Efficacy and choice of treatment for eosinophilic esophagitis in childhood

CYBER | Tuesday, August 27, 2024

A collaborative study based on data from the European Registry of Clinical, Environmental and Genetic Determinants of Eosinophilic Esophagitis (EoE CONNECT) and coordinated by the CIBER Group on Liver and Digestive Diseases (CIBERHD), led by Alfredo J. Lucendo (Tomelloso General Hospital). assessed factors influencing the choice of first-line treatment and its effectiveness in children and adolescents with eosinophilic esophagitis (EoE).

The results are published in the format open access V European Journal of Pediatricsand they Researchers from two other CIBEREHD groups contributed.: Cecilio Santander (La Princesa University Hospital) and Danila Guagnozzi (Vall d’Hebron Hospital).

EoE is a chronic immune-mediated inflammatory disease of the esophagus characterized by eosinophil-predominant inflammation and symptoms of esophageal dysfunction. In adults and adolescents, they consist mainly of dysphagia and delayed feeding, while in young children the disease often presents in a non-specific manner, with feeding problems, chest or abdominal pain and vomiting, often superimposed on symptoms of gastroesophageal reflux disease. EoE has a peak incidence in childhood and is a major cause of dysphagia among these patients. Persistent inflammation can lead to fibrostenotic remodeling of the esophagus, which is the major long-term consequence of EoE.

In this work the authors assessed the effectiveness of pharmacological anti-inflammatory treatment (proton pump inhibitors -PPIs- and topical corticosteroids) and dietary nutrition for the induction of clinical and histological remission of EoE, as well as the factors that determined their choice and those that influence the effectiveness of first-line treatment.

For this it is analyzed 393 first-line prescriptions used in monotherapy. (64% of them in adolescents over 12 years old) collected from hospitals in Spain, Italy, France and Denmark. PPIs were the most common initial treatment option (71% of patients). However, topical corticosteroids were the most effective option in achieving clinical and histological remission (66%), followed by PPIs (44%) and dietary interventions (42%). Logistic regression analysis showed that the choice of topical oral corticosteroids as first line was associated with the presence of fibrotic features at diagnostic endoscopy of EoE and with care in Italian hospitals, while the use of dietary therapy was predominant in younger patients aged 12 years. On the other hand, PPIs were more effective when used in high doses and when the patient was treated in pediatric units. In addition, PPIs were able to reverse fibrotic endoscopic changes (rings and strictures) in patients who responded to these drugs.

This real-world data-based study represents the largest analysis to date of factors determining the choice and effectiveness of pediatric EoE treatments, and its results should guide future treatment recommendations.

Link to product:

https://link.springer.com/article/10.1007/s00431-024-05618-z

Determinants of first-line treatment choice and efficacy in pediatric eosinophilic esophagitis: analysis of the EUREOS EoE CONNECT registry