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BACKGROUND: To assess the efficacy of applying the endoscopic reference score for EoE (EREFS) in children with symptoms of esophageal dysfunction naïve to proton pump inhibitor (PPI) therapy. METHODS: An observational cross-sectional study was conducted by reviewing reports and photographs of upper gastrointestinal endoscopies (UGE) and esophageal biopsies of patients with symptoms of esophageal dysfunction. Patients who were treated with PPI or had other conditions that may cause esophageal eosinophilia were excluded. RESULTS: Of the 2,036 patients evaluated, endoscopic findings of EoE were identified in 248 (12.2%) and more than one abnormality was observed in 167 (8.2%). Among all patients, 154 (7.6%) presented esophageal eosinophilia (≥15 eosinophils per high power field) (P<0.01). In this group, 30 patients (19.5%) had normal endoscopy. In patients with EoE, edema (74% vs 6.5%, P<0.01) and furrows (66.2% vs 2.4%, P<0.01) were more prevalent than in the control group. Association of edema and furrows was more frequent in patients with EoE than in the control group (29.2% vs 1.6%, P<0.01, OR=24.7, CI=15.0-40.5). The presence of more than one endoscopic finding had sensitivity of 80.5%, specificity of 93.4%, positive predictive value (PPV) of 50%, negative predictive value (NPV) of 98.3%, and accuracy of 92.4%. CONCLUSION: In conclusion, this study showed that endoscopic features suggestive of EoE had high specificity and NPV for diagnosing EoE in children naïve to PPI therapy. These findings highlight the importance of the EREFS in contributing to early identification of inflammatory and fibrostenosing characteristics of EoE, making it possible to identify and to avoid progression of the disease. BACKGROUND: • The EoE endoscopic reference score (EREFS) was developed and validated in adults and has been demonstrated to be an adequate tool for diagnosing and assessing treatment response in children. BACKGROUND: • The presence of more than one endoscopic finding stronglysuggests EoE. BACKGROUND: • The EoE endoscopic reference score presents high specificity and negative predictive value for diagnosing EoE in children naïve to proton pump inhibitor (PPI) therapy. BACKGROUND: • Endoscopic findings suggestive of EoE in patients naïve to treatment may be useful to characterize disease phenotype and individualize treatment according to the initial clinical presentation.

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BACKGROUND: The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. PATIENTS AND METHODS: We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. RESULTS: We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08-0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06-0.69, p < 0.001), particularly allergic rhinitis and food allergy. CONCLUSIONS: We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.

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Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus characterized by symptoms of esophageal dysfunction such as dysphagia, food impaction, and chest pain in adults. It is associated with atopic di- seases such as allergic rhinitis, atopic dermatitis, and asthma. Diagnosis requires symptoms of esophageal dysfunction, eosinophilic inflammation in esophageal biopsies with at least 15 eosinophils per high power field, and exclusion of other causes of local or systemic eosinophilia. EoE is more common in men and has an increasing prevalence, varying globally. The pathophysiology involves TH2-mediated eosinophilic inflammation driven by food antigens, esophageal barrier dysfunction and tissue remodeling. Various therapeutic options aim for clinical and histological remission, including dietary and pharmacological treatments. Dietary therapy, topical corticosteroids and proton pump inhibitors are first-line treatments. Topical corticosteroids achieve high histological remission. Development of new therapies is ongoing. Dupilumab, an antibody against IL-4Rα, shows efficacy in achieving histological and symptomatic remission in patients unresponsive to proton pump inhibitors. Other targeted therapies with clinical trials for EoE include mepolizumab, reslizumab, cendakimab, lirentelimab, and etrasimod with variable clinical and histological results. A subgroup of patients with EoE unresponsive or with bad adherence to first line therapies or patients with multiple comorbid atopic diseases may benefit from biological therapies. This review aims to describe new therapeutic options, detailing their mechanisms, efficacy, and safety profiles.

