Malnutrition in Eosinophilic Gastrointestinal Disorders

Martina Votto, Maria De Filippo, Francesca Olivero, Alessandro Raffaele, Emanuele Cereda, Mara De Amici, Giorgia Testa, Gian Luigi Marseglia, Amelia Licari, Martina Votto, Maria De Filippo, Francesca Olivero, Alessandro Raffaele, Emanuele Cereda, Mara De Amici, Giorgia Testa, Gian Luigi Marseglia, Amelia Licari

Abstract

Primary eosinophilic gastrointestinal disorders (EGIDs) are emerging chronic/remittent inflammatory diseases of unknown etiology, which may involve any part of the gastrointestinal (GI) tract, in the absence of secondary causes of GI eosinophilia. Eosinophilic esophagitis is the prototype of eosinophilic gastrointestinal disorders and is clinically characterized by symptoms related to esophageal inflammation and dysfunction. A few studies have assessed the nutritional status of patients with eosinophilic gastrointestinal disorders, showing conflicting results. This review summarizes the current evidence on the nutritional status of patients with EGIDs, focusing on the pediatric point of view and also speculating potential etiological mechanisms.

Keywords: adolescents; children; eosinophilic esophagitis; eosinophilic gastrointestinal disorders; failure to thrive; growth; malnutrition; obesity; undernutrition; vitamin.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Process of literature screening.
Figure 2
Figure 2
The multidisciplinary approach of children and adolescents with eosinophilic gastrointestinal disorders.
Figure 3
Figure 3
Nutritional status assessment of children and adolescents with eosinophilic gastrointestinal disorders.

References

    1. Licari A., Votto M., D’Auria E., Castagnoli R., Caimmi S.M.E., Marseglia G.L. Eosinophilic gastrointestinal diseases in children: A practical review. Curr. Pediatr. Rev. 2020;16:106–114. doi: 10.2174/1573396315666191022154432.
    1. Cianferoni A., Spergel J.M. Eosinophilic esophagitis and gastroenteritis. Curr. Allergy Asthma Rep. 2015;15:58. doi: 10.1007/s11882-015-0558-5.
    1. Furuta G.T., Katzka D.A. Eosinophilic Esophagitis. N. Engl. J. Med. 2015;373:1640–1648. doi: 10.1056/NEJMra1502863.
    1. Dellon E.S., Liacouras C.A., Molina-Infante J., Furuta G.T., Spergel J.M., Zevit N., Spechler S.J., Attwood S.E., Straumann A., Aceves S.S., et al. Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference. Gastroenterology. 2018;155:1022–1033. doi: 10.1053/j.gastro.2018.07.009.
    1. Spergel J.M., Dellon E.S., Liacouras C.A., Hirano I., Molina-Infante J., Bredenoord A.J., Furuta G.T. Participants of AGREE. Summary of the updated international consensus diagnostic criteria for eosinophilic esophagitis: AGREE conference. Ann. Allergy Asthma Immunol. 2018;121:281–284. doi: 10.1016/j.anai.2018.05.035.
    1. O’Shea K.M., Aceves S.S., Dellon E.S., Gupta S.K., Spergel J.M., Furuta G.T., Rothenberg M.E. Pathophysiology of Eosinophilic Esophagitis. Gastroenterology. 2018;154:333–345. doi: 10.1053/j.gastro.2017.06.065.
    1. Votto M., Marseglia G.L., De Filippo M., Brambilla I., Caimmi S.M.E., Licari A. Early life risk factors in pediatric EoE: Could we prevent this modern disease? Front. Pediatr. 2020;8:263. doi: 10.3389/fped.2020.00263.
    1. World Health Organization (WHO) [(accessed on 28 November 2020)]; Available online: .
    1. Tambucci R., Quitadamo P., Ambrosi M., De Angelis P., Angelino G., Stagi S., Verrotti A., Staiano A., Farello G. Association between obesity/overweight and functional gastrointestinal disorders in children. J. Pediatr. Gastroenterol. Nutr. 2019;68:517–520. doi: 10.1097/MPG.0000000000002208.
