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1.
Pediatr Allergy Immunol ; 35(4): e14122, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38581140

RESUMO

PURPOSE: Neurodevelopmental disorders, such as autism spectrum disorder (ASD), have been increasingly associated with eosinophilic gastrointestinal disorders (EGID). However, the relationship between these diseases remains unclear. We performed a systematic review with meta-analysis to address this issue. METHODS: The search was performed according to the PRISMA guidelines using descriptors for ASD and EGIDs from the MEDLINE, Embase, PsycInfo, LILACS, and Web of Science databases. Observational studies with the prevalence of ASD in any EGID were included. The study protocol was registered on the PROSPERO platform under the number CRD42023455177. RESULTS: The total dataset comprised 766,082 participants. The result of the single-arm meta-analysis showed an overall prevalence of ASD in the population with EGID of 21.59% (95% CI: 10.73-38.67). There was an association between EGID and ASD (OR: 3.44; 95% CI: 1.25-2.21), also significant when restricted only to EoE (OR: 3.70; 95% CI: 2.71-5.70). DISCUSSION: Recent studies have implicated the influence of an inadequate epithelial barrier integrity in the pathogenesis of several diseases. The role of this mechanism can be extended to situations beyond allergic reactions, including other conditions with underlying immunological mechanisms. Several diseases are potentially related to the systemic effect of bacterial translocation in tissues with defective epithelial barriers. CONCLUSION: Our meta-analysis provides evidence that supports the consideration of EGID in patients with ASD and ASD in patients with EGID. Despite its limitations, the results should also be validated by future studies, preferably using multicenter prospective designs in populations with low referral bias.


Assuntos
Transtorno do Espectro Autista , Transtorno Autístico , Enterite , Eosinofilia , Gastrite , Humanos , Transtorno do Espectro Autista/epidemiologia , Eosinofilia/epidemiologia , Gastrite/epidemiologia , Estudos Multicêntricos como Assunto
3.
Immunol Allergy Clin North Am ; 44(2): 129-143, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575213

RESUMO

Most of the major clinical signs and consequences of eosinophilic esophagitis seem to be related to tissue remodeling. Important data on remodeling activity in patients with eosinophilic esophagitis are provided by a range of current and new biologic markers and diagnostics. To completely clarify the possible advantages and restrictions of therapeutic approaches, clinical studies should take into consideration the existence and reversibility of esophageal remodeling. The degree of mucosal or submucosal disease activity may not be reflected by epithelial eosinophilic inflammation, which is used to define one criterion of disease activity".


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Fibrose
4.
Immunol Allergy Clin North Am ; 44(2): 157-171, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575215

RESUMO

The diagnosis of eosinophilic esophagitis (EoE) is based on clinical symptoms of esophageal dysfunction and eosinophil predominant esophageal inflammation. Clinical symptoms in children with EoE vary based on age and may be nonspecific. EoE has a male predominance with the majority having comorbid atopic disorders. At present, treatment options include medications (proton pump inhibition, swallowed topical steroids), dietary therapy or biologic therapy (dupilumab, approved for those ≥12 years of age). Outside of EoE in the context of oral immunotherapy, EoE is typically chronic requiring lifelong therapy. Long-term complications including feeding difficulties, malnutrition, and fibrostenotic disease.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Criança , Masculino , Humanos , Feminino , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Glucocorticoides/uso terapêutico , Enterite/tratamento farmacológico
5.
Immunol Allergy Clin North Am ; 44(2): 185-196, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575217

RESUMO

Adult patients with eosinophilic esophagitis (EoE) typically present with a history of dysphagia for solids, sometimes with additional reflux-like pain and a history of prior food impactions. In contrast to these alarming symptoms, the general appearance and physical examination of adult patients with EoE is in line with apparently healthy individuals. Therefore, the diagnosis is based on a history of solid-food dysphagia and eosinophilic tissue infiltration. Importantly, the increasing prevalence of EoE variants, that is, typical EoE symptoms in the absence of a relevant eosinophilia, and several studies with eosinophil-targeting drugs, call the pathogenic role of eosinophils into question.


