Detailed Histologic Evaluation of Eosinophilic Esophagitis in Pediatric Patients Presenting with Dysphagia or Abdominal Pain and Comparison of the Histology between the Two Groups

EoE in children presents with four main symptoms. Most common symptoms exhibited by our clinic population are dysphagia (D) and abdominal pain (AP). Despite similar treatments, we found in an earlier study that the outcomes between these two groups were different. Therefore, we investigated if there exist any histological differences between these groups that could further our knowledge of EoE. Aim. To compare esophageal histology in detail, apart from the eosinophil count, between EoE-D and EoE-AP. Method. Biopsies of patients with EoE-D and EoE-AP were reevaluated for 10 additional histological criteria, in addition to the eosinophil count. Results. Both groups had 67 patients; peak mean eosinophil was 33.9 and 31.55 for EoE-D and EoE-AP (p<0.05). Eosinophilic microabscesses, superficial layering of eosinophils, and epithelial desquamation were twice as common and significant in EoE-D group than EoE-AP. Eosinophil distribution around rete pegs was also significantly higher in EoE-D group. The remaining criteria were numerically higher in EoE-D, but not significant, with the exception of rete peg elongation. Conclusion. EoE-D patients have significantly higher eosinophils compared to EoE-AP, and the level of inflammation as seen from eosinophil microabscesses, superficial layering, desquamation, and the distribution around rete pegs is significantly higher.

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Eosinophilic Esophagitis in Brazilian Pediatric Patients

Clinical Medicine Insights Pediatrics ◽

10.4137/cmped.s12733 ◽

2013 ◽

Vol 7 ◽

pp. CMPed.S12733 ◽

Cited By ~ 8

Author(s):

Mayra Isabel Correia Pinheiro ◽

Luciano Pamplona De Góes Cavalcanti ◽

Rodrigo Schuler Honório ◽

Luïs Hélder De Alencar Moreno ◽

Mayara Carvalho Fortes ◽

...

Keyword(s):

Abdominal Pain ◽

Topical Corticosteroid ◽

Eosinophilic Esophagitis ◽

Pediatric Patients ◽

Erosive Esophagitis ◽

Normal Mucosa ◽

Patient Treatment ◽

Therapeutic Approaches ◽

Endoscopic Findings ◽

The Mean

We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils.

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Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

The American Surgeon ◽

10.1177/000313481307901114 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1140-1141 ◽

Cited By ~ 4

Author(s):

Ann A. Albert ◽

Tracy L. Nolan ◽

Bryan C. Weidner

Keyword(s):

Abdominal Pain ◽

African American Male ◽

Pediatric Patients ◽

Primary Anastomosis ◽

Exploratory Laparotomy ◽

Sigmoid Volvulus ◽

Sudden Onset ◽

Contrast Enema ◽

Pediatric Age Group ◽

History Of

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CTwas consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

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The Prevalence of Eosinophilic Esophagitis in Pediatric Patients with IgE-Mediated Food Allergy

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2016.11.020 ◽

2017 ◽

Vol 5 (2) ◽

pp. 369-375 ◽

Cited By ~ 49

Author(s):

David A. Hill ◽

Jesse W. Dudley ◽

Jonathan M. Spergel

Keyword(s):

Food Allergy ◽

Eosinophilic Esophagitis ◽

Pediatric Patients ◽

Ige Mediated

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Newly developed and validated eosinophilic esophagitis histology scoring system and evidence that it outperforms peak eosinophil count for disease diagnosis and monitoring

Diseases of the Esophagus ◽

10.1111/dote.12470 ◽

2016 ◽

pp. n/a-n/a ◽

Cited By ~ 23

Author(s):

M. H. Collins ◽

L. J. Martin ◽

E. S. Alexander ◽

J. Todd Boyd ◽

R. Sheridan ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Eosinophil Count ◽

Scoring System ◽

Disease Diagnosis

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Multiple Somatic Symptoms Linked to Positive Screen for Depression in Pediatric Patients With Chronic Abdominal Pain

Journal of Pediatric Gastroenterology and Nutrition ◽

10.1097/01.mpg.0000243423.93968.7c ◽

2007 ◽

Vol 44 (1) ◽

pp. 58-62 ◽

Cited By ~ 28

Author(s):

Cheryl A Little ◽

Sara E Williams ◽

Martina Puzanovova ◽

Erin R Rudzinski ◽

Lynn S Walker

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Somatic Symptoms ◽

Chronic Abdominal Pain ◽

Positive Screen

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Fr629 ELECTRODERMAL ACTIVITY OF AURICULAR ACUPOINTS IN PEDIATRIC PATIENTS WITH FUNCTIONAL ABDOMINAL PAIN DISORDERS

Gastroenterology ◽

10.1016/s0016-5085(21)01630-9 ◽

2021 ◽

Vol 160 (6) ◽

pp. S-383

Author(s):

Rachel Borlack ◽

Amanda M. Zong ◽

Sophie Shan ◽

Julie Khlevner ◽

Garbers Samantha ◽

...

