儿童期和成人期发病的嗜酸性粒细胞性食管炎之间的差异：来自EoE connect注册研究的分析
Differences between childhood- and adulthood-onset eosinophilic esophagitis: An analysis from the EoE connect registry.
作者信息
Laserna-Mendieta Emilio José, Navarro Pilar, Casabona-Francés Sergio, Savarino Edoardo V, Pérez-Martínez Isabel, Guagnozzi Danila, Barrio Jesús, Perello Antonia, Guardiola-Arévalo Antonio, Betoré-Glaria María Elena, Blas-Jhon Leonardo, Racca Francesca, Krarup Anne Lund, Gutiérrez-Junquera Carolina, Fernández-Fernández Sonia, la Riva Susana De, Naves Juan E, Carrión Silvia, García-Morales Natalia, Roales Valentín, Rodríguez-Oballe Juan Armando, Dainese Raffaella, Rodríguez-Sánchez Alba, Masiques-Mas María Lluisa, Feo-Ortega Sara, Ghisa Matteo, Maniero Daria, Suarez Adolfo, Llerena-Castro Ronald, Gil-Simón Paula, de la Peña-Negro Luisa, Granja-Navacerrada Alicia, Alcedo Javier, Hurtado de Mendoza-Guena Lonore, Pellegatta Gaia, Pérez-Fernández María Teresa, Santander Cecilio, Tamarit-Sebastián Sonsoles, Arias Ángel, Lucendo Alfredo J
机构信息
Department of Gastroenterology. Hospital General de Tomelloso, Tomelloso, Spain; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; Laboratory Medicine Department. Hospital Universitario de La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Spain.
Department of Gastroenterology. Hospital General de Tomelloso, Tomelloso, Spain; Instituto de Investigación Sanitaria La Princesa, Madrid, Spain; Instituto de Investigación Sanitaria de Castilla-La Mancha (IDISCAM), Spain.
出版信息
Dig Liver Dis. 2023 Mar;55(3):350-359. doi: 10.1016/j.dld.2022.09.020. Epub 2022 Oct 22.
BACKGROUND
Direct comparisons of childhood- and adulthood-onset eosinophilic esophagitis (EoE) are scarce.
AIM
To compare disease characteristics, endoscopic and histological features, allergic concomitances and therapeutic choices across ages.
METHODS
Cross-sectional analysis of the EoE CONNECT registry.
RESULTS
The adulthood-onset cohort (those diagnosed at ≥18y) comprised 1044 patients and the childhood-onset cohort (patients diagnosed at <18 y), 254. Vomiting, nausea, chest and abdominal pain, weight loss, slow eating and food aversion were significantly more frequent in children; dysphagia, food bolus impaction and heartburn predominated in adults. A family history of EoE was present in 16% of pediatric and 8.2% of adult patients (p<0.001). Concomitant atopic diseases did not vary across ages. Median±IQR diagnostic delay (years) from symptom onset was higher in adults (2.7 ± 6.1) than in children (1 ± 2.1; p<0.001). Esophageal strictures and rings predominated in adults (p<0.001), who underwent esophageal dilation more commonly (p = 0.011). Inflammatory EoE phenotypes were more common in children (p = 0.001), who also presented higher eosinophil counts in biopsies (p = 0.015) and EREFS scores (p = 0.017). Despite PPI predominating as initial therapy in all cohorts, dietary therapy and swallowed topical corticosteroids were more frequently prescribed in children (p<0.001).
CONCLUSIONS
Childhood-onset EoE has differential characteristics compared with adulthood-onset, but similar response to treatment.
背景
儿童期和成人期发病的嗜酸性食管炎（EoE）的直接比较很少见。
目的
比较不同年龄段的疾病特征、内镜和组织学特征、过敏伴发情况及治疗选择。
方法
对EoE CONNECT注册研究进行横断面分析。
结果
成人期发病队列（诊断时年龄≥18岁）包括1044例患者，儿童期发病队列（诊断时年龄<18岁）包括254例患者。呕吐、恶心、胸痛和腹痛、体重减轻、进食缓慢和食物厌恶在儿童中更为常见；吞咽困难、食物团块嵌塞和烧心在成人中更为突出。16%的儿科患者和8.2%的成人患者有EoE家族史（p<0.001）。伴发的特应性疾病在各年龄段无差异。从症状出现到诊断的中位±四分位间距延迟时间（年）在成人中（2.7±6.1）高于儿童（1±2.1；p<0.001）。食管狭窄和环在成人中更为常见（p<0.001），成人更常接受食管扩张治疗（p = 0.011）。炎症性EoE表型在儿童中更为常见（p = 0.001），儿童活检中的嗜酸性粒细胞计数（p = 0.015）和EREFS评分也更高（p = 0.017）。尽管质子泵抑制剂（PPI）在所有队列中都是主要的初始治疗药物，但饮食疗法和吞咽局部糖皮质激素在儿童中更常使用（p<0.001）。
结论
儿童期发病的EoE与成人期发病的EoE具有不同的特征，但对治疗的反应相似。
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