Assuntos
Transtornos de Deglutição , Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Adulto , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/epidemiologia , Esofagite Eosinofílica/terapia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/patologia , Eosinófilos , Inflamação/patologia
6.
Immunol Allergy Clin North Am ; 44(2): 205-221, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575219

RESUMO

Microscopic examination of esophageal biopsies is essential to diagnose eosinophilic esophagitis (EoE). Eosinophil inflammation is the basis for the diagnosis, but additional abnormalities may contribute to persistent symptoms and epithelial barrier dysfunction. Both peak eosinophil count and assessments of additional features should be included in pre-therapy and post-therapy pathology reports. Pathologic abnormalities identified in esophageal biopsies of EoE are reversible in contrast to esophageal strictures.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Eosinófilos , Biópsia
7.
Immunol Allergy Clin North Am ; 44(2): 173-184, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575216

RESUMO

Feeding is a complex skill requiring coordination of multiple body systems. Multiple factors are considered in feeding dysfunction in pediatric patients with eosinophilic gastrointestinal disorders, including overall development, nutritional status, mealtime behaviors, and medical comorbidities. Symptoms of feeding dysfunction vary by age, with maladaptive learned feeding behaviors spanning all age ranges. Knowledge of the normal acquisition of feeding skills is critical to interpret the impact of the disease and plan appropriate intervention. Assessment and treatment from a feeding and swallowing disorders specialist can dramatically impact successful outcomes in nutrition, growth, mealtime dynamics and ultimatly quality of life for children and their caregivers in home and social settings.


Assuntos
Transtornos de Deglutição , Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Criança , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Qualidade de Vida , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia
8.
Immunol Allergy Clin North Am ; 44(2): 299-309, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575225

RESUMO

Eosinophilic gastrointestinal disorder (EGID) is an umbrella term encompassing a group of chronic, immune-mediated disorders characterized by eosinophil-rich inflammation affecting one or more segments of the gastrointestinal tract. A recent consensus in nomenclature and emerging data made possible through multi-center consortia are beginning to unravel the molecular and cellular underpinnings of EGIDs below the esophagus. These emerging findings are revealing both overarching commonalities related to a food allergen-driven, chronic, Th2-mediated immune response as well as location-specific nuances in the pathophysiology of the collective EGIDs. Altogether, these advances offer promise for improved diagnoses and more efficacious interventional strategies.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Eosinofilia/diagnóstico , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia
9.
Immunol Allergy Clin North Am ; 44(2): 311-327, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575226

RESUMO

Mast cells play a central role in the pathogenesis of eosinophilic gastrointestinal disorders (EGIDs), including eosinophilic esophagitis. Their interactions with immune and structural cells, involvement in tissue remodeling, and contribution to symptoms make them attractive targets for therapeutic intervention. More is being discovered regarding the intricate interplay of mast cells and eosinophils. Recent studies demonstrating that depletion of eosinophils is insufficient to improve symptoms of EGIDs have raised the question of whether other cells may play a role in symptomatology and pathogenesis of EGIDs.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Mastócitos , Enterite/terapia , Enterite/diagnóstico , Gastrite/diagnóstico , Gastrite/terapia , Esofagite Eosinofílica/terapia , Esofagite Eosinofílica/diagnóstico
10.
Immunol Allergy Clin North Am ; 44(2): 245-264, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575221

RESUMO

Proton pump inhibitors (PPIs), swallowed topical corticosteroids (STSs), and dupilumab are highly effective therapies for the treatment of eosinophilic esophagitis. Shared decision-making informs the choice of therapy and factors such as ease of use, safety, cost, and efficacy should be addressed. PPIs are the most common medication utilized early in the disease course; however, for nonresponders, STSs are an excellent alternative. Dupilumab is unlikely to replace PPIs or STSs as first-line therapy, except in highly specific circumstances. Identification of novel biologic pathways and the development of small molecules may lead to a wider range of treatment options in the future.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Esofagite Eosinofílica/tratamento farmacológico , Glucocorticoides/uso terapêutico , Inibidores da Bomba de Prótons/uso terapêutico , Enterite/tratamento farmacológico
11.
Immunol Allergy Clin North Am ; 44(2): 329-348, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575227

