediatria
This study compared short-term effectiveness of proton pump inhibitors (PPI), swallowed topical corticosteroids (STC), and dietary therapies in reversing clinical and histological features in pediatric patients with eosinophilic esophagitits (EoE). Determinants for treatment choice and PPI therapy effectiveness were also assessed. A cross-sectional study analysis of patients under 18 years old recruited onto the multicenter EoE CONNECT registry was performed. Clinico-histological response was defined as symptomatic improvement plus a peak eosinophil count below 15 per high-power field after treatment. Effectiveness of first-line options used in monotherapy was compared. Overall, 393 patients (64% adolescents) receiving PPI, STC, or dietary monotherapy to induce EoE remission were identified. PPI was the preferred option (71.5%), despite STC providing the highest clinico-histological response rates (66%) compared to PPI (44%) and diet (42%). Logistic regression identified fibrotic features and recruitment at Italian sites independently associated to first-line STC treatment; age under 12 associated to dietary therapy over other options. Analysis of 262 patients in whom PPI effectiveness was evaluated after median (IQR) 96 (70–145) days showed that this effectiveness was significantly associated with management at pediatric facilities and use of high PPI doses. Among PPI responders, decrease in rings and structures in endoscopy from baseline was documented, with EREFS fibrotic subscore for rings also decreasing among responders (0.27 ± 0.63 vs. 0.05 ± 0.22, p < 0.001). Conclusion: Initial therapy choice for EoE depends on endoscopic phenotype, patient’s age, and patients’ origin. High PPI doses and treatment in pediatric facilities significantly determined effectiveness, and reversed fibrotic endoscopic features among responders.
EoE CONNECT was established with funds from the United European Gastroenterology (National Societies Link Award Program), and is supported by the European Consortium for Eosinophilic Diseases of the GI Tract (EUREOS).
Article
Published version
English
Esòfag - Malalties - Tractament; Eosinofília; Corticosteroides - Ús terapèutic; Inhibidors enzimàtics - Ús terapèutic; Dietoteràpia; DISEASES::Digestive System Diseases::Gastrointestinal Diseases::Esophageal Diseases::Esophagitis::Eosinophilic Esophagitis; CHEMICALS AND DRUGS::Chemical Actions and Uses::Pharmacologic Actions::Molecular Mechanisms of Pharmacological Action::Enzyme Inhibitors::Proton Pump Inhibitors; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Nutrition Therapy::Diet Therapy; CHEMICALS AND DRUGS::Hormones, Hormone Substitutes, and Hormone Antagonists::Hormones::Adrenal Cortex Hormones; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Diagnosis::Prognosis::Treatment Outcome; ENFERMEDADES::enfermedades del sistema digestivo::enfermedades gastrointestinales::enfermedades del esófago::esofagitis::esofagitis eosinofílica; COMPUESTOS QUÍMICOS Y DROGAS::acciones y usos químicos::acciones farmacológicas::mecanismos moleculares de acción farmacológica::inhibidores enzimáticos::inhibidores de la bomba de protones; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapia nutricional::dietoterapia; COMPUESTOS QUÍMICOS Y DROGAS::hormonas, sustitutos de hormonas y antagonistas de hormonas::hormonas::hormonas de la corteza suprarrenal; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::diagnóstico::pronóstico::resultado del tratamiento
Springer
European Journal of Pediatrics;183
https://doi.org/10.1007/s00431-024-05618-z
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
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