Eosinophilic esophagitis in children: Immunopathological analysis and response to fluticasone propionate
Eosinophilic esophagitis(EE) shares symptoms with gastroesophageal reflux disease but has distinctive pathologic features and unknown immunopathology. Treatments with antigen restriction or systemic immunosuppression pose problems with compliance and side effects. Topically applied steroids offer an...
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| Veröffentlicht in: | Gastroenterology (New York, N.Y. 1943) N.Y. 1943), 2002-05, Vol.122 (5), p.1216-1225 |
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| container_title | Gastroenterology (New York, N.Y. 1943) |
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| creator | Teitelbaum, Jonathan E. Fox, Victor L. Twarog, Frank J. Nurko, Samuel Antonioli, Don Gleich, Gerald Badizadegan, Kamran Furuta, Glenn T. |
| description | Eosinophilic esophagitis(EE) shares symptoms with gastroesophageal reflux disease but has distinctive pathologic features and unknown immunopathology. Treatments with antigen restriction or systemic immunosuppression pose problems with compliance and side effects. Topically applied steroids offer an attractive alternative treatment. The aims of this study were to determine the immunopathologic features of EE and the effectiveness of antigen-specific diet restriction (DR) and topical immunosuppression.
A prospective trial was conducted examining the impact of DR and swallowed fluticasone propionate (FP) on pediatric patients with EE. Clinicopathologic features, including immunohistochemical analysis of the esophageal mucosa, were measured before and after treatment.
Immunohistochemical analysis of 11 prospectively identified children showed a significantly greater number of mucosal CD3 and CD8 lymphocytes, as well as CD1a antigen-presenting cells compared with normal controls. DR did not induce clinical improvement in any patients, whereas all children who completed treatment with FP had resolution of symptoms. Posttreatment analysis of proximal and distal esophageal mucosa showed a significant reduction in the number of eosinophils, as well as CD3+ and CD8+ lymphocytes compared with pretreatment sections.
EE is characterized by immunologically active esophageal mucosa. FP. not DR. effectively relieves symptoms. FP significantly reduces mucosal inflammation associated with EE. |
| doi_str_mv | 10.1053/gast.2002.32998 |
| format | Article |
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A prospective trial was conducted examining the impact of DR and swallowed fluticasone propionate (FP) on pediatric patients with EE. Clinicopathologic features, including immunohistochemical analysis of the esophageal mucosa, were measured before and after treatment.
Immunohistochemical analysis of 11 prospectively identified children showed a significantly greater number of mucosal CD3 and CD8 lymphocytes, as well as CD1a antigen-presenting cells compared with normal controls. DR did not induce clinical improvement in any patients, whereas all children who completed treatment with FP had resolution of symptoms. Posttreatment analysis of proximal and distal esophageal mucosa showed a significant reduction in the number of eosinophils, as well as CD3+ and CD8+ lymphocytes compared with pretreatment sections.
EE is characterized by immunologically active esophageal mucosa. FP. not DR. effectively relieves symptoms. FP significantly reduces mucosal inflammation associated with EE.</description><identifier>ISSN: 0016-5085</identifier><identifier>EISSN: 1528-0012</identifier><identifier>DOI: 10.1053/gast.2002.32998</identifier><identifier>PMID: 11984507</identifier><identifier>CODEN: GASTAB</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Adolescent ; Adult ; Androstadienes - therapeutic use ; Anti-Inflammatory Agents - therapeutic use ; Antigens, CD1 - analysis ; Biological and medical sciences ; Child ; Child, Preschool ; Diet ; Digestive system ; Eosinophilia - drug therapy ; Eosinophilia - immunology ; Eosinophilia - pathology ; Esophagitis - drug therapy ; Esophagitis - immunology ; Esophagitis - pathology ; Female ; Fluticasone ; Humans ; Infant ; Male ; Medical sciences ; Pharmacology. Drug treatments ; Prospective Studies ; T-Lymphocytes - immunology</subject><ispartof>Gastroenterology (New York, N.Y. 1943), 2002-05, Vol.122 (5), p.1216-1225</ispartof><rights>2002 American Gastroenterology Association</rights><rights>2002 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4248-d34d0bf86ddc731e962e46ae220e32127b84a79431bb7a2c55c5026d824c19333</citedby><cites>FETCH-LOGICAL-c4248-d34d0bf86ddc731e962e46ae220e32127b84a79431bb7a2c55c5026d824c19333</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1053/gast.2002.32998$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=13659354$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11984507$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Teitelbaum, Jonathan E.</creatorcontrib><creatorcontrib>Fox, Victor L.</creatorcontrib><creatorcontrib>Twarog, Frank J.</creatorcontrib><creatorcontrib>Nurko, Samuel</creatorcontrib><creatorcontrib>Antonioli, Don</creatorcontrib><creatorcontrib>Gleich, Gerald</creatorcontrib><creatorcontrib>Badizadegan, Kamran</creatorcontrib><creatorcontrib>Furuta, Glenn T.</creatorcontrib><title>Eosinophilic esophagitis in children: Immunopathological analysis and response to fluticasone propionate</title><title>Gastroenterology (New York, N.Y. 1943)</title><addtitle>Gastroenterology</addtitle><description>Eosinophilic esophagitis(EE) shares symptoms with gastroesophageal reflux disease but has distinctive pathologic features and unknown immunopathology. Treatments with antigen restriction or systemic immunosuppression pose problems with compliance and side effects. Topically applied steroids offer an attractive alternative treatment. The aims of this study were to determine the immunopathologic features of EE and the effectiveness of antigen-specific diet restriction (DR) and topical immunosuppression.
