Эозинофильный эзофагит у детей: обзор современных рекомендаций на основе разбора клинического случая

Захарова И.Н., Бережная И.В., Гончарова Л.В. Эозинофильный эзофагит у детей: обзор современных рекомендаций на основе разбора клинического случая. Педиатрия. Consilium Medicum. 2024;2:152–155. DOI: 10.26442/26586630.2024.2.202969

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Zakharova IN, Berezhnaya IV, Goncharova LV. Eosinophilic esophagitis in children: A review of current guidelines based on case studies. Pediatrics. Consilium Medicum. 2024;2:152–155. DOI: 10.26442/26586630.2024.2.202969

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Аннотация

Эозинофильный эзофагит (ЭоЭ) до настоящего времени считается редким заболеванием. Однако за последние десятилетия отмечен рост публикаций по диагностике и терапии ЭоЭ как у взрослых, так и у детей. Сложности диагностики ЭоЭ, особенно у детей, связаны с недооценкой факторов риска и неспецифическими жалобами у детей. Для взрослой популяции описан основной симптом – дисфагия в сочетании с эозинофильной инфильтрацией тканей пищевода выше 15 в поле зрения, диагноз может быть верифицирован. В статье рассмотрен клинический случай ЭоЭ у подростка с ранним атопическим маршем и длительными жалобами на боль за грудиной, дисфагию, а также критерии принятия решения о терапии.

Ключевые слова: эозинофильный эзофагит, дети, атопия, атопический марш, дисфагия

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Eosinophilic esophagitis (EoE) is still considered a rare disease. However, over the past decades, there has been an increase in publications on the diagnosis and treatment of EoE in both adults and children. Challenges in diagnosing EoE, especially in children, are associated with underestimation of risk factors and non-specific symptoms. For adults, the main symptom is dysphagia combined with eosinophilic infiltration of esophageal tissue (over 15 per field of view); thus, the diagnosis can be verified. The article presents a clinical case of EoE in an adolescent with an early atopic march and long-term retrosternal pain and dysphagia, and criteria for deciding on therapy are provided.

