A Practical Update on Pediatric Eosinophilic Esophagitis

Economic Burden and Health Care Resource Utilization of Patients With Eosinophilic Esophagitis in the United States

GOALS

To estimate health care resource utilization (HCRU) and costs among patients with eosinophilic esophagitis (EoE) in the US.

BACKGROUND

The EoE prevalence in the US has risen in recent years. Assessing HCRU and costs may assist in understanding the economic burden of EoE in the US.

STUDY

In IQVIA's PharMetrics Plus claims database, prevalent patients with EoE were identified and matched with non-EoE controls. The index date was a randomly selected EoE diagnosis date for the EoE cohort (January 2018 to June 2019) and a random date for non-EoE controls. Patients had 1-year of continuous enrollment before and after the index date, with ≥1 EoE diagnostic claim before the index. Descriptive and regression analyses adjusting for comorbidities unrelated to EoE were performed to compare HCRU and costs (EoE vs. non-EoE), 1-year after the index date.

RESULTS

The analysis included 15,432 patients with EoE and matched non-EoE controls (mean age: 36.2 y). The annual HCRU, including the mean outpatient visits, was higher in patients with EoE versus non-EoE controls [mean difference (MD): 9.2 d; 95% CI: 8.8-9.6]; with consistent results across age groups. The mean total health care costs (annual) were ∼2.5 times higher in patients with EoE than in non-EoE controls. Patients with EoE who underwent esophageal dilation had higher HCRU (emergency room visit: MD: 0.9 d; 95% CI: 0.8-1.0) and total health care costs (MD: $10,174; $8493-$11,855) than non-EoE controls.

CONCLUSIONS

Patients with EoE had higher annual costs and HCRU than non-EoE controls, indicating a substantial economic burden, particularly among patients with EoE with prior esophageal dilation.

Approach to the spectrum of infant non-IgE-mediated food allergy manifestations and physiologic infant behaviors

Physiologic infant behaviors and symptoms of pathologic conditions such as gastroesophageal reflux disease, IgE-mediated food allergy, eosinophilic esophagitis, and other non-IgE-mediated food allergy (including food protein-induced allergic proctocolitis, acute and chronic forms of food protein-induced enterocolitis syndrome, and food protein-induced enteropathy) may have significant overlap, leading to diagnostic uncertainty for primary care physicians and pediatric subspecialists alike. Here we explore the clinical features of gastroesophageal reflux disease and IgE-mediated and non-IgE-mediated food allergy in infants, highlighting the considerable similarities in symptomology and difficulties in ascertaining an accurate diagnosis. Utilizing case studies, we discuss diagnostic and management pearls and review the ramifications of delayed diagnosis or misdiagnosis of infant food allergy for both infants and their caregivers.

Diagnosis and Management of Long-term Gastrointestinal Complications in Pediatric Esophageal Atresia/Tracheoesophageal Fistula

PURPOSE OF REVIEW

Esophageal atresia/tracheoesophageal fistula (EA/TEF) causes gastrointestinal (GI) complications that can begin in infancy and extend into adulthood. The etiology of these is frequently multifactorial, and they can adversely affect feeding, growth, respiratory health, and overall quality of life. This review highlights the importance of early diagnosis, multidisciplinary surveillance, and individualized treatment strategies to effectively manage these complications and improve long-term outcomes for affected children.

RECENT FINDINGS

Recent studies have focused on the development of evidence-based surveillance protocols to optimally manage the numerous observed EA/TEF-associated digestive complications. Many of these complications stem from the combination of gastroesophageal dysmotility and mechanical obstruction inherent to EA/TEF and its surgical management, and include gastroesophageal reflux disease, feeding difficulties, dysphagia, eosinophilic esophagitis, and pulmonary consequences of aspiration. Management of GI complications in children with EA/TEF requires careful, multidisciplinary evaluation and treatment, incorporating dietary modifications, feeding therapy, pharmacotherapy, and surgical and endoscopic interventions.

Eosinophilic esophagitis improved by the discontinuation of sublingual immunotherapy for aeroallergens: a case report

Introduction

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated inflammation of the esophagus, characterized by symptoms related to esophageal dysfunction, resulting from severe eosinophilic infiltration of the esophageal mucosa. It is common in atopic subjects and food antigens have been identified as the most common triggers. However, a seasonal variation in EoE prevalence, correlated with air pollen levels, is reported, suggesting that also aeroallergens may play a role. Little is known about the interplay between EoE and concomitant atopy treatment for aeroallergens.

Case presentation

We describe the case of an 11-year-old boy who presented dysphagia, vomiting, drooling, and chest pain while eating meat, developed 15 months after receiving sublingual immunotherapy (SLIT) for Alternaria (SUBLIVAC®). He underwent esophagogastroduodenoscopy (EGD) revealing severe eosinophilic predominant inflammation (100 eos/HPF), consistent with the diagnosis of EoE, not improving at the EGDs performed after both omeprazole and topical corticosteroids treatment, despite symptom improvement. Afterward, immunotherapy was switched from sublingual to injective form. At the EGD performed 1 month later, macroscopic examination of the esophageal mucosa was normal and eosinophilic infiltration was significantly decreased (5-10 eos/HPF).

Conclusions

SLIT may induce EoE by chronic antigenic exposure of oral mucosa in patients with a robust allergic susceptibility: while attenuating the IgE-mediated immune reactions, the progressive contact with the causative allergen might induce a chronic stimulation of the immune system with the consequent activation of tissue eosinophils. Our data suggest monitoring patients receiving SLIT for EoE symptoms and to discontinue SLIT on their earlier appearance, possibly as a first-line treatment.