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Characteristics Associated with Treatment Choice in Pediatric Eosinophilic Esophagitis
AB44 Abstracts
SATURDAY
135
Impact of Swallowed Topical Steroid Treatment on Growth in Children with Eosinophilic Esophagitis Chih-Yin Yeh; Morehouse School of Medicine, Atlanta, GA. RATIONALE: Swallowed topical corticosteroid treatment is an effective first-line pharmacologic therapy in eosinophilic esophagitis (EoE). However, the impression of a potential adverse effect, growth retardation, has prevented some parents from giving corticosteroids to their children. Clinically, such treatment can alleviate EoE’s symptoms such as food aversion and failure to thrive. Therefore, we hypothesize that treating EoE patients with corticosteroids may lead to the improvement in growth. METHODS: The study includes a retrospective cohort of EoE patients in Children’s Healthcare of Atlanta that were treated with corticosteroid, less than 18 years old, and followed up for at least 6 months. We extracted data, including patients’ demographic information, presenting symptoms, and corticosteroid options, from the health care software Epic. Using before and after treatment standard deviation scores (SDS) for height, we evaluated the significance of our hypothesis by right-tailed Wilcoxon signed-rank test. RESULTS: Seventeen of 66 patients met the eligibility criteria. Of the 17 patients, the mean age was 6.9 years old and the mean follow up duration was 15.0 months. The p-value was 0.0448, which indicated a significant improvement of patients’ growth after the corticosteroid treatment. CONCLUSIONS: No data have been published to address the impact of corticosteroids on the growth of children with EoE. Through our retrospective study, we showed that corticosteroid treatment contributes to an improvement in the growth in children with EoE, possibly by alleviating EoE symptoms such as food aversions and failure to thrive.
136
Eosinophilic Esophagitis (EoE): Individualizing a Long-Term Treatment Plan Lyvia Leigh, MD1, Elizabeth Sterrett Rothstein, PA-C2, Clifford W. Bassett, MD, FACAAI, FAAAAI3; 1New York University School of Medicine, Internal Medicine Residency Program, New York, NY, 2Allergy & Asthma Care of New York, New York, NY, 3NYU School of Medicine, New York, NY; Allergy and Asthma Care of NY, New York, NY. RATIONALE: EoE, a perplexing chronic inflammatory disease, is increasing in incidence. Identifying factors surrounding symptom recurrence and treatment compliance may optimize individual treatment. METHODS: Retrospective review of 57 adult patients with biopsyproven EoE in the outpatient setting, all contacted by phone asking about symptom recurrence, seasonal association, medication and diet compliance. RESULTS: 64% men, 36% women with median age of 38 years. Most common initial symptoms: food impaction (45%) and dysphagia (25%). Of 57, 16 were available for follow-up. Of this subset, 56% had recurring symptoms, of which 56% noticed increased dysphagia in the spring, 22% in the fall. 81% stopped using fluticasone, and 63% stopped their proton pump inhibitor (PPI) upon symptom resolution. 44% remain on diet therapy (low acid, avoidance). 67% compliant on fluticasone but not diet still had symptoms. 83% compliant on PPI but not diet still had symptoms. 57% compliant on diet alone still had symptoms. CONCLUSIONS: In adults, there may be different subtypes of EoE. Patients treated with fluticasone, PPI, and food avoidance saw improved esophageal function after a few weeks to months, which often led to therapy cessation. Many improved after PPI alone, hinting at a PPIresponsive EoE. Recurring symptoms have a seasonal pattern, mostly spring and fall, further implicating aeroallergens in EoE pathogenesis. Diet therapy (food allergen avoidance) may make more sense than medical therapy alone given EoE is an antigen/immune-mediated disease. Combination (medication and diet) therapy may have increased efficacy, especially during seasonal transitions. Ultimately, treatment choice and length need to be tailored to each individual.
