Çirkin Gül, Güler Yunus, Gülpinar Aydin Özlem, Atay Özge, Kangalli Boyacioğlu Özge, Asilsoy Suna, Uzuner Nevin, Öztürk Yeşim
Department of Pediatrics, Dokuz Eylul University Faculty of Medicine, Division of Pediatric Gastroenterology, Hepatology and Nutrition, Izmir, Turkey.
Department of Pediatrics, Dokuz Eylul University School of Medicine, Division of Pediatric Allergy Immunology, Izmir, Turkey.
Medicine (Baltimore). 2025 Aug 8;104(32):e43803. doi: 10.1097/MD.0000000000043803.
Pediatric eosinophilic esophagitis (EoE) is a chronic, immune-mediated disorder defined by esophageal dysfunction and eosinophilic infiltration of the esophageal mucosa. Its incidence is increasing, particularly among children. However, assessing disease severity and monitoring treatment response over time remain challenging. Conventional histological methods often fail to capture ongoing inflammation or predict symptom recurrence. This study aimed to evaluate the utility of a multimodal approach incorporating clinical symptom scoring (Pediatric Eosinophilic Esophagitis Symptom Score [PEESS]), endoscopic findings (Eosinophilic Esophagitis Reference Score [EREFS]), and subepithelial imaging (endoscopic ultrasonography [EUS]) for the diagnosis, treatment monitoring, and long-term follow-up of pediatric EoE. We conducted a retrospective review of 23 pediatric patients diagnosed with EoE between 2018 and 2022 at a tertiary care center. Diagnosis was based on clinical presentation, endoscopic appearance, and histological confirmation (≥15 eosinophils/high-power field). All patients received a combination of proton pump inhibitors, topical corticosteroids, and personalized elimination diets. PEESS and EREFS scores were assessed before and after treatment. EUS was performed in a subset of patients to evaluate esophageal wall changes. The median age at diagnosis was 11 years. Atopic comorbidities were identified in 82.6% of patients. Post-treatment, both PEESS and EREFS scores showed significant improvements. Histological remission was achieved in 95.6% of cases. Among the 8 patients who underwent EUS, persistent esophageal wall thickening was observed despite mucosal healing, suggesting ongoing subepithelial inflammation. Long-term dietary management without steroids was successful in a subset of patients after initial remission. PEESS and EREFS are valuable, complementary tools for assessing treatment response in pediatric EoE. EUS provides additional insights into residual disease activity beyond mucosal healing. This multimodal evaluation may facilitate personalized, less-invasive, and more effective long-term management of pediatric EoE.
小儿嗜酸性粒细胞性食管炎（EoE）是一种慢性免疫介导性疾病，其特征为食管功能障碍和食管黏膜嗜酸性粒细胞浸润。其发病率呈上升趋势，尤其是在儿童中。然而，评估疾病严重程度以及长期监测治疗反应仍然具有挑战性。传统的组织学方法往往无法捕捉到持续的炎症或预测症状复发。本研究旨在评估一种多模式方法的效用，该方法结合临床症状评分（小儿嗜酸性粒细胞性食管炎症状评分[PEESS]）、内镜检查结果（嗜酸性粒细胞性食管炎参考评分[EREFS]）和上皮下成像（内镜超声检查[EUS]），用于小儿EoE的诊断、治疗监测和长期随访。我们对2018年至2022年期间在一家三级医疗中心确诊为EoE的23例儿科患者进行了回顾性研究。诊断基于临床表现、内镜表现和组织学确认（每高倍视野≥15个嗜酸性粒细胞）。所有患者均接受了质子泵抑制剂、局部糖皮质激素和个性化排除饮食的联合治疗。在治疗前后评估PEESS和EREFS评分。对一部分患者进行了EUS检查，以评估食管壁的变化。诊断时的中位年龄为11岁。82.6%的患者存在特应性合并症。治疗后，PEESS和EREFS评分均有显著改善。95.6%的病例实现了组织学缓解。在接受EUS检查的8例患者中，尽管黏膜愈合，但仍观察到食管壁持续增厚，提示上皮下炎症持续存在。在初始缓解后的一部分患者中，无类固醇的长期饮食管理取得了成功。PEESS和EREFS是评估小儿EoE治疗反应的有价值的互补工具。EUS提供了超越黏膜愈合的残余疾病活动的额外见解。这种多模式评估可能有助于小儿EoE的个性化、微创和更有效的长期管理。
