Primary Eosinophilic Gastrointestinal Diseases Beyond Eosinophilic Esophagitis in Children.

OBJECTIVES: There are many unknowns about primary eosinophilic gastrointestinal disease (EGID) in childhood. The aim of this study is to provide data about the frequency, management, control level, and prognosis of well documented primary EGID in childhood. METHODS: This study was conducted in children who underwent endoscopy and/or colonoscopy at a single center over 10-year period up to August 2018. Primary EGID was diagnosed after exclusion of secondary EGID and classified as eosinophilic gastritis (EG), eosinophilic enteritis (EE), eosinophilic gastroenteritis (EGE: eosinophilic gastritis with eosinophilic enteritis) and eosinophilic colitis (EC) according to histopathological evaluation. The pathological number of eosinophil counts were accepted as >30 hpf for gastric mucosa in 5 hpf area, ≥20/hpf for duodenal, jejunal, and ileal mucosa, >50/hpf for right colonic mucosa, >35/hpf for transverse colonic mucosa, and >25/hpf for left colonic mucosa. Presenting symptoms, signs, management, follow-up, disease control level, and remission were analyzed. Remission is defined if the patient is controlled with all clinical, endoscopic/colonoscopic, and histopathologic parameters without any treatments or diet for at least a year. RESULTS: During the study period, 7457 biopsies were taken in 8262 endoscopy and/or colonoscopy procedures. Primary and secondary EGID frequencies were found 0.23% (n = 17 patients) and 0.1% (n =8 patients) per procedure with biopsy in children, respectively. Endoscopy/colonoscopy procedures were not able to performed in 9 patients because of short follow-up period (n = 6) or patients leaving follow-up (n = 3). Nine of the primary EGID patients had esophageal eosinophilia (EsE) at the time of diagnosis, 5 of them were previously managed as EoE. The median follow-up period of primary EGID patients excluding the ones without a control endoscopy/colonoscopy procedure was 3.35 years (min-max: 1.1-9.0 years). Proton pump inhibitors (PPI) were the most frequently used treatment alone or in combination with diet, systemic and/or topical corticosteroids. Disease control was evaluated in 8 of 17 patients and it was uncontrolled in 4, partially controlled in 1, and controlled in 3 patients. Remission was achieved in 2 patients. CONCLUSIONS: The frequency of primary EGID beyond eosinophilic esophagitis (EoE) in children is low. It may be difficult to achieve control in children with primary EGID in the long-term follow-up.

Interaction between childhood vocal fold nodules and allergic diseases.

OBJECTIVES: Vocal fold nodules (VFNs) are benign lesions at the junction of the anterior and middle third of the vocal folds. Although VFNs are often a result of vocal cord trauma due to vocal abuse, childhood allergic diseases, and medications may be a cause. We aimed to investigate the association of detected VFNs with allergic diseases in childhood patients with vocal abuse. METHODS: This is a prospective, cross-sectional, case-control study. Caucasian children in ages 3-12, who speak loud, vocal abuse confirmed with Turkish Children's voice handicap index-10 (TR-CVHI-10) above 9 were enrolled to the study. 33 children with VFN were included as the study group and age-matched 26 healthy children without VFN were included as the control group. Children questioned and tested for allergic diseases with Allergometric tests. RESULTS: Asthma was detected in 42.4% of the study group and absent in the control group. The history of inhaler or nasal steroid use was positive in 30.3% of the study group and 7.7% of the control group (p = 0.032). Dysphonia and the presence of allergic diseases were determined as independent risk factors for the study group (p = 0.001; 0.021, respectively). The median values of blood lymphocyte counts were significantly different among study and control groups (2900 µl vs 2335 µl, respectively; p = 0.04). CONCLUSION: Investigating allergic diseases, especially asthma, for success in the treatment of pediatric patients with VFNs is of utmost importance.