Characteristics and management of eosinophilic esophagitis in Australasian children: a decade of experience

IF 1.8 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Hamish Philpott, Daniel A. Lemberg, Andrew S. Day, Jeremy Rosenbaum, Harveen Singh, Sarah Rumore, Samuel Ellison, Michael Couper, Jody Porter, Amin Roberts, Kunal Thacker, David Moore, Glenn Furata, Ajay Sharma
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引用次数: 0

Abstract

Background

The frequency of EoE has been increasing in Northern Hemisphere cohorts, yet there is a scarcity of data in our region. Regional climatic factors, and lifestyle habits may influence the presentation of EoE, and appropriate management is crucial to prevent complications. WIth this is mind we undertook the first comprehensive multisite study of EoE in Australasian children.

Aim

To determine the incidence, prevalence, clinical characteristics and management of eosinophilic esophagitis (EoE) in Australasian children.

Methods

Retrospective audit of endoscopic records, histology reports and case notes (ICD code) over a 10-year period (1 January 2008 to 31 December 2018). Cases were defined as having >15 eosinophils per high-power field (HPF) at endoscopy and oesophageal biopsy, while treatment response was defined as <5 eosinophils per HPF. Included were patients aged 0–18 years presenting to tertiary paediatric hospitals in seven capital cities (Adelaide, Auckland, Brisbane, Christchurch, Melbourne, Perth and Sydney), while those with conditions that could cause eosinophilia (organ transplantation, hyper-eosinophilic syndrome) or taking medications that may influence tissue eosinophilia (systemic corticosteroids immunosuppressants) were excluded. Australian Bureau of Statistics and Stats NZ were used to define comparative population data. Demographics (age at diagnosis, gender, country of birth, race) comorbidities (atopic conditions, e.g. asthma, seasonal rhinitis, eczema) and treatment (diet, steroids, proton pump inhibitors) were noted.

Results

The prevalence of EoE ranged from 15 to 54 per 100 000 children, where cases were more common in Adelaide than other localities. Incidence increased significantly in all sites across the 10 years, with peak incidence in Adelaide of 6.4 per 100 000 children in 2017. EoE was most frequent in males (male:female ratio = 3:1) and >90% were white Caucasian. Polynesian racial background in Auckland (10%) and middle eastern racial background in Sydney (10%) were the next most frequent. Treatment choice varied across sites, and greater than 30% of patients did not undergo endoscopy to assess initial treatment success.

Conclusion

The prevalence of EoE in Australasian children is comparable to that observed elsewhere, and the incidence is increasing significantly. Regional differences in disease frequency, management practices and access to endoscopy warrant further study.

澳大利亚儿童嗜酸性粒细胞性食管炎的特点和治疗:十年的经验。
背景:在北半球队列中,EoE的频率一直在增加,但我们地区的数据缺乏。区域气候因素和生活习惯可能影响EoE的表现,适当的管理对预防并发症至关重要。带着这样的想法,我们对澳大利亚儿童的EoE进行了第一次全面的多地点研究。目的:了解澳大利亚儿童嗜酸性粒细胞性食管炎(EoE)的发病率、患病率、临床特点及治疗方法。方法:回顾性审核10年间(2008年1月1日至2018年12月31日)的内镜记录、组织学报告和病例记录(ICD代码)。病例被定义为内镜检查和食管活检中每高倍视野(HPF)有bb150个嗜酸性粒细胞,而治疗反应被定义为:结果:EoE的患病率为每10万名儿童15至54名,其中病例在阿德莱德比其他地区更常见。10年来,所有地区的发病率都显著增加,2017年阿德莱德的发病率最高,为每10万名儿童6.4例。EoE以男性居多(男女比例为3:1),其中白种人居多(90%)。其次是奥克兰的波利尼西亚种族背景(10%)和悉尼的中东种族背景(10%)。不同部位的治疗选择不同,超过30%的患者没有接受内窥镜检查来评估初始治疗的成功。结论:澳大拉西亚儿童EoE患病率与其他地区相当,发病率呈明显上升趋势。疾病频率、管理方法和内窥镜检查的区域差异值得进一步研究。
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来源期刊
Internal Medicine Journal
Internal Medicine Journal 医学-医学:内科
CiteScore
3.50
自引率
4.80%
发文量
600
审稿时长
3-6 weeks
期刊介绍: The Internal Medicine Journal is the official journal of the Adult Medicine Division of The Royal Australasian College of Physicians (RACP). Its purpose is to publish high-quality internationally competitive peer-reviewed original medical research, both laboratory and clinical, relating to the study and research of human disease. Papers will be considered from all areas of medical practice and science. The Journal also has a major role in continuing medical education and publishes review articles relevant to physician education.
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