| Abstract | Eozinofilni ezofagitis (EoE) kronična je bolest posredovana imuno/antigenim patofiziološkim mehanizmima, karakterizirana predominantno eozinofilnom upalom sluznice jednjaka. Ekspozicija određenim nutritivnim i/ili inhalacijskim alergenima, kao najčešći okidač EoE, potiče citokinsku aktivaciju eozinofila. Privlačenjem drugih upalnih stanica u sluznicu jednjaka, narušava se barijera što je vidljivo u endoskopskim i histološkim nalazima. Klinički se manifestira spektrom simptoma, u djece najčešće kao bol u trbuhu, zatim disfagija, impakcija bolusa hrane i odinofagija. Svjedočimo porastu incidencije i prevalencije EoE zadnjih desetak godina, stoga je evidencija 15-godišnjeg iskustva jednog centra značajna za nastavak praćenja ove poligenske bolesti čije pravodobno liječenje prevenira kronično remodeliranje sluznice i nastanak ezofagealne fibroze. Cilj ovog rada bio je ispitati pojavnost, klinički fenotip i endoskopska obilježja u skupini djece s EoE liječene na Klinici za pedijatriju KBC Sestre milosrdnice, u periodu od 1. siječnja 2009. do 1. siječnja 2024. godine. Podaci su prikupljeni iz digitalne arhive službene bolničke dokumentacije.
U istraživanje je uključeno 36 ispitanika životne dobi 5-17 godina (prosječno 12,78 godina). EoE se klinički najčešće manifestirao bolovima u trbuhu, ukupno 19 (53%) ispitanika. Disfagija (30%), odinofagija (8%) i impakcija bolusa hrane (25%) zabilježeni su isključivo kod dječaka. Od pridruženih atopijskih obilježja, najčešće se javljao alergijski rinitis (30%), zatim astma (25%) i atopijski dermatitis (17%). Kod 72% ispitanika utvrđena je nutritivna, kod 44% inhalacijska senzitizacija. Prilikom postavljanja dijagnoze, važan je histološki nalaz koji opisuje broj eozinofila u uzorku bioptata sluznice jednjaka (upalna infiltracija) te je najveći broj ispitanika (33%) bilježio mikroskopski evaluirano 20-30 eozinofila u VVP (velikom vidnom polju). Prema endoskopskom bodovniku za EoE, EREFS (engl. ‘Endoscopic Reference Score’), najčešće validirane bile su EREFS 2 promjene sluznice jednjaka (33%), zatim podjednako zastupljene EREFS 1 i 3 (22%), a EREFS 4 u manje od 3% bolesnika. Ključan dio istraživanja bio je podijeliti ispitanike u dvije skupine, prema prisutnosti atopije, i usporediti težinu bolesti ovisno o pripadnosti ispitanika pojedinoj skupini. Opisan je teži stupanj promjena prema EREFS bodovniku u ispitanika s prisutnom atopijom te je veća zastupljenost disfagičnih tegoba u toj skupini ispitanika. Ovi rezultati naglašavaju činjenicu da je kod bolesnika s atopijom koji javljaju simptome disfunkcije jednjaka važno sumnjati na EoE i očekivati lokalno uznapredovalu upalu. |
| Abstract (english) | Eosinophilic esophagitis (EoE) is a chronic disease mediated by immune/antigenic pathophysiological mechanisms, characterized predominantly by eosinophilic inflammation of the esophageal mucosa. Exposure to certain nutritional and/or inhaled allergens stimulates cytokine activation of eosinophils. By attracting other inflammatory cells to the esophageal mucosa, the barrier is disrupted, which is evident in endoscopic and histological findings. Clinically, in children it manifests most commonly as abdominal pain, followed by dysphagia, food bolus impaction, and odynophagia. We have witnessed an increase in prevalence of EoE over the past decade, which makes the documentation of 15 years of experience at a single center significant for the ongoing monitoring of this polygenic disease, whose timely treatment prevents chronic mucosal remodeling and the development of esophageal fibrosis. The aim of this study was to examine the occurrence, clinical phenotype, and endoscopic features in a group of children with EoE treated in the Pediatrics Clinic at Sisters of Charity University Hospital from January 1, 2009, to January 1, 2024. Data were collected from the digital archive of official hospital documentation.
The study included 36 participants aged 5 to17 years (average age 12.78 years). EoE clinically manifested as abdominal pain in 19 (53%) patients. Dysphagia (30%), odynophagia (8%), and food bolus impaction (25%) were recorded exclusively in boys. Among associated atopic features, allergic rhinitis was most common (30%), followed by asthma (25%) and atopic dermatitis (17%). Nutritional sensitization was identified in 72% of patients, inhalational in 44%. For diagnosis, the histological finding describing the number of eosinophils in a biopsy sample of the esophageal mucosa (inflammatory infiltration) is crucial, with the highest number of patients (33%) having 20-30 eosinophils per high power field (HPF). According to the EoE endoscopic scoring system, EREFS (Endoscopic Reference Score), the most commonly validated changes in were EREFS 2 (33%), followed by EREFS 1 and 3 (22%), and EREFS 4 in less than 3% of patients. A key part of the study was dividing patients into two groups based on the presence of atopy and comparing the severity of the disease depending on group membership. A more severe degree of changes, according to the EREFS score, was described in patients with atopy, also with a higher prevalence of dysphagic symptoms. These results emphasize the fact that in patients with atopy who report symptoms of esophageal dysfunction, it is important to suspect EoE and expect locally advanced inflammation. |