Keywords: eosinophilic esophagitis, children, atopy, atopic march, dysphagia

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Список литературы

1. Barni S, Arasi S, Mastrorilli C, et al. Pediatric eosinophilic esophagitis: a review for the clinician. Ital J Pediatr. 2021;47(1):230. DOI:10.1186/s13052-021-01178-2
2. Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978;74(6):1298-301.
3. Münch R, Kuhlmann U, Makek M, et al. Eosinophile osophagitis, eine seltene manifestation der eosinophilen gastroenteritis [Eosinophilic esophagitis, a rare manifestation of eosinophilic gastroenteritis]. Schweiz Med Wochenschr. 1982;112(20):731-4 [Article in German].
4. Munitiz V, Martinez de Haro LF, Ortiz A, et al. Primary eosinophilic esophagitis. Dis. Esophagus. 2003;16(2):165-8. DOI:10.1046/j.1442-2050.2003.00319.x
5. Straumann A, Schoepfer A. Update on basic and clinical aspects of eosinophilic oesophagitis. Gut. 2014;63(8):1355-63. DOI:10.1136/gutjnl-2013-306414
6. Hurtado CW, Furuta GT, Kramer RE. Etiology of esophageal food impactions in children. J Pediatr Gastroenterol Nutr. 2011;52(1):43-6. DOI:10.1097/MPG.0b013e3181e67072
7. Hruz P, Straumann A, Bussmann C, et al. Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland. J Allergy Clin Immunol. 2011;128(6):1349-50.e5. DOI:10.1016/j.jaci.2011.09.013
8. Arias Á, Lucendo AJ. Prevalence of eosinophilic oesophagitis in adult patients in a central region of Spain. Eur J Gastroenterol Hepatol.
2013;25(2):208-12. DOI:10.1097/MEG.0b013e32835a4c95
9. Soon IS, Butzner JD, Kaplan GG, deBruyn JC. Incidence and prevalence of eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr. 2013;57(1):72-80. DOI:10.1097/MPG.0b013e318291fee2
10. Mackenzie SH, Go M, Chadwick B, et al. Eosinophilic oesophagitis in patients presenting with dysphagia – a prospective analysis. Aliment Pharmacol Ther. 2008;28(9):1140-6. DOI:10.1111/j.1365-2036.2008.03795.x
11. Hruz P. Epidemiology of eosinophilic esophagitis. Dig Dis. 2014;32(1-2):40-7. DOI:10.1159/000357008
12. Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus guidelines for diagnosis and treatment. Gastroenterol Int. 2007;133(4):1342-63. DOI:10.1053/j.gastro.2007.08.017
13. Amil-Dias J, Oliva S, Papadopoulou A, et al. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2024;79(2):394-437. DOI:10.1002/jpn3.12188
14. Morrison HA, Hoyt KJ, Mounzer C, et al. Expression profiling identifies key genes and biological functions associated with eosinophilic esophagitis in human patients. Front Allergy. 2023;4:1239273. DOI:10.3389/falgy.2023.1239273
15. Захарова И.Н., Османов И.М., Пампура А.Н., и др. Эозинофильный эзофагит: все еще трудно и редко диагностируемое состояние. Клинический случай. Педиатрия. Consilium Medicum. 2021; 1: 57–62. DOI: 10.26442/26586630.2021.1.200838 [Zakharova IN, Osmanov IM, Pampura AN, Khomeriki SG, et al. Eosinophilic esophagitis: still a difficult condition to diagnose. Case report. Pediatrics. Consilium Medicum. 2021; 1: 57–62. DOI: 10.26442/26586630.2021.1.200838 (in Russian)]
16. Carrasco AEAB, Machado RS, Patrício FRDS, Kawakami E. Histological features of eosinophilic esophagitis in children and adolescents. Arq Gastroenterol. 2017;54(4):281-5. DOI:10.1590/S0004-2803.201700000-44
17. Odetola S, Feulefack J, Sergi CM. Eosinophilic esophagitis: absolute eosinophilic count, peak eosinophilic count, and potential biomarkers of eosinophilic degranulation products-an in-depth systematic review. Transl Pediatr. 2024;13(3):474-83. DOI:10.21037/tp-23-478
18. Lexmond WS, Pardo M, Rooney K, et al. Elevated leukotriene synthase C4 mRNA levels distinguish a subset of patients with eosinophilic esophagitis. Clin Exp Allergy.
2013;43:902-13. DOI:10.1111/cea.12146
19. Gomez Torrijos E, Gonzalez-Mendiola R, Alvarado M, et al. Eosinophilic Esophagitis: Review and Update. Front Med (Lausanne). 2018;5:247. DOI:10.3389/fmed.2018.00247
20. Rank MA, Sharaf RN, Furuta GT, et al. Technical review on the management of eosinophilic esophagitis: a report from the AGA Institute and the Allergy and Immunology Joint Practice Options Task Force. Gastroenterology. 2020;158:1789-810.e15.

