A Case Study Vignette for a Pediatric Patient With Eosinophilic Esophagitis

Abstract Objectives Eosinophilic Esophagitis (EoE) is a chronic inflammatory, immune/antigen-mediated condition of the esophagus. It is common in pediatric patients and can lead to several complications such as esophageal remodeling/fibrosis, growth stunting, and low bone mineral density. Nutrition interventions, such as elimination or elemental diets, are the first therapeutic tool for EoE management along with pharmacological interventions. Methods KS is a 20 month-old female whose weight-for-length has fallen above the 55th percentile since birth. She has a history of gastroesophageal reflux, dysphagia, and aspiration requiring thickened liquids for almost 2 years. During infancy she tolerated milk based thickened formula and transitioned to 1% milk at 1 year. She was diagnosed with EoE during a triple endoscope for laryngeal cleft repair. The pathology revealed rings and furrows in the mid/distal esophagus, and > 20 eosinophils per high powered field (HPF) in distal, mid, and proximal esophagus with evidence of subepithelial fibrosis. At that time she had no dietary restrictions or use of antacids. Since cleft repair, dysphagia improved and she started on a dairy free diet for EoE. However, she experienced an adverse reaction to dairy free nut-based cheese with subsequent positive radioallergosorbent testing to tree nuts. Follow-up endoscopy improved on an 8-week dairy and tree nut free diet, but eosinophils persisted in proximal esophagus with evidence of basal cell hyperplasia. Results The patient was able to make important strides towards remission by eliminating suspected trigger foods, with diagnosis and intervention initiation before signs of inadequate growth or nutrition. Conclusions Nutrition interventions are often imperative to achieve remission of EoE. There are potential nutrition related concerns including increased risk of nutrient deficiencies, inadequate growth, and poor quality of life as the patient follows an elimination/elemental diet. EoE should become a consideration when feeding or swallowing difficulties arise, especially in pediatric patients. Proper diagnosis, tailored interventions, and appropriate monitoring and evaluation with the help of a multidisciplinary team can lead to successful management. Funding Sources N/A.

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Family History of Diabetes Is Associated with Increased Risk of Recurrent DKA in Pediatric Patients in Rhode Island

Diabetes ◽

10.2337/db18-1378-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1378-P

Author(s):

JANAKI D. VAKHARIA ◽

SUNGEETA AGRAWAL ◽

JANINE BACIC ◽

LISA S. TOPOR

Keyword(s):

Family History ◽

Rhode Island ◽

Pediatric Patients ◽

Family History Of Diabetes ◽

Increased Risk ◽

History Of

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Faculty Opinions recommendation of Central venous catheter repair is associated with an increased risk of bacteremia and central line-associated bloodstream infection in pediatric patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14264133.15777271 ◽

2012 ◽

Author(s):

Theo Zaoutis

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Pediatric Patients ◽

Venous Catheter ◽

Central Line ◽

Central Venous ◽

Increased Risk

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Faculty Opinions recommendation of Infliximab is not associated with increased risk of malignancy or hemophagocytic lymphohistiocytosis in pediatric patients with inflammatory bowel disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727309453.793568142 ◽

2019 ◽

Author(s):

Ashish Patel

Keyword(s):

Inflammatory Bowel Disease ◽

Bowel Disease ◽

Hemophagocytic Lymphohistiocytosis ◽

Pediatric Patients ◽

Increased Risk ◽

Risk Of Malignancy ◽

Inflammatory Bowel

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Osteoarthritis: Insights Offered by the Study of Bone Mass Genetics

Current Osteoporosis Reports ◽

10.1007/s11914-021-00655-1 ◽

2021 ◽

Vol 19 (2) ◽

pp. 115-122

Author(s):

A. Hartley ◽

C. L. Gregson ◽

L. Paternoster ◽

J. H. Tobias

Keyword(s):

Bone Mass ◽

Causal Effect ◽

Mendelian Randomisation ◽

Mineral Density ◽

High Bone Mass ◽

Increased Risk ◽

High Bone ◽

Genetic Mechanisms ◽

Additional Support

Abstract Purpose of Review This paper reviews how bone genetics has contributed to our understanding of the pathogenesis of osteoarthritis. As well as identifying specific genetic mechanisms involved in osteoporosis which also contribute to osteoarthritis, we review whether bone mineral density (BMD) plays a causal role in OA development. Recent Findings We examined whether those genetically predisposed to elevated BMD are at increased risk of developing OA, using our high bone mass (HBM) cohort. HBM individuals were found to have a greater prevalence of OA compared with family controls and greater development of radiographic features of OA over 8 years, with predominantly osteophytic OA. Initial Mendelian randomisation analysis provided additional support for a causal effect of increased BMD on increased OA risk. In contrast, more recent investigation estimates this relationship to be bi-directional. However, both these findings could be explained instead by shared biological pathways. Summary Pathways which contribute to BMD appear to play an important role in OA development, likely reflecting shared common mechanisms as opposed to a causal effect of raised BMD on OA. Studies in HBM individuals suggest this reflects an important role of mechanisms involved in bone formation in OA development; however further work is required to establish whether the same applies to more common forms of OA within the general population.