La esofagitis eosinofílica (EEo) es una enfermedad crónica, inmunomediada del esófago, caracterizada por síntomas de disfunción esofágica como disfagia, impactación y dolor torácico en adultos. Se asocia a otras enfermedades atópicas como rinitis alérgica, dermatitis atópica y asma. El diagnóstico requiere síntomas de disfunción esofágica, inflamación eosinofílica en biopsias de esófago con al menos 15 eosinófilos por campo de aumento mayor, y exclusión de otras causas de eosinofilia local o sistémica. La EEo es más común en hombres y tiene una prevalencia en aumento. La fisiopatología incluye inflamación eosinofílica mediada por una respuesta TH2 gatillada por antígenos alimenticios, además disfunción de barrera esofágica y remodelación de tejido. Varias opciones terapéuticas tienen como objetivo la remisión clínica e histológica, incluyendo terapias dietéticas y tratamientos farmacológicos. La terapia dietética, inhibidores de bomba de protones o corticosteroides tópicos sin terapias de primera línea. Los corticosteroides tópicos alcanzan altas tasas de remisión histológica. El desarrollo de nuevas terapias se está llevando a cabo. Dupilumab, un anticuerpo contra IL-4Rα, muestra eficacia en alcanzar remisión histológica y sintomática en pacientes no responde- dores a inhibidores de bomba de protones. Otras terapias con estudios clínicos para EEo incluyen el mepolizumab, reslizumab, cendakimab, lirentelimab y etrasimod, con resultados variables. Un subgrupo de pacientes con EEo no respondedores o con mala adherencia a terapias de primera línea o con comorbilidades atópicas graves se podrían beneficiar de terapias biológicas como dupilumab. Esta revisión tiene como objetivo describir nuevas opciones tera- péuticas, detallando su mecanismo de acción, eficacia y perfil de seguridad.

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Although swallowed topical steroids are effective in inducing histological remission in eosinophilic esophagitis (EoE), their efficacy is limited by treatment nonadherence. In this study, we objectively measured adherence rates to swallowed topical steroids in adolescents with EoE over the course of 8 weeks and analyzed the association between adherence rate, disease and demographic features, symptom severity, and medication-taking habit strength. We found that approximately 20% of adolescents with EoE were over-dosing on their medications. After excluding these patients, mean adherence rate was 67.0% (±19.4%) and median adherence rate was 63% (interquartile range 53%-88%). Adherence was not associated with demographic features, disease history, symptom severity, or quality of life but was associated with habit strength (Pearson r = 0.48, P = 0.04). These findings suggest that habit strength may serve as a potential target for interventions aimed at improving adherence in adolescents with EoE.

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PURPOSE: Eosinophilic esophagitis (EoE) is an immunologically mediated chronic disease of the gastrointestinal tract. The objective of this study was to clinically and demographically describe a child population with EoE diagnosed in a high-complexity hospital in Cali, Colombia. METHODS: A retrospective study was carried out. The clinical histories of patients between 0 and 18 years with clinical suspicion and a histological diagnosis of EoE were analyzed. All patients underwent an allergy study, either by measurement of specific immunoglobulin (Ig) E and/or an intraepidermal skin-prick test. RESULTS: Thirty-five patients were included in the study, of which 21 (60%) women. The median age was 8 years (interquartile range [IQR] 5-12), and the age of onset of symptoms was 5 years (IQR 2-10). Thirty patients (85.7%) reported a history of allergic disease, with rhinitis being the most frequent (n = 25, 71.4%). Only one patient reported with food allergy mediated by IgE. The main symptoms in patients included abdominal pain (17 [48.6%]), refractory gastroesophageal reflux (16 [45.7%]), and choking (9 [25.7%]). Upper gastrointestinal endoscopy was normal in 10 patients (38.5%). The median number of eosinophils in the biopsy was 42 (IQR 31-92). Allergenic sensitization was verified in 25 of 35 patients (71.4%). Of these, dust mite allergy was positive in 21 patients (84%), while the most frequent food allergy was toward cow's milk, in five patients (31.3%). CONCLUSIONS: The majority of patients with EoE were females. The most frequent symptom was abdominal pain. Endoscopic abnormalities were also observed frequently, and the prevalence of other allergic diseases (especially rhinitis) and allergenic sensitization (especially to mites) was high.

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BACKGROUND/OBJECTIVES: Eosinophilic esophagitis (EoE) is an inflammatory disease of unclear etiology. The aim of this study was to use untargeted plasma metabolomics to identify metabolic pathway alterations associated with EoE to better understand the pathophysiology. METHODS: This prospective, case-control study included 72 children, aged 1-17 years, undergoing clinically indicated upper endoscopy (14 diagnosed with EoE and 58 controls). Fasting plasma samples were analyzed for metabolomics by high-resolution dual-chromatography mass spectrometry. Analysis was performed on sex-matched groups at a 2:1 ratio. Significant differences among the plasma metabolite features between children with and without EoE were determined using multivariate regression analysis and were annotated with a network-based algorithm. Subsequent pathway enrichment analysis was performed. RESULTS: Patients with EoE had a higher proportion of atopic disease (85.7% vs 50%, P = 0.019) and any allergies (100% vs 57.1%, P = 0.0005). Analysis of the dual chromatography features resulted in a total of 918 metabolites that differentiated EoE and controls. Glycerophospholipid metabolism was significantly enriched with the greatest number of differentiating metabolites and overall pathway enrichment ( P < 0.01). Multiple amino and fatty acid pathways including linoleic acid were also enriched, as well as pyridoxine metabolism ( P < 0.01). CONCLUSIONS: In this pilot study, we found differences in metabolites involved in glycerophospholipid and inflammation pathways in pediatric patients with EoE using untargeted metabolomics, as well as overlap with amino acid metabolome alterations found in atopic disease.

