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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...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Lippincott Williams & Wilkins, Inc.
2022
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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 |
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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 |
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