A prospective trial was conducted examining the impact of DR and swallowed fluticasone propionate (FP) on pediatric patients with EE. Clinicopathologic features, including immunohistochemical analysis of the esophageal mucosa, were measured before and after treatment.
Immunohistochemical analysis of 11 prospectively identified children showed a significantly greater number of mucosal CD3 and CD8 lymphocytes, as well as CD1a antigen-presenting cells compared with normal controls. DR did not induce clinical improvement in any patients, whereas all children who completed treatment with FP had resolution of symptoms. Posttreatment analysis of proximal and distal esophageal mucosa showed a significant reduction in the number of eosinophils, as well as CD3+ and CD8+ lymphocytes compared with pretreatment sections.
EE is characterized by immunologically active esophageal mucosa. FP. not DR. effectively relieves symptoms. FP significantly reduces mucosal inflammation associated with EE.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Androstadienes - therapeutic use</subject><subject>Anti-Inflammatory Agents - therapeutic use</subject><subject>Antigens, CD1 - analysis</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Diet</subject><subject>Digestive system</subject><subject>Eosinophilia - drug therapy</subject><subject>Eosinophilia - immunology</subject><subject>Eosinophilia - pathology</subject><subject>Esophagitis - drug therapy</subject><subject>Esophagitis - immunology</subject><subject>Esophagitis - pathology</subject><subject>Female</subject><subject>Fluticasone</subject><subject>Humans</subject><subject>Infant</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>T-Lymphocytes - immunology</subject><issn>0016-5085</issn><issn>1528-0012</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2002</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10L9v1DAUwHELgehRmNlQFthy9c_EZkNVgUqVWGC2HPvlziixg1-C1P--Pu6kTky2rI-frS8h7xndM6rEzcHhuueU8r3gxugXZMcU1y2ljL8ku7p0raJaXZE3iL8ppUZo9ppcMWa0VLTfkeNdxpjycoxT9A1g3blDXCM2MTW-noYC6XNzP89bVW495ikfondT45KbHrFCl0JTAJecEJo1N-O0rVVgTtAsJS8xJ7fCW_JqdBPCu8t6TX59vft5-719-PHt_vbLQ-sll7oNQgY6jLoLwfeCgek4yM4B5xQEZ7wftHS9kYINQ--4V8oryrugufTMCCGuyafz3Pr0nw1wtXNED9PkEuQNbc86oXumKrw5Q18yYoHRLiXOrjxaRu0prj3Ftae49l_ceuPDZfQ2zBCe_aVmBR8vwGFNNBaXfMRnJzplhJLVmbODGuJvhGLRR0geQizgVxty_O8nngC4yZen</recordid><startdate>200205</startdate><enddate>200205</enddate><creator>Teitelbaum, Jonathan E.</creator><creator>Fox, Victor L.</creator><creator>Twarog, Frank J.</creator><creator>Nurko, Samuel</creator><creator>Antonioli, Don</creator><creator>Gleich, Gerald</creator><creator>Badizadegan, Kamran</creator><creator>Furuta, Glenn T.</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>200205</creationdate><title>Eosinophilic esophagitis in children: Immunopathological analysis and response to fluticasone propionate</title><author>Teitelbaum, Jonathan E. ; Fox, Victor L. ; Twarog, Frank J. ; Nurko, Samuel ; Antonioli, Don ; Gleich, Gerald ; Badizadegan, Kamran ; Furuta, Glenn T.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4248-d34d0bf86ddc731e962e46ae220e32127b84a79431bb7a2c55c5026d824c19333</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2002</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Androstadienes - therapeutic use</topic><topic>Anti-Inflammatory Agents - therapeutic use</topic><topic>Antigens, CD1 - analysis</topic><topic>Biological and medical sciences</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Diet</topic><topic>Digestive system</topic><topic>Eosinophilia - drug therapy</topic><topic>Eosinophilia - immunology</topic><topic>Eosinophilia - pathology</topic><topic>Esophagitis - drug therapy</topic><topic>Esophagitis - immunology</topic><topic>Esophagitis - pathology</topic><topic>Female</topic><topic>Fluticasone</topic><topic>Humans</topic><topic>Infant</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>T-Lymphocytes - immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Teitelbaum, Jonathan E.