Skip to main content

Advertisement

SpringerLink
Log in

Oesophageal wall thickness assessment at endoscopic ultrasound in children and adolescents with eosinophilic oesophagitis: a case–control study

  • Original Paper
  • Published:
Journal of Ultrasound Aims and scope Submit manuscript

Abstract

Purpose

Eosinophilic oesophagitis (EoE) is a chronic immune-mediated disease, and an endosonographic evaluation may help the diagnosis. The main objectives of this study were to measure the thickness of the oesophageal wall using a radial endoscopic ultrasound (EUS), mucosa/submucosa (MSM), muscularis propria (MP) and mucosa to muscularis propria (MMP); to compare these measurements between patients with and without EoE; to correlate them with the Endoscopic Reference Score (EREFS); and to evaluate the diagnostic accuracy of these measurements.

Methods

Children and adolescents (aging from 4 to 17 years) were evaluated in this prospective cross-sectional study. A radial EUS at 12 MHz frequency was used, and EREFS was employed to grade macroscopic findings. Accuracy of the measurements for the diagnosis of EoE was assessed by receiver operating characteristics (ROC) curve.

Results

Twenty-six (19 M/7 F) patients (median age 10.83 years, range 5.65–17.46) were evaluated. EoE was diagnosed in 6 patients. The mean (and SD) oesophageal wall thicknesses in the distal oesophagus in millimetres in groups with and without EoE, respectively, were: MSM 1.07 (0.44) and 1.11 (0.33); MP 0.67 (0.25) and 0.60 (0.19); and MMP 1.73 (0.46) and 1.72 (0.32). Mid-oesophagus: MSM 1.16 (0.34) and 1.15 (0.34); MP 0.63 (0.16) and 0.60 (0.2); and MMP 1.79 (0.41) and 1.74 (0.34). In the ROC curve, the distal MP layer thickness presented better discriminative performance, with an area under the curve of 0.61 (95% CI 0.28–0.93) at 0.73 mm cut-off (66.67% sensitivity, 80% specificity, likelihood ratios of 3.33 for positive and 0.42 for negative test).

Conclusion

The evaluation of oesophageal thickness measurements by EUS is not useful for diagnosing EoE.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Arias Á, Pérez-Martínez I, Tenías JM, Lucendo AJ (2016) Systematic review with meta-analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 43(1):3–15. https://doi.org/10.1111/apt.13441

    Article  CAS  PubMed  Google Scholar 

  2. Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N et al (2018) Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology 155(4):1022-1033.e10. https://doi.org/10.1053/j.gastro.2018.07.009

    Article  PubMed  Google Scholar 

  3. Nhu QM, Aceves SS (2018) Medical and dietary management of eosinophilic esophagitis. Ann Allergy Asthma Immunol 121(2):156–161. https://doi.org/10.1016/j.anai.2018.05.006

    Article  CAS  PubMed  Google Scholar 

  4. Dellon ES, Katzka DA, Collins MH, Gupta SK, Lan L, Williams J et al (2019) Efficacy of budesonide oral suspension maintenance therapy in patients with eosinophilic esophagitis. Clin Gastroenterol Hepatol 17(4):666-673.e8. https://doi.org/10.1016/j.cgh.2018.05.051

    Article  CAS  PubMed  Google Scholar 

  5. Vieira GG, Ribeiro LBM, Truppel SK, Rosário Filho NA, Vieira MC (2020) Endoscopic and histological characteristics in patients with eosinophilic esophagitis responsive and non-responsive to proton pump inhibitors. J Pediatr (Rio J) 96(5):638–643. https://doi.org/10.1016/j.jped.2019.05.005

    Article  PubMed  Google Scholar 

  6. Dellon ES, Liacouras CA (2014) Advances in clinical management of eosinophilic esophagitis. Gastroenterology 147(6):1238–1254. https://doi.org/10.1053/j.gastro.2014.07.055

    Article  PubMed  Google Scholar 

  7. Navarro P, Arias Á, Arias-González L, Laserna-Mendieta EJ, Ruiz-Ponce M, Lucendo AJ (2019) Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 49(9):1116–1125. https://doi.org/10.1111/apt.15231

    Article  PubMed  Google Scholar 

  8. Guarino MP, Cicala M, Behar J (2016) Eosinophilic esophagitis: new insights in pathogenesis and therapy. World J Gastrointest Pharmacol Ther 7(1):66–77. https://doi.org/10.4292/wjgpt.v7.i1.66

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gomez Torrijos E, Gonzalez-Mendiola R, Alvarado M, Avila R, Prieto-Garcia A, Valbuena T et al (2018) Eosinophilic esophagitis: review and update. Front Med (Lausanne) 5:247. https://doi.org/10.3389/fmed.2018.00247