    1. Fifi A.C., Velasco-Benitez C., Saps M. Functional abdominal pain and nutritional status of children. A school-based study. Nutrients. 2020;12:2559. doi: 10.3390/nu12092559.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G., PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009;339:e1000097. doi: 10.1136/bmj.b2535.
    1. Lee E.Y., Yoon K.H. Epidemic obesity in children and adolescents: Risk factors and prevention. Front Med. 2018;12:658–666. doi: 10.1007/s11684-018-0640-1.
    1. Umano G.R., Pistone C., Tondina E., Moiraghi A., Lauretta D., Miraglia Del Giudice E., Brambilla I. Pediatric obesity and the immune system. Front. Pediatr. 2019;7:487. doi: 10.3389/fped.2019.00487.
    1. Figueroa-Munoz J.I., Chinn S., Rona R.J. Association between obesity and asthma in 4-11-year-old children in the UK. Thorax. 2001;56:133–137. doi: 10.1136/thorax.56.2.133.
    1. Del Giudice M.M., Marseglia G.L., Leonardi S., Tosca M.A., Marseglia A., Perrone L., Ciprandi G. Fractional exhaled nitric oxide measurements in rhinitis and asthma in children. Int. J. Immunopathol. Pharmacol. 2011;24:29–32. doi: 10.1177/03946320110240S407.
    1. Chen Y.C., Dong G.H., Lin K.C., Lee Y.L. Gender difference of childhood overweight and obesity in predicting the risk of incident asthma: A systematic review and meta-analysis. Obes. Rev. 2013;14:222–231. doi: 10.1111/j.1467-789X.2012.01055.x.
    1. von Mutius E., Schwartz J., Neas L.M., Dockery D., Weiss S.T. Relation of body mass index to asthma and atopy in children: The National Health and Nutrition Examination Study III. Thorax. 2001;56:835–838. doi: 10.1136/thorax.56.11.835.
    1. Boulet L.P. Obesity and atopy. Clin. Exp. Allergy. 2015;45:75–86. doi: 10.1111/cea.12435.
    1. Zdanowicz K., Kucharska M., Sobaniec-Lotowska M.E., Lebensztejn D.M., Daniluk U. Eosinophilic Esophagitis in Children in North-Eastern Poland. J. Clin. Med. 2020;9:3869. doi: 10.3390/jcm9123869.
    1. Alexander R., Alexander J.A., Akambase J., Harmsen W.S., Geno D., Tholen C., Katzka D.A., Ravi K. Proton pump inhibitor therapy in eosinophilic esophagitis: Predictors of nonresponse. Dig. Dis. Sci. :2020. doi: 10.1007/s10620-020-06633-4.
    1. Jensen E.T., Huang K.Z., Chen H.X., Landes L.E., McConnell K.A., Almond M.A., Safta A.M., Johnston D.T., Durban R., Jobe L., et al. Longitudinal growth outcomes following first-line treatment for pediatric patients with eosinophilic esophagitis. J. Pediatr. Gastroenterol. Nutr. 2019;68:50–55. doi: 10.1097/MPG.0000000000002114.
    1. Kovačić M., Unić J., Mišak Z., Jadrešin O., Konjik V., Kolaček S., Hojsak I. One-year outcomes in children with eosinophilic esophagitis. Esophagus. 2019;16:162–167. doi: 10.1007/s10388-018-0647-3.
    1. Tanaka F., Fukumoto S., Morisaki T., Otani K., Hosomi S., Nagami Y., Kamata N., Taira K., Nakano A., Kimura T., et al. Obesity and hiatal hernia may be non-allergic risk factors for esophageal eosinophilia in Japanese adults. Esophagus. 2019;16:309–315. doi: 10.1007/s10388-019-00662-3.
    1. Mehta P., Furuta G.T., Brennan T., Henry M.L., Maune N.C., Sundaram S.S., Menard-Katcher C., Atkins D., Takurukura F., Giffen S., et al. Nutritional state and feeding behaviors of children with eosinophilic esophagitis and gastroesophageal reflux disease. J. Pediatr Gastroenterol. Nutr. 2018;66:603–608. doi: 10.1097/MPG.0000000000001741.