</creatorcontrib><creatorcontrib>Fox, Victor L.</creatorcontrib><creatorcontrib>Twarog, Frank J.</creatorcontrib><creatorcontrib>Nurko, Samuel</creatorcontrib><creatorcontrib>Antonioli, Don</creatorcontrib><creatorcontrib>Gleich, Gerald</creatorcontrib><creatorcontrib>Badizadegan, Kamran</creatorcontrib><creatorcontrib>Furuta, Glenn T.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Teitelbaum, Jonathan E.</au><au>Fox, Victor L.</au><au>Twarog, Frank J.</au><au>Nurko, Samuel</au><au>Antonioli, Don</au><au>Gleich, Gerald</au><au>Badizadegan, Kamran</au><au>Furuta, Glenn T.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Eosinophilic esophagitis in children: Immunopathological analysis and response to fluticasone propionate</atitle><jtitle>Gastroenterology (New York, N.Y. 1943)</jtitle><addtitle>Gastroenterology</addtitle><date>2002-05</date><risdate>2002</risdate><volume>122</volume><issue>5</issue><spage>1216</spage><epage>1225</epage><pages>1216-1225</pages><issn>0016-5085</issn><eissn>1528-0012</eissn><coden>GASTAB</coden><abstract>Eosinophilic esophagitis(EE) shares symptoms with gastroesophageal reflux disease but has distinctive pathologic features and unknown immunopathology. Treatments with antigen restriction or systemic immunosuppression pose problems with compliance and side effects. Topically applied steroids offer an attractive alternative treatment. The aims of this study were to determine the immunopathologic features of EE and the effectiveness of antigen-specific diet restriction (DR) and topical immunosuppression.
A prospective trial was conducted examining the impact of DR and swallowed fluticasone propionate (FP) on pediatric patients with EE. Clinicopathologic features, including immunohistochemical analysis of the esophageal mucosa, were measured before and after treatment.
Immunohistochemical analysis of 11 prospectively identified children showed a significantly greater number of mucosal CD3 and CD8 lymphocytes, as well as CD1a antigen-presenting cells compared with normal controls. DR did not induce clinical improvement in any patients, whereas all children who completed treatment with FP had resolution of symptoms. Posttreatment analysis of proximal and distal esophageal mucosa showed a significant reduction in the number of eosinophils, as well as CD3+ and CD8+ lymphocytes compared with pretreatment sections.
EE is characterized by immunologically active esophageal mucosa. FP. not DR. effectively relieves symptoms. FP significantly reduces mucosal inflammation associated with EE.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>11984507</pmid><doi>10.1053/gast.2002.32998</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Androstadienes - therapeutic use Anti-Inflammatory Agents - therapeutic use Antigens, CD1 - analysis Biological and medical sciences Child Child, Preschool Diet Digestive system Eosinophilia - drug therapy Eosinophilia - immunology Eosinophilia - pathology Esophagitis - drug therapy Esophagitis - immunology Esophagitis - pathology Female Fluticasone Humans Infant Male Medical sciences Pharmacology. Drug treatments Prospective Studies T-Lymphocytes - immunology |
| title | Eosinophilic esophagitis in children: Immunopathological analysis and response to fluticasone propionate |
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