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PURPOSE: Oesophageal squamous papilloma (OSP) is a rare epithelial lesion with an unclear aetiology, found incidentally in upper gastrointestinal endoscopy (UGE). We evaluate the epidemiology, general features and endoscopic and histological characteristics of OSP in children in a single centre. METHODS: We conducted a retrospective search of 3568 medical records of children under 18 years old who underwent UGE between 2004 and 2022, at Hospital Metropolitano de Quito, Ecuador. We described the general features of 15 patients diagnosed with OSP. Histopathology reports were analysed, including a chromogenic in situ hybridisation (CISH) for human papillomavirus (HPV) 6/11. RESULTS: OSP was diagnosed in 15 patients between 10 and 16 years of age, with an estimated prevalence of 0.4%. The gender ratio male to female was 1:1.1. Most patients (n=14) underwent UGE due to abdominal pain. Lesions were found predominantly in the upper and lower part of the oesophagus; 12 patients had isolated lesions, and none of the lesions tested positive for HPV on CISH 6/11 analysis. Additionally, Helicobacter pylori and eosinophilic oesophagitis (EoE) were diagnosed in one patient each. CONCLUSION: Our study describes the clinical features of paediatric OSP in a single centre. The prevalence was similar to that in the adult population but higher than in other paediatric populations, and none of our patients had HPV.

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OBJECTIVE: To evaluate the impact of type and dose of swallowed topical steroids (STS) and concurrent steroid therapy on the development and resolution of adrenal insufficiency (AI) in pediatric eosinophilic esophagitis (EoE). METHODS: We performed a retrospective case-control study of pediatric EoE subjects in a single tertiary care center, who were treated with STS for at least 3 months and diagnosed with AI based on a peak stimulated cortisol level of <18 µg/dL (500 nmol/L). Steroid forms and doses, and endoscopy data were collected at the time of AI diagnosis and AI resolution or the last known evaluation. Steroid formulations were converted to a fluticasone-equivalent dose for analysis. RESULTS: Thirty-two EoE subjects with AI were identified, and 20 had AI resolution, including 12 who remained on lower dose STS. Eight of the 32 patients were also treated with extended-release budesonide (ER budesonide), which resulted in a 7-fold higher total daily steroid dose, and thus were analyzed separately. When the 24 cases that were not on ER budesonide were compared to the 81 controls, no difference was found in the STS dose nor total daily steroid dose, although the inhaled steroid dose had marginal significance. Peak eosinophil counts tended to increase when STS doses were decreased, except in subjects on ER budesonide at AI diagnosis. CONCLUSION: Altering the total daily steroid regimen can lead to resolution of AI in patients with EoE, though this may come at the expense of disease control.

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La esofagitis eosinofílica (EoE) es una enfermedad causada por una respuesta inmune frente a antígenos alimentarios en contacto con la mucosa esofágica; por su parte, la enfermedad de Von Willebrand (EVW) es el trastorno hemorrágico hereditario más común en los seres humanos. La característica central de todos los tipos de EVW, es la presencia de cantidades reducidas o de formas anormales del factor de Von Willebrand (FVW) en el torrente sanguíneo. Debido a que no se han reportado casos previos de EVW tipo 2A asociada a EoE, se describe este caso clínico con el objetivo principal de dar a conocer el hallazgo casual de estas dos patologías, la seguridad de la evaluación por endoscopia de vías digestivas altas y el pronóstico de posibles complicaciones

Eosinophilic esophagitis (EoE) is a disease caused by an immune response against food antigens in contact with the esophageal mucosa; alternatively, Von Willebrand disease (VWD) is the most common inherited bleeding disorder in humans. The central characteristic of all types of VWD is the presence of reduced amounts or abnormal forms of VWF in the bloodstream. Since no previous cases of VWD type 2A associated to EoE have been reported, this clinical case is described with the main objective to present the coincidental finding of these two pathologies, the safety of the evaluation by upper gastrointestinal endoscopy, and the prognosis of possible complications

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