    1. Wolf W.A., Piazza N.A., Gebhart J.H., Rusin S., Covey S., Higgins L.L., Beitia R., Speck O., Woodward K., Cotton C.C., et al. Association between body mass index and clinical and endoscopic features of eosinophilic esophagitis. Dig. Dis. Sci. 2017;62:143–149. doi: 10.1007/s10620-016-4357-1.
    1. Lee Y.J., Redd M., Bayman L., Frederickson N., Valestin J., Schey R. Comparison of clinical features in patients with eosinophilic esophagitis living in an urban and rural environment. Dis. Esophagus. 2015;28:19–24. doi: 10.1111/dote.12164.
    1. Rezende E.R., Barros C.P., Ynoue L.H., Santos A.T., Pinto R.M., Segundo G.R. Clinical characteristics and sensitivity to food and inhalants among children with eosinophilic esophagitis. BMC Res. Notes. 2014;7:47.
    1. Licari A., Votto M., Scudeller L., De Silvestri A., Rebuffi C., Cianferoni A., Marseglia G.L. Epidemiology of nonesophageal eosinophilic gastrointestinal diseases in symptomatic patients: A systematic review and meta-analysis. J. Allergy Clin. Immunol. Pract. 2020;8:1994–2003. doi: 10.1016/j.jaip.2020.01.060.
    1. Silva F.M.C.E., Oliveira E.E., Ambrósio M.G.E., Ayupe M.C., Souza V.P., Gameiro J., Reis D.R.L., Machado M.A., Macedo G.C., Mattes J., et al. High-fat diet-induced obesity worsens TH2 immune response and immunopathologic characteristics in murine model of eosinophilic oesophagitis. Clin. Exp. Allergy. 2020;50:244–255. doi: 10.1111/cea.13533.
    1. Pensabene L., Salvatore S., D’Auria E., Parisi F., Concolino D., Borrelli O., Thapar N., Staiano A., Vandenplas Y., Saps M. Cow’s milk protein allergy in infancy: A risk factor for functional gastrointestinal disorders in children? Nutrients. 2019;10:1716. doi: 10.3390/nu10111716.
    1. Cheng E., Souza R.F., Spechler S.J. Eosinophilic esophagitis: Interactions with gastroesophageal reflux disease. Gastroenterol. Clin. N. Am. 2014;43:243–256. doi: 10.1016/j.gtc.2014.02.004.
    1. Tobey N.A., Hosseini S.S., Argote C.M., Dobrucali A.M., Awayda M.S., Orlando R.C. Dilated intercellular spaces and shunt permeability in nonerosive acid-damaged esophageal epithelium. Am. J. Gastroenterol. 2004;99:13–22. doi: 10.1046/j.1572-0241.2003.04018.x.
    1. Cao W., Cheng L., Behar J., Fiocchi C., Biancani P., Harnett K.M. Proinflammatory cytokines alter/reduce esophageal circular muscle contraction in experimental cat esophagitis. Am. J. Physiol. Gastrointest. Liver Physiol. 2004;287:1131–1139. doi: 10.1152/ajpgi.00216.2004.
    1. El-Serag H.B., Graham D.Y., Satia J.A., Rabeneck L. Obesity is an independent risk factor for GERD symptoms and erosive esophagitis. Am. J. Gastroenterol. 2005;100:1243–1250. doi: 10.1111/j.1572-0241.2005.41703.x.
    1. Vaishnav B., Bamanikar A., Maske P., Reddy A., Dasgupta S., Dasgupta S. Gastroesophageal reflux disease and its association with body mass index: Clinical and endoscopic study. J. Clin. Diagn. Res. 2017;11:OC01–OC04. doi: 10.7860/JCDR/2017/24151.9562.
    1. Nam S.Y., Choi I.J., Ryu K.H., Park B.J., Kim Y.-W., Kim H.B., Kim J. The effect of abdominal visceral fat, circulating inflammatory cytokines, and leptin levels on reflux esophagitis. J. Neurogastroenterol. Motil. 2015;21:247–254. doi: 10.5056/jnm14114.
    1. Lim H.-S., Kim S., Hong S.J. Food Elimination Diet and Nutritional Deficiency in Patients with Inflammatory Bowel Disease. Clin. Nutr. Res. 2018;7:48–55. doi: 10.7762/cnr.2018.7.1.48.