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Thyroid Function within the Upper Normal Range Is Associated with Reduced Bone Mineral Density and an Increased Risk of Nonvertebral Fractures in Healthy Euthyroid Postmenopausal Women

Yearbook of Medicine ◽

10.1016/s0084-3873(11)00357-9 ◽

2011 ◽

Vol 2011 ◽

pp. 509-511

Author(s):

M. Schott

Keyword(s):

Bone Mineral Density ◽

Postmenopausal Women ◽

Thyroid Function ◽

Bone Mineral ◽

Mineral Density ◽

Normal Range ◽

Nonvertebral Fractures ◽

Increased Risk

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The Ability of Exercise to Mitigate Caloric Restriction-Induced Bone Loss in Older Adults: A Structured Review of RCTs and Narrative Review of Exercise-Induced Changes in Bone Biomarkers

Nutrients ◽

10.3390/nu13041250 ◽

2021 ◽

Vol 13 (4) ◽

pp. 1250

Author(s):

Sarah J. Wherry ◽

Ryan M. Miller ◽

Sarah H. Jeong ◽

Kristen M. Beavers

Keyword(s):

Older Adults ◽

Bone Loss ◽

Caloric Restriction ◽

Controlled Trial ◽

Areal Bone Mineral Density ◽

Bone Biomarkers ◽

Mineral Density ◽

Increased Risk ◽

Exercise Induced ◽

Induced Changes

Despite the adverse metabolic and functional consequences of obesity, caloric restriction- (CR) induced weight loss is often contra-indicated in older adults with obesity due to the accompanying loss of areal bone mineral density (aBMD) and subsequent increased risk of fracture. Several studies show a positive effect of exercise on aBMD among weight-stable older adults; however, data on the ability of exercise to mitigate bone loss secondary to CR are surprisingly equivocal. The purpose of this review is to provide a focused update of the randomized controlled trial literature assessing the efficacy of exercise as a countermeasure to CR-induced bone loss among older adults. Secondarily, we present data demonstrating the occurrence of exercise-induced changes in bone biomarkers, offering insight into why exercise is not more effective than observed in mitigating CR-induced bone loss.

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Common variants in MAEA gene contributed the susceptibility to osteoporosis in Han Chinese postmenopausal women

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-020-02140-4 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Xuan Cai ◽

Jun Dong ◽

Teng Lu ◽

Liqiang Zhi ◽

Xijing He

Keyword(s):

Postmenopausal Women ◽

Chinese Women ◽

Han Chinese ◽

Blood Levels ◽

Nucleotide Polymorphisms ◽

Mineral Density ◽

Association Analyses ◽

Metabolism Disorder ◽

Increased Risk ◽

Chinese Postmenopausal Women

Abstract Background Osteoporosis (OP) is a complex bone metabolism disorder characterized by the loss of bone minerals and an increased risk of bone fracture. A recent study reported the relationship of the macrophage erythroblast attacher gene (MAEA) with low bone mineral density in postmenopausal Japanese women. Our study aimed to investigate the association of MAEA with postmenopausal osteoporosis (PMOP) in Han Chinese individuals. Methods A total of 968 unrelated postmenopausal Chinese women comprising 484 patients with PMOP and 484 controls were recruited. Four tag single nucleotide polymorphisms (SNPs) that covered the gene region of MAEA were chosen for genotyping. Single SNP and haplotypic association analyses were performed, and analysis of variance was conducted to test the correlation between blood MAEA protein level and genotypes of associated SNPs. Results SNP rs6815464 was significantly associated with the risk of PMOP. The C allele of rs6815464 was strongly correlated with the decreased risk of PMOP in our study subjects (OR[95% CI]=0.75[0.63-0.89], P=0.0015). Significant differences in MAEA protein blood levels among genotypes of SNP rs6815464 were identified in both the PMOP (F=6.82, P=0.0012) and control groups (F=11.5, P=0.00001). The C allele was positively associated with decreased MAEA protein levels in blood. Conclusion This case-control study on Chinese postmenopausal women suggested an association between SNP rs6815464 of MAEA and PMOP. Further analyses showed that genotypes of SNP rs6815464 were also associated with the blood level of MAEA protein.

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DXA parameters, Trabecular Bone Score (TBS) and Bone Mineral Density (BMD), in fracture risk prediction in endocrine-mediated secondary osteoporosis

Endocrine ◽

10.1007/s12020-021-02806-x ◽

2021 ◽

Author(s):

Enisa Shevroja ◽

Francesco Pio Cafarelli ◽

Giuseppe Guglielmi ◽

Didier Hans

Keyword(s):

Bone Mineral Density ◽

Trabecular Bone ◽

Bone Mineral ◽

Trabecular Bone Score ◽

Bone Microarchitecture ◽

Fragility Fractures ◽

Endocrine Disorders ◽

Mineral Density ◽

Increased Risk

AbstractOsteoporosis, a disease characterized by low bone mass and alterations of bone microarchitecture, leading to an increased risk for fragility fractures and, eventually, to fracture; is associated with an excess of mortality, a decrease in quality of life, and co-morbidities. Bone mineral density (BMD), measured by dual X-ray absorptiometry (DXA), has been the gold standard for the diagnosis of osteoporosis. Trabecular bone score (TBS), a textural analysis of the lumbar spine DXA images, is an index of bone microarchitecture. TBS has been robustly shown to predict fractures independently of BMD. In this review, while reporting also results on BMD, we mainly focus on the TBS role in the assessment of bone health in endocrine disorders known to be reflected in bone.

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