J ALLERGY CLIN IMMUNOL FEBRUARY 2015
137
Characteristics Associated with Treatment Choice in Pediatric Eosinophilic Esophagitis Melanie M. Makhija, MD, MS1,2, Katie Amsden, MPH1,3, Samuel Wing, MPH1,3, Kristin Johnson, BS1,3, Amir F. Kagalwalla, MD4,5; 1 Northwestern University Feinberg School of Medicine, Chicago, IL, 2Division of Allergy and Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 3Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 4Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, 5John H. Stroger Hospital of Cook County, Chicago, IL. RATIONALE: To evaluate factors associated with choice of therapy with either dietary elimination or topical steroids for the treatment of eosinophilic esophagitis(EoE) in children. METHODS: Data from 108 children enrolled in a prospective EoE patient database at a tertiary-care pediatric hospital was analyzed. Bivariate analyses and multivariate logistic regression were used. Patients who chose no treatment were excluded from the analyses. RESULTS: 108 patients with a mean age of 7.8 years (1.1–18.7 years) were included. 77.8% were male. The ethnic distribution was 63.9% Caucasian, 14.8% Hispanic and 21.3% other races. Atopic history included 55.9% with food allergies, 40.6% with asthma, 41.5 % with atopic dermatitis, and 57.7% with allergic rhinitis. Personal history of food allergy, asthma, atopic dermatitis or rhinitis; family history of allergic or GI diseases and demographic characteristics other than racial background were not significantly associated with treatment choice by bivariate analyses. Increased parental education level trended towards a significant association with choosing dietary treatment; however, due to incomplete data it was not included in our logistic regression model. When controlling for demographics, personal and family history, and severity of disease burden in a logistic regression model, Hispanic patients disproportionately chose steroids compared to Caucasians (OR 18.29, p<.001). Children with a history of other gastrointestinal diseases were more likely to choose dietary elimination (OR 6.59, p<.05). CONCLUSIONS: In our pediatric cohort, only Hispanic patients were more likely to choose steroid therapy over elimination diet. A personal or family history of atopy was not significantly associated with choice of EoE treatment.
SATURDAY
135
Impact of Swallowed Topical Steroid Treatment on Growth in Children with Eosinophilic Esophagitis Chih-Yin Yeh; Morehouse School of Medicine, Atlanta, GA. RATIONALE: Swallowed topical corticosteroid treatment is an effective first-line pharmacologic therapy in eosinophilic esophagitis (EoE). However, the impression of a potential adverse effect, growth retardation, has prevented some parents from giving corticosteroids to their children. Clinically, such treatment can alleviate EoE’s symptoms such as food aversion and failure to thrive. Therefore, we hypothesize that treating EoE patients with corticosteroids may lead to the improvement in growth. METHODS: The study includes a retrospective cohort of EoE patients in Children’s Healthcare of Atlanta that were treated with corticosteroid, less than 18 years old, and followed up for at least 6 months. We extracted data, including patients’ demographic information, presenting symptoms, and corticosteroid options, from the health care software Epic. Using before and after treatment standard deviation scores (SDS) for height, we evaluated the significance of our hypothesis by right-tailed Wilcoxon signed-rank test. RESULTS: Seventeen of 66 patients met the eligibility criteria. Of the 17 patients, the mean age was 6.9 years old and the mean follow up duration was 15.0 months. The p-value was 0.0448, which indicated a significant improvement of patients’ growth after the corticosteroid treatment. CONCLUSIONS: No data have been published to address the impact of corticosteroids on the growth of children with EoE. Through our retrospective study, we showed that corticosteroid treatment contributes to an improvement in the growth in children with EoE, possibly by alleviating EoE symptoms such as food aversions and failure to thrive.