    1. Liacouras C.A., Spergel J., Gober L.M. Eosinophilic esophagitis: Clinical presentation in children. Gastroenterol. Clin. N. Am. 2014;43:219–229. doi: 10.1016/j.gtc.2014.02.012.
    1. Hoofien A., Dias J.A., Malamisura M., Rea F., Chong S., Oudshoorn J., Nijenhuis-Hendriks D., Otte S., Papadopoulou A., Romano C., et al. Pediatric Eosinophilic Esophagitis: Results of the European Retrospective Pediatric Eosinophilic Esophagitis Registry (RetroPEER) J. Pediatr. Gastroenterol. Nutr. 2019;68:552–558. doi: 10.1097/MPG.0000000000002215.
    1. Chehade M., Jones S.M., Pesek R.D., Burks A.W., Vickery B.P., Wood R.A., Leung D.Y., Furuta G.T., Fleischer D.M., Henning A.K., et al. Phenotypic Characterization of Eosinophilic Esophagitis in a Large Multicenter Patient Population from the Consortium for Food Allergy Research. J. Allergy Clin. Immunol. Pract. 2018;6:1534–1544. doi: 10.1016/j.jaip.2018.05.038.
    1. Alhmoud T., Hanson J.A., Parasher G. Eosinophilic Gastroenteritis: An Underdiagnosed Condition. Dig. Dis. Sci. 2016;61:2585–2592. doi: 10.1007/s10620-016-4203-5.
    1. Paquet B., Bégin P., Paradis L., Drouin E., Roches A.D. High rate of failure to thrive in a pediatric cohort with eosinophilic esophagitis. Ann. Allergy Asthma Immunol. 2016;116:73–74. doi: 10.1016/j.anai.2015.09.015.
    1. Colson D., Kalach N., Soulaines P., Vannerom Y., Campeotto F., Talbotec C., Chatenoud L., Hankard R., Dupont C. The impact of dietary therapy on clinical and biologic parameters of pediatric patients with eosinophilic esophagitis. J. Allergy Clin. Immunol. Pract. 2014;2:587–593. doi: 10.1016/j.jaip.2014.05.012.
    1. Spergel J.M., Brown-Whitehorn T.F., Beausoleil J.L., Franciosi J., Shuker M., Verma R., A Liacouras C. 14 years of eosinophilic esophagitis: Clinical features and prognosis. J. Pediatr. Gastroenterol. Nutr. 2009;48:30–36. doi: 10.1097/MPG.0b013e3181788282.
    1. Schoepfer A.M., Safroneeva E., Bussmann C., Kuchen T., Portmann S., Simon H.U., Straumann A. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology. 2013;145:1230–1236. doi: 10.1053/j.gastro.2013.08.015.
    1. Votto M., Castagnoli R., De Filippo M., Brambilla I., Cuppari C., Marseglia G.L., Licari A. Behavioral issues and quality of life in children with eosinophilic esophagitis. Minerva Pediatr. 2020;72:424–432. doi: 10.23736/S0026-4946.20.05913-7.
    1. Mehta H., Groetch M., Wang J. Growth and nutritional concerns in children with food allergy. Curr. Opin. Allergy Clin. Immunol. 2013;13:275–279. doi: 10.1097/ACI.0b013e328360949d.
    1. Wu Y.P., Franciosi J.P., Rothenberg M.E., Hommel K.A. Behavioral feeding problems and parenting stress in eosinophilic gastrointestinal disorders in children. Pediatr. Allergy Immunol. 2012;23:730–735. doi: 10.1111/j.1399-3038.2012.01340.x.
    1. Mukkada V.A., Haas A., Maune N.C., Capocelli K.E., Henry M., Gilman N., Petersburg S., Moore W., Lovell M.A., Fleischer D.M., et al. Feeding dysfunction in children with eosinophilic gastrointestinal diseases. Pediatrics. 2010;126:e672–e677. doi: 10.1542/peds.2009-2227.
    1. Pesek R.D., Reed C.C., Muir A.B., Fulkerson P.C., Menard-Katcher C., Falk G.W., Kuhl J., Martin E.K., Magier A.Z., Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR) et al. Increasing rates of diagnosis, substantial co-occurrence, and variable treatment patterns of eosinophilic gastritis, gastroenteritis, and colitis based on 10-year data across a multicenter consortium. Am. J. Gastroenterol. 2019;114:984–994. doi: 10.14309/ajg.0000000000000228.