RESUMO

Eosinophilic gastrointestinal disorders (EGIDs) are becoming more common causing significant suffering and reduced quality of life. These conditions can affect different parts of the digestive system, either individually or in combination. Recognition of their link to allergic disorders or other gastrointestinal (GI) diseases has raised questions about their shared underlying mechanisms, which has had implications for diagnosis and management. The authors critically examine the current understanding of the connection between EGIDs and allergic conditions (ie, atopic dermatitis, allergic rhinitis, asthma, and food allergy) and GI diseases (ie, inflammatory bowel disease, celiac disease, gastroesophageal reflux disease, and motility disorders).


Assuntos
Dermatite Atópica , Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Qualidade de Vida , Eosinofilia/diagnóstico , Eosinofilia/complicações , Gastrite/diagnóstico , Gastrite/complicações , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/epidemiologia , Esofagite Eosinofílica/terapia
12.
Immunol Allergy Clin North Am ; 44(2): 265-280, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575222

RESUMO

Measuring health-related quality of life (HRQOL) gained relevance in research and clinical practice in patients with eosinophilic esophagitis. The physical discomfort and social and psychological consequences of this food-related disease substantially affect HRQOL. Determinant of an impaired HRQOL include symptom severity, disease duration, biological disease activity, and psychological factors. Patients prioritize symptom relief and improved HRQOL as treatment objectives. Available treatment options can address these goals; however, there is a suboptimal adherence to treatment. There is a need for enhanced patient guidance and education. The assessment of HRQOL will help to prioritize patient's needs in management.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Qualidade de Vida/psicologia , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Alimentos
13.
Immunol Allergy Clin North Am ; 44(2): 293-298, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575224

RESUMO

Eosinophilic gastrointestinal diseases (EGIDs) including eosinophilic esophagitis (EoE) are rare diseases in which eosinophils abnormally infiltrate the gastrointestinal tract. Because these are rare diseases, there is limited information regarding race and ethnicity in EGIDs and even less is known about the impact of socioeconomic factors. There is some evidence that access to care in rural settings may be affecting epidemiologic understanding of EGIDs in the pediatric populations. Future work should try to evaluate bias in research and strive for representation in clinical trials and medicine.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Criança , Humanos , Diversidade, Equidade, Inclusão , Doenças Raras , Esofagite Eosinofílica/epidemiologia , Esofagite Eosinofílica/terapia
14.
Immunol Allergy Clin North Am ; 44(2): 357-368, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575229

RESUMO

Endoscopic evaluation with biopsies is a mainstay of the diagnosis of eosinophilic esophagitis (EoE) and non-EoE eosinophilic gastrointestinal diseases (EGIDs). Increasing knowledge has resulted in the development of 2 standardized scoring systems: the Endoscopic REFerence Score (EREFS) for EoE and the EG-REFS for eosinophilic gastritis, although the latter has not been validated. In EGIDs, diagnosis and follow-up focus on eosinophil infiltration in biopsies. In this article, we will discuss the most commonly used endoscopic scores in EoE and non-EoE EGIDs, their validity for the diagnosis and follow-up of disease activity, as well as endoscopic interventions and areas of uncertainty.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Endoscopia/métodos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico
15.
Immunol Allergy Clin North Am ; 44(2): 369-381, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575230

RESUMO

Eosinophilic gastrointestinal diseases (EGID), such as eosinophilic gastritis (EoG), eosinophilic enteritis, and eosinophilic colitis (EoC), are chronic inflammatory conditions characterized by persistent gastrointestinal symptoms and elevated levels of activated eosinophils in the gastrointestinal tract. EoG and eosinophilic duodenitis (EoD) are strongly associated with food allergen triggers and TH2 inflammation, whereas EoC shows minimal transcriptomic overlap with other EGIDs. The level of expression of certain genes associated with TH2 immune response is associated with certain histopathologic findings of EoG, EoD, and EoC. Current immune therapy for EoG depletes tissue eosinophilia with persistence of other histopathologic features of disease.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Gastrite/terapia , Inflamação
16.
Immunol Allergy Clin North Am ; 44(2): 383-396, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575231