136
Eosinophilic Esophagitis (EoE): Individualizing a Long-Term Treatment Plan Lyvia Leigh, MD1, Elizabeth Sterrett Rothstein, PA-C2, Clifford W. Bassett, MD, FACAAI, FAAAAI3; 1New York University School of Medicine, Internal Medicine Residency Program, New York, NY, 2Allergy & Asthma Care of New York, New York, NY, 3NYU School of Medicine, New York, NY; Allergy and Asthma Care of NY, New York, NY. RATIONALE: EoE, a perplexing chronic inflammatory disease, is increasing in incidence. Identifying factors surrounding symptom recurrence and treatment compliance may optimize individual treatment. METHODS: Retrospective review of 57 adult patients with biopsyproven EoE in the outpatient setting, all contacted by phone asking about symptom recurrence, seasonal association, medication and diet compliance. RESULTS: 64% men, 36% women with median age of 38 years. Most common initial symptoms: food impaction (45%) and dysphagia (25%). Of 57, 16 were available for follow-up. Of this subset, 56% had recurring symptoms, of which 56% noticed increased dysphagia in the spring, 22% in the fall. 81% stopped using fluticasone, and 63% stopped their proton pump inhibitor (PPI) upon symptom resolution. 44% remain on diet therapy (low acid, avoidance). 67% compliant on fluticasone but not diet still had symptoms. 83% compliant on PPI but not diet still had symptoms. 57% compliant on diet alone still had symptoms. CONCLUSIONS: In adults, there may be different subtypes of EoE. Patients treated with fluticasone, PPI, and food avoidance saw improved esophageal function after a few weeks to months, which often led to therapy cessation. Many improved after PPI alone, hinting at a PPIresponsive EoE. Recurring symptoms have a seasonal pattern, mostly spring and fall, further implicating aeroallergens in EoE pathogenesis. Diet therapy (food allergen avoidance) may make more sense than medical therapy alone given EoE is an antigen/immune-mediated disease. Combination (medication and diet) therapy may have increased efficacy, especially during seasonal transitions. Ultimately, treatment choice and length need to be tailored to each individual.
J ALLERGY CLIN IMMUNOL FEBRUARY 2015
137
Characteristics Associated with Treatment Choice in Pediatric Eosinophilic Esophagitis Melanie M. Makhija, MD, MS1,2, Katie Amsden, MPH1,3, Samuel Wing, MPH1,3, Kristin Johnson, BS1,3, Amir F. Kagalwalla, MD4,5; 1 Northwestern University Feinberg School of Medicine, Chicago, IL, 2Division of Allergy and Immunology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 3Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, 4Division of Gastroenterology, Hepatology, and Nutrition, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, 5John H. Stroger Hospital of Cook County, Chicago, IL. RATIONALE: To evaluate factors associated with choice of therapy with either dietary elimination or topical steroids for the treatment of eosinophilic esophagitis(EoE) in children. METHODS: Data from 108 children enrolled in a prospective EoE patient database at a tertiary-care pediatric hospital was analyzed. Bivariate analyses and multivariate logistic regression were used. Patients who chose no treatment were excluded from the analyses. RESULTS: 108 patients with a mean age of 7.8 years (1.1–18.7 years) were included. 77.8% were male. The ethnic distribution was 63.9% Caucasian, 14.8% Hispanic and 21.3% other races. Atopic history included 55.9% with food allergies, 40.6% with asthma, 41.5 % with atopic dermatitis, and 57.7% with allergic rhinitis. Personal history of food allergy, asthma, atopic dermatitis or rhinitis; family history of allergic or GI diseases and demographic characteristics other than racial background were not significantly associated with treatment choice by bivariate analyses. Increased parental education level trended towards a significant association with choosing dietary treatment; however, due to incomplete data it was not included in our logistic regression model. When controlling for demographics, personal and family history, and severity of disease burden in a logistic regression model, Hispanic patients disproportionately chose steroids compared to Caucasians (OR 18.29, p<.001). Children with a history of other gastrointestinal diseases were more likely to choose dietary elimination (OR 6.59, p<.05). CONCLUSIONS: In our pediatric cohort, only Hispanic patients were more likely to choose steroid therapy over elimination diet. A personal or family history of atopy was not significantly associated with choice of EoE treatment.