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Electrodermal Activity ◽

Functional Abdominal Pain

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620 GASTRODUODENAL EOSINOPHILIA IS UNDER-APPRECIATED IN EOSINOPHILIC ESOPHAGITIS (EOE) PATIENTS WITH FUNCTIONAL BOWEL SYMPTOMS: A REAL LIFE EXPERIENCE

Diseases of the Esophagus ◽

10.1093/dote/doab052.620 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Kathryn Peterson ◽

Robert Genta ◽

Henrik Rasmussen ◽

Bradford Youngblood ◽

Amol Kamboj

Keyword(s):

Abdominal Pain ◽

Small Bowel ◽

Eosinophilic Esophagitis ◽

Life Experience ◽

Real Life ◽

Gastrointestinal Disorder ◽

Control Group ◽

Abdominal Symptoms ◽

Gi Symptoms ◽

Initial Work

Abstract Eosinophilic esophagitis (EoE) is currently thought to be the most common Eosinophilic Gastrointestinal Disorder. EoE patients often present with non-esophageal GI symptoms. Presence of EoE increases one’s risk of developing distal eosinophilia, including eosinophilic gastritis (EG) and duodenitis (EoD). A diagnosis of EG/EoD often takes years due to lack of provider awareness and absence of consensus diagnostic guidelines. The aim was to evaluate the prevalence of EG/EoD in patients with EoE and functional abdominal symptoms. Methods 52 EoE patients with extra-esophageal GI symptoms (i.e. abdominal pain, nausea, bloating, irritable bowel) who had stomach and small bowel biopsies interpreted as non-specific inflammation or normal were identified (‘EoE + S’). 15 EoE patients without extra-esophageal complaints who had routine screening stomach and small bowel biopsies at their initial endoscopies were included as a control group (‘EoE-S’). Biopsies taken at initial work up were identified and blocks were cut for H&E staining and assessment by an independent, blinded GI pathologist skilled in eosinophil (eos) assessment. Results 45 EoE + S and 12 EoE-S patients were evaluated (Table 1). Common symptoms were abdominal pain, bloating and nausea. All prior pathology reports were consistent with non-specific inflammation or normal tissue. Upon blinded re-assessment, 8/45 (17.8%) EoE + S patients met criteria for EG (≥30 eos/hpf in ≥5 gastric hpfs). None of the EoE-S patients met criteria for EG. 24/45 (53%) EoE + S patients met criteria for EoD (≥30 eos/hpf in ≥3 duodenal hpfs). 7 patients had concomitant EG + EoD. 3/12 EoE-S patients met criteria for EoD. Peak gastric and duodenal eos counts for the EoE + S group were higher than for the EoE-S group. Conclusion In patients with EoE and extra-esophageal GI complaints, review of gastric and duodenal biopsies previously reported as normal or ‘non-specific inflammation’ demonstrated a high discovery rate of gastroduodenal eosinophilia. These findings suggest that intentional evaluation of gastric and duodenal eos is indicated in patients with EoE and persistent non-esophageal GI symptoms. Increased awareness of EG/EoD and consensus diagnostic criteria may lead to the identification of currently undiagnosed patients with EG/EoD.

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Gluten and Functional Abdominal Pain Disorders in Children

Nutrients ◽

10.3390/nu10101491 ◽

2018 ◽

Vol 10 (10) ◽

pp. 1491 ◽

Cited By ~ 2

Author(s):

Alejandro Llanos-Chea ◽

Alessio Fasano

Keyword(s):

Abdominal Pain ◽

Pediatric Patients ◽

Functional Gastrointestinal Disorders ◽

Gastrointestinal Symptoms ◽

Gluten Sensitivity ◽

Gluten Free ◽

Functional Abdominal Pain ◽

Adults And Children ◽

Small Intestinal ◽

Irritable Bowel

In children, functional gastrointestinal disorders (FGIDs) are common at all ages. Consumption of certain foods, particularly gluten, is frequently associated with the development and persistence of FGIDs and functional abdominal pain disorders (FAPDs) in adults and children. However, this association is not well defined. Even without a diagnosis of celiac disease (CD), some people avoid gluten or wheat in their diet since it has been shown to trigger mostly gastrointestinal symptoms in certain individuals, especially in children. The incidence of conditions such as non-celiac gluten sensitivity (NCGS) is increasing, particularly in children. On the other hand, CD is a chronic, autoimmune small intestinal enteropathy with symptoms that can sometimes be mimicked by FAPD. It is still unclear if pediatric patients with irritable bowel syndrome (IBS) are more likely to have CD. Abdominal, pain-associated FGID in children with CD does not seem to improve on a gluten-free diet. The threshold for gluten tolerance in patients with NCGS is unknown and varies among subjects. Thus, it is challenging to clearly distinguish between gluten exclusion and improvement of symptoms related solely to functional disorders.

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