ABSTRACT
OBJECTIVES: Few pediatric data on phenotypic aspects of eosinophilic esophagitis (EoE) are available. The pEEr registry was developed to prospectively characterize children with EoE from Europe and Israel. METHODS: pEEr is an ongoing prospective registry enrolling children with esophageal eosinophilia (≥15 eos/HPF). Anonymized data were collected from 19 pediatric centers. Data regarding demographics, clinical manifestations, endoscopy, histology, and therapies were collected. RESULTS: A total of 582 subjects (61% male) were analyzed. The median age at diagnosis was 10.5 years [interquartile range (IQR): 5.7-17.7], whereas the age at symptom onset was 9.2 years (IQR: 4.3-16.4), resulting in a median diagnostic delay of 1.2 years (IQR: 0.7-2.3). The diagnostic delay was longer below age <6 years. Shorter diagnostic delays were associated with the presence of food allergy or a family history for EoE. Symptoms varied by age with dysphagia and food impaction more common in adolescents, while vomiting and failure to thrive more common in younger children ( P < 0.001). Among endoscopic findings, esophageal rings were more common in adolescents, whereas exudates were more frequent in younger children( P < 0.001). Patients who responded to proton pump inhibitors (PPIs) were more likely to be older, males, and less often presented severe endoscopic findings. Patients unresponsive to PPIs received topical steroids (40%), elimination diet (41%), or a combined therapy (19%). CONCLUSIONS: EoE findings vary according to age in pediatric EoE. Young children are commonly characterized by non-specific symptoms, atopic dermatitis, food allergy, and inflammatory endoscopic lesions. Adolescents usually have dysphagia or food impaction, fibrostenotic lesions, and a better PPI response.
Subject(s)
Deglutition Disorders , Eosinophilic Esophagitis , Food Hypersensitivity , Adolescent , Child , Child, Preschool , Deglutition Disorders/drug therapy , Deglutition Disorders/etiology , Delayed Diagnosis , Endoscopy, Gastrointestinal , Enteritis , Eosinophilia , Eosinophilic Esophagitis/complications , Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/epidemiology , Female , Gastritis , Humans , Male , Proton Pump Inhibitors/therapeutic use , RegistriesABSTRACT
BACKGROUND: The importance of norovirus as a cause of gastroenteritis outbreaks is well documented, but the role of norovirus in sporadic acute severe gastroenteritis is not so well established. The aim of this study was to determine the prevalence and clinical characteristics of norovirus gastroenteritis among hospitalized children. METHODS: A prospective study was conducted in children less than 5 years old, admitted with acute gastroenteritis between January 2005 and January 2008 to the Pediatrics Department of the Universitary Hospital, Albacete, Spain. Demographic and clinical data were collected. A stool sample from each child was screened for enteropathogenic bacteria and tested by reverse transcription polymerase chain reaction for rotavirus, astrovirus, norovirus, and sapovirus and by immunochromatographic method for enteric adenoviruses. RESULTS: Norovirus was the second most frequent pathogen after rotavirus, being detected in 61 (17.3%) of the 352 children enrolled, in 29 of them (8.2%) as single agent. Mixed infections involving other viruses or bacteria were present in 52.4% of norovirus positive samples, a nosocomial source of infection was demonstrated in 17.2%. Norovirus infection was more prevalent in winter and affected mainly children less than 2 years of age. Vomiting was present in 68% and fever in 48.3% of cases, 3 children had nonfebrile seizures. Compared with rotavirus enteritis, norovirus infection was slightly less severe (in terms of severity score and need of intravenous rehydration) and fever was less frequent. CONCLUSIONS: Norovirus was a frequent cause of acute severe sporadic gastroenteritis in children representing the second etiologic agent after rotavirus.