Nader Luiza Salgado, Epifanio Matias, Coelho Mariana Guimarães, Steinhaus Cintia, Melere Melina, da Silva Carolina Soares, Ferreira Cristina Targa
Division of Pediatric Gastroenterology Unit, Santa Casa de Porto Alegre, Porto Alegre, Brazil.
Graduate Program in Pediatrics, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil.
Front Allergy. 2024 Apr 8;5:1346843. doi: 10.3389/falgy.2024.1346843. eCollection 2024.
Eosinophilic esophagitis is a newly recognized entity, in which there is significant evidence available that clearly demonstrates the positive impact of PPIs on reducing esophageal eosinophilia in individuals across different age groups, including children, adolescents, and adults. Multiple mechanisms have been proposed to explain how this treatment effect occurs. In Brazil, there seems to be a lack of studies that have prospectively assessed the clinical and therapeutic response rate in pediatric patients with EoE. The objective of this study was to prospectively evaluate the clinical and therapeutic response of pediatric patients with EoE in a medical center located in southern Brazil, by investigating the effectiveness of PPI treatment.
This study is a clinical, prospective, open trial that took place in a pediatric hospital located in southern Brazil. The focus of the study was on patients diagnosed with Eosinophilic Esophagitis (EoE) who were given treatment using omeprazole/esomeprazole at a dosage of 1 mg.kg per dose, twice daily, for a period of 8-12 weeks. Following the treatment period, the patients underwent another endoscopy. Patients who exhibited 15 or less eosinophils in the biopsy conducted after the treatment were considered as responders.
A total of 27 patients was evaluated (74.1% boys). The average age (± standard deviation) was 8 years (±4). Nineteen patients (70.3%) were considered as responders to PPI treatment: 6 patients-22.2%-exhibited a complete response (defined as having 5 or fewer eosinophil per high power field. Additionally, 13 patients-48.1%-demonstrated a partial response, characterized by eosinophil counts exceeding 5 but less than 15 eos/hpf. When comparing the responder and non-responder groups at presentation, a statistical difference was observed in the prevalence of food refusal as a presenting symptom. Food refusal was found to be more prevalent in the non-responder group (87.5% vs. 26.3%, = 0.008). No differences were observed in terms of atopy history and endoscopic scores. Upon comparing the histological findings from the post-treatment endoscopy of the two groups, it was observed that PPI responders exhibited a greater tendency to decrease basal cell hyperplasia ( = 0.06) and intercellular edema ( = 0.08).
In this group of pediatric patients with EoE in Southern Brazil most patients showed a high prevalence of histological, endoscopic, and clinical response to PPI treatment. PPIs showed efficacy in Brazilian patients with EoE, most of whom would probably not be able to adequately undergo other treatments.
https://ensaiosclinicos.gov.br/rg/RBR-2ntbth9, identifier (U1111-1301-1842).
嗜酸性粒细胞性食管炎是一种新认识的疾病，有大量证据清楚表明质子泵抑制剂（PPIs）对降低不同年龄组（包括儿童、青少年和成人）个体的食管嗜酸性粒细胞增多有积极作用。已提出多种机制来解释这种治疗效果是如何产生的。在巴西，似乎缺乏对儿童嗜酸性粒细胞性食管炎（EoE）患者的临床和治疗反应率进行前瞻性评估的研究。本研究的目的是通过调查PPIs治疗的有效性，前瞻性评估巴西南部一家医疗中心儿童EoE患者的临床和治疗反应。
本研究是一项在巴西南部一家儿童医院进行的临床、前瞻性、开放试验。研究重点是诊断为嗜酸性粒细胞性食管炎（EoE）的患者，给予奥美拉唑/埃索美拉唑治疗，剂量为每剂1 mg/kg，每日两次，持续8 - 12周。治疗期结束后，患者接受另一次内镜检查。治疗后活检中嗜酸性粒细胞为15个或更少的患者被视为反应者。
共评估了27例患者（74.1%为男孩）。平均年龄（±标准差）为8岁（±4）。19例患者（70.3%）被认为对PPIs治疗有反应：6例患者（22.2%）表现为完全缓解（定义为每高倍视野嗜酸性粒细胞为5个或更少）。此外，13例患者（48.1%）表现为部分缓解，其特征是嗜酸性粒细胞计数超过5但少于15个/高倍视野。在比较反应者和非反应者组初诊时的情况时，发现食物拒纳作为初发症状的患病率存在统计学差异。食物拒纳在非反应者组中更常见（87.5%对26.3%，P = 0.008）。在特应性病史和内镜评分方面未观察到差异。比较两组治疗后内镜检查的组织学结果时，发现PPIs反应者在基底细胞增生减少（P = 0.06）和细胞间水肿减少（P = 0.08）方面有更大趋势。
在巴西南部这组儿童EoE患者中，大多数患者对PPIs治疗在组织学、内镜和临床方面有较高的反应率。PPIs对巴西EoE患者有效，其中大多数患者可能无法充分接受其他治疗。
https://ensaiosclinicos.gov.br/rg/RBR-2ntbth9，标识符（U1111-1301-1842）
