ABSTRACT
BACKGROUND: In children with eosinophilic esophagitis (EoE) foods are the most common disease triggers, but environmental allergens are also suspected culprits. OBJECTIVE: To determine the effects of environmental allergen sensitization on response to treatment in children with EoE in the southeastern United States. METHODS: Patients 2 to 18 years old who were referred to the Arkansas Children's Hospital Eosinophilic Gastrointestinal Disorders Clinic from January 2012 to January 2016 were enrolled in a prospective, longitudinal cohort study with collection of demographics, clinical symptoms, medical history, allergy sensitization profiles, and response to treatment over time. Comparisons were made between complete responders (peak esophageal eosinophil count <15 per high-power field [HPF]) and nonresponders (>25 eosinophils per HPF) after treatment with diet elimination alone, swallowed corticosteroids alone, or diet elimination and swallowed corticosteroids. Sensitization patterns to environmental allergens found in the southeastern United States were analyzed for the effect on treatment response. RESULTS: A total of 223 individuals were enrolled. Of these, 182 had environmental allergy profiling and at least one endoscopy while receiving proton pump inhibitor (PPI) therapy. Twenty-nine individuals had PPI-responsive EoE and were excluded from further analysis, leaving 123 individuals with non-PPI-responsive EoE who were further analyzed; 72 (58.5%) were complete responders and 33 (26.8%) were nonresponders. Seventeen individuals (13.8%) were partial responders (≥1 but ≤25 eosinophils per HPF) and excluded from further analysis. Nonresponders were more likely to be sensitized to perennial allergens (P = .02). There was no significant difference in response based on seasonal allergen sensitization. Individuals with mold or cockroach sensitization were more likely to fail combination diet and swallowed corticosteroid treatment (P = .02 and P = .002). CONCLUSION: Perennial allergen and mold sensitization may lead to nonresponse to EoE treatment in some patients. Additional studies are needed to further understand the effect of environmental allergens on EoE. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01779154.
Subject(s)
Allergens/immunology , Eosinophilic Esophagitis/immunology , Eosinophilic Esophagitis/therapy , Eosinophils/immunology , Esophagus/pathology , Hypersensitivity/immunology , Hypersensitivity/pathology , Adolescent , Arkansas , Child , Child, Preschool , Environmental Exposure , Female , Humans , Immunization/adverse effects , Longitudinal Studies , Male , Particulate Matter/immunology , Prospective Studies , Proton Pump Inhibitors/therapeutic use , Seasons , Treatment OutcomeABSTRACT
Intestinal failure (IF) results from a critical reduction in the functional intestinal mass resulting in dependence on total parenteral nutrition (TPN) for growth and survival. Short bowel syndrome (SBS) is the most common cause of intestinal failure in pediatrics. Following resection, the small bowel undergoes adaptation, a process wherein the bowel elongates and dilates in order to increase intestinal absorptive capacity. Small bowel dilatation can lead to dysmotility and small bowel bacterial overgrowth which may further enhance feeding intolerance. Bowel lengthening procedures are beneficial when there is significant dilatation of the small bowel and subsequent inability to advance enteral feeds. We describe a patient with intestine failure and short bowel syndrome due to gastroschisis who, presented with anemia and occult gastrointestinal bleeding, following Serial Transverse Enteroplasty procedure (STEP). Video capsule endoscopy (VCE) revealed multiple ulcerations at surgical staple sites throughout the distal 2/3 of the remaining small intestine which were the likely source of intestinal blood loss.