RESUMO

Patients with non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) are prone to nutritional deficiencies due to food-avoidant behaviors, malabsorption, and high nutrition impact symptoms. Nutrient deficiencies correspond to the segment, depth, and extent of the gastrointestinal tract involved and can impact organs distant from the gut. Patients with non-EoE EGIDs are often atopic, and some appear to respond to dietary avoidance of specific food allergens. Tests to identify food triggers other than response to elimination diets are lacking. Dietary restriction therapy should be considered in such patients and is best implemented through a multidisciplinary approach to avoid nutritional complications.


Assuntos
Enterite , Eosinofilia , Hipersensibilidade Alimentar , Gastrite , Humanos , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Gastrite/terapia , Eosinofilia/terapia , Eosinofilia/diagnóstico , Hipersensibilidade Alimentar/terapia , Alérgenos
17.
Immunol Allergy Clin North Am ; 44(2): 349-355, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38575228

RESUMO

The clinical presentation of eosinophilic gastrointestinal diseases beyond eosinophilic esophagitis (non-EoE EGIDs) varies depending on the gastrointestinal segments affected by the eosinophilic inflammation, the extent of eosinophilic inflammation within the gastrointestinal tract and its depth through the bowel wall. Non-EoE EGIDs with mucosal involvement tend to present with diarrhea, malabsorption, and sometimes bleeding, those with muscular involvement may present with symptoms of obstruction or pseudo-obstruction, intussusception, and even perforation, whereas those with serosal involvement may present with eosinophilic ascites. Here we describe the differences in symptoms experienced by children with non-EoE EGIDs with varying degrees of eosinophilic inflammation through the bowel wall.


Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Gastrite , Criança , Humanos , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/terapia , Gastrite/diagnóstico , Enterite/diagnóstico , Enterite/terapia , Inflamação
20.
Artigo em Inglês | MEDLINE | ID: mdl-38575380

RESUMO

INTRODUCTION: The use of herbal medicine as a part of the Complementary and Alternative Medicine is increasing worldwide. Herbal remedies are used to better different conditions including gastritis. MATERIAL AND METHODS: We conducted a prospective randomized control clinical trial on a total sample of 72 patients with gastritis in order to examine the effects of the commercial herbal product Gastro Protect. After 6 weeks of conventional therapy the patients were divided into two groups with 36 patients each. As a continuation of the treatment, Group 1 received conventional therapy + Gastro Protect and Group 2 received conventional therapy + Placebo. We analyzed 14 selected gastrointestinal symptoms, five related to digestive problems, and nine related to stool and bowel problems. For assessing the selected symptoms we used seven point gastrointestinal symptom rating scale (GSRS). RESULTS: The Gastro Protect group had a significantly lower GSRS score (better condition) compared to the Placebo group related to all five selected symptoms of digestive problems as: abdominal pain (p=0.0250), hunger pain (p=0.0276), nausea (p=0.0019), heartburn (p=0.00001), and acid reflux (p=0.0017). The Gastro Protect group, also had a significantly lower GSRS score (better condition) compared to the Placebo group related to three out of nine selected bowel symptoms: rumbling (p=0.0022), abdominal distension (p=0.0029), and gas or flatus (p=0.0039). CONCLUSION: Gastro protect was effective in treating gastritis and other gastrointestinal symptoms. It was safe for usage and showed almost no side effects. In our study, Gastro Protect reduced the examined gastric symptoms and related examined intestinal symptoms.


Assuntos
Terapias Complementares , Gastrite , Refluxo Gastroesofágico , Humanos , Estudos Prospectivos , Qualidade de Vida , Refluxo Gastroesofágico/tratamento farmacológico , Gastrite/diagnóstico , Gastrite/tratamento farmacológico
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