    1. Capucilli P., Hill D.A. Allergic Comorbidity in Eosinophilic Esophagitis: Mechanistic Relevance and Clinical Implications. Clin. Rev. Allergy Immunol. 2019;57:111–127. doi: 10.1007/s12016-019-08733-0.
    1. Capucilli P., Cianferoni A., Grundmeier R.W., Spergel J.M. Comparison of comorbid diagnoses in children with and without eosinophilic esophagitis in a large population. Ann. Allergy Asthma Immunol. 2018;121:711–716. doi: 10.1016/j.anai.2018.08.022.
    1. Mailhot G., White J.H. Vitamin D and Immunity in Infants and Children. Nutrients. 2020;12:1233. doi: 10.3390/nu12051233.
    1. Slack M.A., Ogbogu P.U., Phillips G., Platts-Mills T.A., Erwin E.A. Serum vitamin D levels in a cohort of adult and pediatric patients with eosinophilic esophagitis. Ann. Allergy Asthma Immunol. 2015;115:45–50. doi: 10.1016/j.anai.2015.04.016.
    1. Linglart A., Rothenbuhler A., Adamsbaum C., Colson D., Soulaines P., Dupont C. The impact of pediatric eosinophilic esophagitis on bone metabolism. J. Allergy Clin. Immun. 2015;135:AB46. doi: 10.1016/j.jaci.2014.12.1077.
    1. Waterhouse K., Katta A., Teckman J., Foy T., Derdoy J., Jain A., Knutsen A., Becker B. Vitamin D levels in children with eosinophilic esophagitis and gastroesophageal reflux. J. Allergy Clin. Immun. 2011;127:AB107. doi: 10.1016/j.jaci.2010.12.430.
    1. Fissinger A., Mages K.C., Solomon A.B. Vitamin deficiencies in pediatric eosinophilic esophagitis: A systematic review. Pediatr. Allergy Immunol. 2020 doi: 10.1111/pai.13297.
    1. Noimark L., Cox H.E. Nutritional problems related to food allergy in childhood. Pediatr. Allergy Immunol. 2008;19:188–195. doi: 10.1111/j.1399-3038.2007.00700.x.
    1. Muir A.B., Brown-Whitehorn T., Godwin B., Cianferoni A. Eosinophilic esophagitis: Early diagnosis is the key. Clin. Exp. Gastroenterol. 2019;12:391–399. doi: 10.2147/CEG.S175061.
    1. Slack I.F., Schwartz J.T., Mukkada V.A., Hottinger S., Abonia J.P. Eosinophilic Esophagitis: Existing and Upcoming Therapies in an Age of Emerging Molecular and Personalized Medicine. Curr. Allergy Asthma Rep. 2020;20:30. doi: 10.1007/s11882-020-00928-2.
    1. Venkatesh R.D., Dellon E.S. This String’s Attached: The Esophageal String Test for Detecting Disease Activity in Eosinophilic Esophagitis. Gastroenterology. 2020 doi: 10.1053/j.gastro.2020.09.034.
    1. Walker M.M., Potter M., Talley N.J. Eosinophilic gastroenteritis and other eosinophilic gut diseases distal to the oesophagus. Lancet Gastroenterol. Hepatol. 2018;4:271–280. doi: 10.1016/S2468-1253(18)30005-0.
    1. Cotton C.C., Eluri S., Wolf W.A., Dellon E.S. Six-food elimination diet and topical steroids are effective for eosinophilic esophagitis: A meta-regression. Dig. Dis. Sci. 2017;62:2408–2420. doi: 10.1007/s10620-017-4642-7.
    1. Licari A., Castagnoli R., Marseglia A., Olivero F., Votto M., Ciprandi G., Marseglia G.L. Dupilumab to Treat Type 2 Inflammatory Diseases in Children and Adolescents. Paediatr. Drugs. 2020;22:295–310. doi: 10.1007/s40272-020-00387-2.

Source: PubMed

3
Prenumerera