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1. Barni S, Arasi S, Mastrorilli C, et al. Pediatric eosinophilic esophagitis: a review for the clinician. Ital J Pediatr. 2021;47(1):230. DOI:10.1186/s13052-021-01178-2
2. Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978;74(6):1298-301.
3. Münch R, Kuhlmann U, Makek M, et al. Eosinophile osophagitis, eine seltene manifestation der eosinophilen gastroenteritis [Eosinophilic esophagitis, a rare manifestation of eosinophilic gastroenteritis]. Schweiz Med Wochenschr. 1982;112(20):731-4 [Article in German].
4. Munitiz V, Martinez de Haro LF, Ortiz A, et al. Primary eosinophilic esophagitis. Dis. Esophagus. 2003;16(2):165-8. DOI:10.1046/j.1442-2050.2003.00319.x
5. Straumann A, Schoepfer A. Update on basic and clinical aspects of eosinophilic oesophagitis. Gut. 2014;63(8):1355-63. DOI:10.1136/gutjnl-2013-306414
6. Hurtado CW, Furuta GT, Kramer RE. Etiology of esophageal food impactions in children. J Pediatr Gastroenterol Nutr. 2011;52(1):43-6. DOI:10.1097/MPG.0b013e3181e67072
7. Hruz P, Straumann A, Bussmann C, et al. Escalating incidence of eosinophilic esophagitis: a 20-year prospective, population-based study in Olten County, Switzerland. J Allergy Clin Immunol. 2011;128(6):1349-50.e5. DOI:10.1016/j.jaci.2011.09.013
8. Arias Á, Lucendo AJ. Prevalence of eosinophilic oesophagitis in adult patients in a central region of Spain. Eur J Gastroenterol Hepatol.
2013;25(2):208-12. DOI:10.1097/MEG.0b013e32835a4c95
9. Soon IS, Butzner JD, Kaplan GG, deBruyn JC. Incidence and prevalence of eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr. 2013;57(1):72-80. DOI:10.1097/MPG.0b013e318291fee2
10. Mackenzie SH, Go M, Chadwick B, et al. Eosinophilic oesophagitis in patients presenting with dysphagia – a prospective analysis. Aliment Pharmacol Ther. 2008;28(9):1140-6. DOI:10.1111/j.1365-2036.2008.03795.x
11. Hruz P. Epidemiology of eosinophilic esophagitis. Dig Dis. 2014;32(1-2):40-7. DOI:10.1159/000357008
12. Furuta GT, Liacouras CA, Collins MH, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus guidelines for diagnosis and treatment. Gastroenterol Int. 2007;133(4):1342-63. DOI:10.1053/j.gastro.2007.08.017
13. Amil-Dias J, Oliva S, Papadopoulou A, et al. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2024;79(2):394-437. DOI:10.1002/jpn3.12188
14. Morrison HA, Hoyt KJ, Mounzer C, et al. Expression profiling identifies key genes and biological functions associated with eosinophilic esophagitis in human patients. Front Allergy. 2023;4:1239273. DOI:10.3389/falgy.2023.1239273
15. Zakharova IN, Osmanov IM, Pampura AN, Khomeriki SG, et al. Eosinophilic esophagitis: still a difficult condition to diagnose. Case report. Pediatrics. Consilium Medicum.
2021; 1: 57–62. DOI: 10.26442/26586630.2021.1.200838 (in Russian)
16. Carrasco AEAB, Machado RS, Patrício FRDS, Kawakami E. Histological features of eosinophilic esophagitis in children and adolescents. Arq Gastroenterol. 2017;54(4):281-5. DOI:10.1590/S0004-2803.201700000-44
17. Odetola S, Feulefack J, Sergi CM. Eosinophilic esophagitis: absolute eosinophilic count, peak eosinophilic count, and potential biomarkers of eosinophilic degranulation products-an in-depth systematic review. Transl Pediatr. 2024;13(3):474-83. DOI:10.21037/tp-23-478
18. Lexmond WS, Pardo M, Rooney K, et al. Elevated leukotriene synthase C4 mRNA levels distinguish a subset of patients with eosinophilic esophagitis. Clin Exp Allergy.
2013;43:902-13. DOI:10.1111/cea.12146
19. Gomez Torrijos E, Gonzalez-Mendiola R, Alvarado M, et al. Eosinophilic Esophagitis: Review and Update. Front Med (Lausanne). 2018;5:247. DOI:10.3389/fmed.2018.00247
20. Rank MA, Sharaf RN, Furuta GT, et al. Technical review on the management of eosinophilic esophagitis: a report from the AGA Institute and the Allergy and Immunology Joint Practice Options Task Force. Gastroenterology. 2020;158:1789-810.e15.

Авторы

И.Н. Захарова¹, И.В. Бережная*¹, Л.В. Гончарова²

¹ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия;
²ГБУЗ «Детская городская клиническая больница им. З.А. Башляевой» Департамента здравоохранения г. Москвы, Москва, Россия
*berezhnaya-irina26@yandex.ru

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Irina N. Zakharova¹, Irina V. Berezhnaya*¹, Liudmila V. Goncharova²

¹Russian Medical Academy of Continuous Professional Education, Moscow, Russia;
²Bashlyaeva Children`s City Clinical Hospital, Moscow, Russia
*berezhnaya-irina26@yandex.ru

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