Investigators Describe Clinical Features of Pediatric Eosinophilic Gastroenteritis

Investigators for the first time ever have begun to learn trends and clinical features for pediatric patients with eosinophilic gastroenteritis (EGE).

A team, led by Soya Kobayashi, Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohama City Tobu Hospital, described the clinical features of pediatric patients with eosinophilic gastroenteritis.

A Lack of Pediatric Data

There is a lack of studying looking at large numbers of cases of eosinophilic gastroenteritis in pediatric patients from a single center.

In the retrospective study, the investigators examined 860 pediatric patients with eosinophilic gastroenteritis at a single center between April 2007 and December 2017. The participants were aged between 1-15 years.

Each patients underwent an endoscopy for gastrointestinal symptoms of unknown causes. Of this group, 12,7% (n = 109) were diagnosed with EGE based on the diagnostic criteria developed by the research group of the Ministry of Health, Labour and Welfare of Japan for eosinophilic gastrointestinal disorder in 2015.

Outcomes

The investigators looked at symptoms, comorbidities, endoscopic findings, pathological findings, treatments, and outcomes.

There were 71 male patients and 38 female patients diagnosed with eosinophilic gastroenteritis included in the study. The median age at diagnosis was 11 years.

The most prevalent complaint among patients was abdominal pain, which occurred in 76.1% (n = 83) of participants, as well as diarrhea, which occurred in 23.9% (n = 26) of participants.

The results also show upper and lower gastrointestinal endoscopies resulted in normal findings for 29.4% (n = 32) of participants.

The most common treatment used was a combination of the elimination of foods suspected of causing eosinophilic gastroenteritis and anti-allergic agents. This occurred in 45.9% (n = 50) of cases.

The outcomes of symptom disappearance was found in 39.4% (n = 43) of participants, while symptom improvement occurred in 48.6% (n = 53) of patients.

“For gastrointestinal symptoms of unknown cause in children, EGE should be considered as a differential diagnosis,” the authors wrote. “Although the symptoms and endoscopic findings are nonspecific, cracked mucosa may be a specific endoscopic finding for pediatric EGE. Elimination diet and/or anti-allergic drugs were effective in most patients with pediatric EGE.”

Finally a Treatment for EoE

Earlier this year, the US Food and Drug Administration (FDA) the first ever treatment for eosinophilic esophagitis (EoE), another eosinophilic gastrointestinal disease (EGID).

The FDA approved dupilumab (Dupixent) in May for the treatment of adult and pediatric patients 12 years and older weighing at least 40 kg with EoE.

Recent data from a phase 3 trial on the biologic found that nearly 10 times as many patients treated with dupilumab achieved histological disease remission during the study, with 59% achieving histological disease remission compared to 6% of the placebo group.

The efficacy and safety of Dupixent in EoE was studied in a randomized, double-blind, parallel-group, multicenter, placebo-controlled trial consisting of two 24-week treatment periods that were conducted independently in separate groups of patients.

In Part A of the trial, 60% of the 42 patients who received dupilumab achieved the pre-determined level of reduced eosinophils in the esophagus compared to 5% of the 39 patients who received a placebo.

Similarly, in Part B, 59% of the 80 patients who received the biologic achieved the pre-determined level of reduced eosinophils in the esophagus compared to 6% of the 79 patients who received a placebo.

The study, “Clinical Features of Pediatric Eosinophilic Gastroenteritis,” was published online in Pediatrics International.