Barriers to Timely Diagnosis of Eosinophilic Gastrointestinal Diseases

Segmental overlap is common in eosinophilic gastrointestinal diseases and impacts clinical presentation and treatment

Little is known about the extent or importance of overlapping gastrointestinal (GI) tract involvement in eosinophilic gastrointestinal diseases (EGIDs), how presentations differ by areas of involvement, and whether overlap impacts treatments. We aimed to evaluate overlapping GI tract involvement in EGIDs and whether clinical differences existed. To do this, we assessed the EGID Partners cohort, an online patient-centered research network. Adults (≥18 years) and caregivers of children <18 years old with EoE or non-EoE EGIDs could join. Surveys were completed at enrollment, comparing patients with EoE alone, EGID without esophageal involvement ('EGID-NE'), and EGID with esophageal involvement ('EGID-WE'). Of 527 cases enrolled, 402 had EoE alone and 125 had non-EoE EGID, 57 (46%) with EGID-NE, and 68 (53%) with EGID-WE. There were 10, 18, and 9 with eosinophilic gastritis, gastroenteritis, and colitis alone, respectively; 88 had overlap. EGID-NE had a higher proportion of females (79%; P < 0.001), and family history of EoE/EGID was more common in EGID-WE (19% vs. 11% in EoE and 7% in EGID-NE; P = 0.007). Patient-Reported Outcomes Measurement Information System measures for anxiety were above general population averages and highest for EGID-WE. Treatments such as elemental formula (47% vs. 32% vs. 20%; P = 0.001), systemic steroids (33% vs. 56% vs. 14%; P < 0.001), and biologics were also more common in EGID-WE and EGID-NE. In conclusion, overlap in regions with eosinophilic infiltration is common for non-EoE EGIDs, with more than half of non-EoE EGIDs having esophageal involvement and a high proportion of multisegmental involvement. EGID-WE patients tended to have more disease burden.

Diagnosing eosinophilic esophagitis in pediatric patients

INTRODUCTION

Eosinophilic esophagitis (EoE) is an increasingly common disease that can present in children with the symptoms of feeding dysfunction, abdominal pain, vomiting, reflux-like symptoms, dysphagia, or food impaction. Diagnostically, children must have symptoms, dense esophageal eosinophilia, and other potential causes of these findings ruled out. Diagnostic recognition is critical to avoid food impactions and potential esophageal stricture development.

AREAS COVERED

In this review, a PubMed search using the search terms eosinophilic esophagitis, pediatric, and diagnosis were used to cover the last 10 years (2013-2023) of literature.

EXPERT OPINION

Early detection of EoE in children depends on increased recognition of diagnostic clues by many specialties. As increasing efforts to publicize the importance of EoE in children continues, our understanding of the molecular underpinnings of EoE is making rapid advances. Increasing growth of this knowledge base will provide more personalized diagnostic approaches, targeted interventions, and innovative treatments.

Advances and ongoing challenges in eosinophilic gastrointestinal disorders presented at the CEGIR/TIGERs Symposium at the 2024 American Academy of Allergy, Asthma & Immunology meeting

The Consortium of Eosinophilic Gastrointestinal disease Researchers (CEGIR) and The International Gastrointestinal Eosinophil Researchers (TIGERs) organized a daylong symposium at the 2024 annual meeting of the American Academy of Allergy, Asthma & Immunology. The symposium featured new discoveries in basic and translational research as well as debates on the mechanisms and management of eosinophilic gastrointestinal diseases. Updates on recent clinical trials and consensus guidelines were also presented. We summarize the updates on eosinophilic gastrointestinal diseases presented at the symposium.

Performing Esophageal Biopsies Is Safe During Upper Endoscopy for Food Impaction but Are Underperformed in Certain Populations

BACKGROUND

Despite recommendations to perform esophageal biopsies during esophagogastroduodenoscopy (EGD) for esophageal food impaction to evaluate for eosinophilic esophagitis (EoE), endoscopists often forgo biopsies. There are minimal data on the risks of biopsies in this setting.

AIMS

To determine the safety of performing biopsies during EGD for food impaction.

METHODS

We conducted a retrospective cohort study of patients who presented to University of North Carolina Hospitals from 2014 to 2021 with endoscopically confirmed food impaction. Data were abstracted from the medical records. Baseline clinical characteristics, procedural details, and adverse events were compared between patients who did and did not undergo biopsy. Adverse events were classified as esophageal (mucosal tear, bleeding, perforation) or extra-esophageal (aspiration, respiratory compromise, hypotension, arrhythmia).

RESULTS

Of 188 patients who underwent EGD for food impaction, 73 (39%) had biopsies taken. Older and non-White patients were less likely to be biopsied. None of the Black patients had biopsies taken. Only 2 (2.7%) of the 73 biopsied patients had an adverse event, and neither was related to the biopsies. Patients who were biopsied were less likely to experience adverse events. There were no differences in re-admission, ICU admission, or 30-day mortality between patients who were and were not biopsied.

CONCLUSIONS

Esophageal biopsies remain underperformed during EGD for food impaction, especially in certain patient populations. Esophageal biopsies at the time of food impaction are unlikely to cause adverse events. Safety concerns should not preclude biopsies, and biopsies should be performed in the absence of extenuating circumstances.

Minimally Invasive Approaches to Diagnose and Monitor Eosinophilic GI Diseases

PURPOSE OF REVIEW

This review seeks to understand novel avenues for eosinophilic GI disease management. Biomarkers offer a unique and non-invasive approach to tracking EoE disease progression. While no biomarkers have definitively met the diagnostic criteria for eosinophilic GI diseases, some biomarkers have been shown to be associated with disease activity. Here, we examine the potential of recently studied biomarkers.

RECENT FINDINGS

Current research shows advancements in blood, luminal fluid, and breath testing. Particular areas of interest include mRNA analyses, protein fingerprinting, amplicon sequence variants (ASVs), T cells and IgE receptors, eosinophilic cationic proteins, cytokines, and nitric oxide exhalation. Preliminary results showed that mucosal biomarkers, directly captured from the esophagus, may reflect the best representation of biopsy-based results, in contrast to biomarkers obtained from indirect or peripheral (blood, breath) methods. However, this is based on limited clinical studies without sufficient numbers to evaluate true diagnostic accuracy. Large-scale randomized trials are needed to fully ascertain both the optimal sampling technique and the specific biomarkers that reflect diagnostic status of the disease.

Challenges in Diagnosis and Management of Unusual Cases of Eosinophilic Enteritis in Rural Health Settings: A Comprehensive Review

This comprehensive review delves into the challenges associated with diagnosing and managing unusual cases of eosinophilic enteritis in rural health settings. Eosinophilic enteritis, characterized by an abnormal accumulation of eosinophils in the gastrointestinal (GI) tract, poses distinct difficulties in diagnosis due to its varied presentations. In rural contexts, limited access to specialized diagnostic tools, a shortage of healthcare professionals, and geographical constraints compound these challenges. This abstract encapsulates the critical issues explored in the review, emphasizing the importance of addressing atypical cases and rural healthcare's unique hurdles. The conclusion is a rallying call for collaborative action, advocating for improved education, telemedicine solutions, and enhanced access to specialized care. The implications extend beyond eosinophilic enteritis, with the potential to instigate systemic improvements in rural healthcare globally. This review is a crucial contribution to understanding eosinophilic enteritis in rural settings and advocates for transformative measures to improve diagnosis, management, and overall healthcare outcomes.