PMID- 35897130
OWN - NLM
STAT- MEDLINE
DCOM- 20220923
LR  - 20221107
IS  - 1536-4801 (Electronic)
IS  - 0277-2116 (Linking)
VI  - 75
IP  - 4
DP  - 2022 Oct 1
TI  - Subtyping of Eosinophilic Esophagitis Based on Disease Presentation in a 
      pediatric Cohort.
PG  - e67-e74
LID - 10.1097/MPG.0000000000003580 [doi]
AB  - OBJECTIVE: Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory 
      disease characterized by eosinophilic infiltration of esophageal tissue. 
      Subtyping of EoE patients could be useful in predicting therapeutic response. We 
      propose clinical subtypes, apply them to our pediatric EoE population 
      retrospectively, and assess therapy choices and remission at one year. METHODS: A 
      retrospective chart review of pediatric patients diagnosed with EoE was 
      conducted. Patients were grouped into proposed subtypes (severe, allergic, 
      fibrostenotic, inflammatory, unclassified) based on presenting characteristics. 
      The primary outcome was histologic remission, which was defined <15 
      eosinophils/high-powered-field (hpf) at the closest visit 1 year postdiagnosis. 
      RESULTS: Subtyping was possible in 242 of 256 patients and follow-up histological 
      data were available in 75 subjects. The majority had an overlap in phenotype with 
      17% severe, 77% allergic, 15% fibrostenotic, 60% inflammatory, and 5% 
      unclassified, whereas 45% of the cohort were assigned to a unique subtype. At 1 
      year, 43/75 (57%) of patients achieved histologic remission, with an overall 
      average decrease of 33 (IQR -47, -12) eosinophils/hpf across the entire cohort. 
      There was no difference in remission rates among subtypes. First-line therapy 
      review revealed higher rates of proton pump inhibitor (PPI) +/- topical steroids 
      utilization in severe patients, while topical steroids were prescribed 
      preferentially over dietary therapy in the fibrostenotic subtype. CONCLUSION: 
      There were no observed differences in remission rates at 1 year among clinically 
      defined subtypes of EoE, although this could be attributed to overlapping 
      subtypes. Most patients responded well to medical therapy. Larger scale 
      prospective studies designed to subtype patients and protocolize treatment may 
      help personalize the approach to EoE management.
CI  - Copyright (c) 2022 by European Society for European Society for Pediatric 
      Gastroenterology, Hepatology, and Nutrition and North American Society for 
      Pediatric Gastroenterology, Hepatology, and Nutrition.
FAU - Sessions, Julia
AU  - Sessions J
AD  - From the Stanford School of Medicine, Stanford, CA.
AD  - the University of Virginia Health System, Charlottesville, VA.
FAU - Purington, Natasha
AU  - Purington N
AD  - the Quantitative Sciences Unit, Division of Biomedical Informatics Research, 
      Departmesnt of Medicine, Stanford University, Palo Alto, CA.
FAU - McGhee, Sean
AU  - McGhee S
AD  - the Lucile Packard Children's Hospital, Palo Alto, CA.
FAU - Bass, Dorsey
AU  - Bass D
AD  - the Lucile Packard Children's Hospital, Palo Alto, CA.
FAU - Wang, Yiwen
AU  - Wang Y
AD  - the Quantitative Sciences Unit, Division of Biomedical Informatics Research, 
      Departmesnt of Medicine, Stanford University, Palo Alto, CA.
FAU - Goyal, Alka
AU  - Goyal A
AD  - the Lucile Packard Children's Hospital, Palo Alto, CA.
FAU - Khavari, Nasim
AU  - Khavari N
AD  - the Lucile Packard Children's Hospital, Palo Alto, CA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20220728
PL  - United States
TA  - J Pediatr Gastroenterol Nutr
JT  - Journal of pediatric gastroenterology and nutrition
JID - 8211545
RN  - 0 (Proton Pump Inhibitors)
RN  - Eosinophilic enteropathy
SB  - IM
MH  - Enteritis
MH  - Eosinophilia
MH  - *Eosinophilic Esophagitis/diagnosis/drug therapy
MH  - Gastritis
MH  - Humans
MH  - Inflammation/drug therapy
MH  - Prospective Studies
MH  - Proton Pump Inhibitors/therapeutic use
MH  - Retrospective Studies
COIS- The authors report no conflicts of interest.
EDAT- 2022/07/29 06:00
MHDA- 2022/09/24 06:00
CRDT- 2022/07/28 00:02
PHST- 2022/07/29 06:00 [pubmed]
PHST- 2022/09/24 06:00 [medline]
PHST- 2022/07/28 00:02 [entrez]
AID - 00005176-202210000-00020 [pii]
AID - 10.1097/MPG.0000000000003580 [doi]
PST - ppublish
SO  - J Pediatr Gastroenterol Nutr. 2022 Oct 1;75(4):e67-e74. doi: 
      10.1097/MPG.0000000000003580. Epub 2022 Jul 28.