Various therapeutic approaches in the treatment of eosinophilic esophagitis in children

Abstract

Eosinophilic esophagitis (EoE) is a multifactorial disease characterized by variable clinical manifestations and varying responses to therapy, especially in pediatric patients. The purpose of this research was to analyze the results of EoE various treatment methods in children. Materials and methods used: a single-center retrospective cohort study conducted in 2020-2023 that included patients from 6 y/o to 17 years and 11 months old whose condition was assessed when verifying the EoE diagnosis and after prescribing therapy at least once. Symptoms of dysphagia were assessed using the Dysphagia Symptom Questionnaire, the endoscopic signs of EoE were recorded using the EREFS scoring system, and the number of eosinophils in biopsy samples of the mucous membrane (MM) of the esophagus was counted (at a magnification of 400) as well. Physical development was assessed using the WHO AnthroPlus application. Results: 18 patients were divided into 3 groups: G1 (n=5) of those who received monotherapy with topical glucocorticosteroids (tGCS), G2 (n=10) of those who received combination therapy with proton pump inhibitors (PPIs) and tGCS, and G3 (n=3) of those receiving dupilumab therapy. The three patients from G2 were prescribed with amino acid mixture as nutritional support. Statistically significant decrease in symptoms of dysphagia (p<0.001), decrease in the total score on the EREFS as well as decrease in the peak number of eosinophils in biopsy specimens of the esophagus were detected after 8 to 12 weeks after the start of treatment in all patients. However, statistically insignificant deterioration in clinical and histological parameters (p=0.06 and 0.2, respectively) coupled with statistically significant increase in EREFS scores (p=0.02) were revealed during the second control esophagogastroduodenoscopies in patients from Groups 1 and 2. Dupilumab therapy was effective in all considered parameters. In addition to the regression in clinical symptoms, endoscopic and histological signs, there was a significant improvement in nutritional status detected on the background of the amino acid mixture in all patients. Signs of esophageal candidiasis were recorded during the long-term therapy with corticosteroids in a singles patient. Conclusion: the too early reduction of therapy in children with EoE happening on the background of signs of clinical and histological remission could lead to the disease relapse. Management of children with EoE requires regular monitoring of the disease activity and dietary therapy taking into consideration the individual characteristics of each patient with EoE.