Cargando…

Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula

Eosinophilic esophagitis (EoE), an eosinophil predominant, TH2-mediated condition increasing in prevalence in pediatric and adult populations, is typically treated with dietary manipulations to avoid triggering antigens. However, identifying specific dietary causes remains a persistent challenge, an...

Descripción completa

Detalles Bibliográficos
Autores principales: Castro, Kenny, Arostegui, Dalia, Schwarz, Steven, Gandhi, Sonia, Peshimam, Juveria, Rabinowitz, Simon, Pittman, Meredith, Wallach, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins, Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158404/
https://www.ncbi.nlm.nih.gov/pubmed/37168474
http://dx.doi.org/10.1097/PG9.0000000000000250
_version_ 1785036921739673600
author Castro, Kenny
Arostegui, Dalia
Schwarz, Steven
Gandhi, Sonia
Peshimam, Juveria
Rabinowitz, Simon
Pittman, Meredith
Wallach, Thomas
author_facet Castro, Kenny
Arostegui, Dalia
Schwarz, Steven
Gandhi, Sonia
Peshimam, Juveria
Rabinowitz, Simon
Pittman, Meredith
Wallach, Thomas
author_sort Castro, Kenny
collection PubMed
description Eosinophilic esophagitis (EoE), an eosinophil predominant, TH2-mediated condition increasing in prevalence in pediatric and adult populations, is typically treated with dietary manipulations to avoid triggering antigens. However, identifying specific dietary causes remains a persistent challenge, and restrictive diets are burdensome. Total dietary modification using amino acid–based formula does not always produce symptomatic or histologic resolution, suggesting that exposure to ingested aeroallergens drives their disease. EoE patients demonstrate symptomatic exacerbation from July to September correlating with higher grass and ragweed pollen counts. We present a 7-year-old tracheostomy- and gastrostomy-dependent girl who was found on surveillance endoscopy to have profound eosinophilic infiltration throughout the esophagus with inflammatory changes including basal cell hyperplasia on histology. She responded partially to topical corticosteroid therapy with fluticasone and had complete resolution of esophageal eosinophilic infiltrate with subcutaneous dupilumab.
format Online
Article
Text
id pubmed-10158404
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Lippincott Williams & Wilkins, Inc.
record_format MEDLINE/PubMed
spelling pubmed-101584042023-05-09 Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula Castro, Kenny Arostegui, Dalia Schwarz, Steven Gandhi, Sonia Peshimam, Juveria Rabinowitz, Simon Pittman, Meredith Wallach, Thomas JPGN Rep Case Report Eosinophilic esophagitis (EoE), an eosinophil predominant, TH2-mediated condition increasing in prevalence in pediatric and adult populations, is typically treated with dietary manipulations to avoid triggering antigens. However, identifying specific dietary causes remains a persistent challenge, and restrictive diets are burdensome. Total dietary modification using amino acid–based formula does not always produce symptomatic or histologic resolution, suggesting that exposure to ingested aeroallergens drives their disease. EoE patients demonstrate symptomatic exacerbation from July to September correlating with higher grass and ragweed pollen counts. We present a 7-year-old tracheostomy- and gastrostomy-dependent girl who was found on surveillance endoscopy to have profound eosinophilic infiltration throughout the esophagus with inflammatory changes including basal cell hyperplasia on histology. She responded partially to topical corticosteroid therapy with fluticasone and had complete resolution of esophageal eosinophilic infiltrate with subcutaneous dupilumab. Lippincott Williams & Wilkins, Inc. 2022-09-01 /pmc/articles/PMC10158404/ /pubmed/37168474 http://dx.doi.org/10.1097/PG9.0000000000000250 Text en Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Case Report
Castro, Kenny
Arostegui, Dalia
Schwarz, Steven
Gandhi, Sonia
Peshimam, Juveria
Rabinowitz, Simon
Pittman, Meredith
Wallach, Thomas
Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula
title Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula
title_full Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula
title_fullStr Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula
title_full_unstemmed Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula
title_short Histologically Remarkable Eosinophilic Esophagitis Responsive to Dupilumab in a Gastrostomy Tube–Dependent Pediatric Patient on Amino Acid Formula
title_sort histologically remarkable eosinophilic esophagitis responsive to dupilumab in a gastrostomy tube–dependent pediatric patient on amino acid formula
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10158404/
https://www.ncbi.nlm.nih.gov/pubmed/37168474
http://dx.doi.org/10.1097/PG9.0000000000000250
work_keys_str_mv AT castrokenny histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula
AT arosteguidalia histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula
AT schwarzsteven histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula
AT gandhisonia histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula
AT peshimamjuveria histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula
AT rabinowitzsimon histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula
AT pittmanmeredith histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula
AT wallachthomas histologicallyremarkableeosinophilicesophagitisresponsivetodupilumabinagastrostomytubedependentpediatricpatientonaminoacidformula