    Article  PubMed  Google Scholar 

  10. Lim AH, Wong S, Nguyen NQ (2021) Eosinophilic esophagitis and IgG4: is there a relationship? Digest Dis Sci 66:4099–4108. https://doi.org/10.1007/s10620-020-06788-0

    Article  CAS  PubMed  Google Scholar 

  11. Muir A, Falk GW (2021) Eosinophilic esophagitis: a review. JAMA 326(13):1310–1318. https://doi.org/10.1001/jama.2021.14920

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Schoepfer AM, Straumann A, Safroneeva E (2018) Pharmacologic treatment of eosinophilic esophagitis: an update. Gastrointest Endosc Clin N Am 28(1):77–88. https://doi.org/10.1016/j.giec.2017.07.007

    Article  PubMed  Google Scholar 

  13. Dunn JLM, Shoda T, Caldwell JM, Wen T, Aceves SS, Collins MH et al (2020) Consortium of Eosinophilic Gastrointestinal Disease Researchers (CEGIR). Esophageal type 2 cytokine expression heterogeneity in eosinophilic esophagitis in a multisite cohort. J Allergy Clin Immunol 145(6):1629-1640.e4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Hirano I (2018) Future directions in eosinophilic esophagitis. Gastrointest Endosc Clin N Am 28(1):111–122. https://doi.org/10.1016/j.giec.2017.07.010

    Article  PubMed  Google Scholar 

  15. Kinoshita Y, Ishimura N, Oshima N, Ishihara S (2015) Systematic review: eosinophilic esophagitis in Asian countries. World J Gastroenterol 21(27):8433–8440. https://doi.org/10.1016/j.jaci.2020.01.051

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kim HP, Vance RB, Shaheen NJ, Dellon ES (2012) The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol 10(9):988–96.e5. https://doi.org/10.1016/j.cgh.2012.04.019

    Article  PubMed  PubMed Central  Google Scholar 

  17. Papadopoulou A, Koletzko S, Heuschkel R, Dias JA, Allen KJ, Murch SH et al (2014) Committee. Management guidelines of eosinophilic esophagitis in childhood. J Pediatr Gastroenterol Nutr 58(1):107–118. https://doi.org/10.1097/MPG.0b013e3182a80be1

    Article  CAS  PubMed  Google Scholar 

  18. Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR (2013) Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 62(4):489–495. https://doi.org/10.1136/gutjnl-2011-301817

    Article  CAS  PubMed  Google Scholar 

  19. Muir AB, Merves J, Liacouras CA (2016) Role of endoscopy in diagnosis and management of pediatric eosinophilic esophagitis. Gastrointest Endosc Clin N Am 26(1):187–200. https://doi.org/10.1016/j.giec.2015.08.006

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kia L, Hirano I (2016) Advances in the endoscopic evaluation of eosinophilic esophagitis. Curr Opin Gastroenterol 32(4):325–331. https://doi.org/10.1097/MOG.0000000000000278

    Article  PubMed  PubMed Central  Google Scholar 

  21. Alexander JA, Ravi K, Geno DM, Tholen CJ, Higginbotham TC, Wildhorn S et al (2019) Comparison of mucosal impedance measurements throughout the esophagus and mucosal eosinophil counts in endoscopic biopsy specimens in eosinophilic esophagitis. Gastrointest Endosc 89(4):693-700.e1. https://doi.org/10.1016/j.gie.2018.08.031

    Article  PubMed  Google Scholar 

  22. Lakhole A, Liu QY (2016) Role of endoscopic ultrasound in pediatric disease. Gastrointest Endosc Clin N Am 26(1):137–153. https://doi.org/10.1016/j.giec.2015.08.001

    Article  PubMed  Google Scholar 

  23. Ari A, Morgenstern S, Chodick G, Matar M, Silbermintz A, Assa A et al (2017) Oesophageal eosinophilia in children with coeliac disease. Arch Dis Child 102(9):825–829. https://doi.org/10.1136/archdischild-2016-311944

    Article  PubMed  Google Scholar 

  24. Patton T, Chugh A, Padhye L, DeGeeter C, Guandalini S (2019) Pediatric celiac disease and eosinophilic esophagitis: outcome of dietary therapy. J Pediatr Gastroenterol Nutr 69(2):e43–e48. https://doi.org/10.1097/MPG.0000000000002343

    Article  PubMed  Google Scholar 

  25. Fox VL, Nurko S, Teitelbaum JE, Badizadegan K, Furuta GT (2003) High-resolution EUS in children with eosinophilic “allergic” esophagitis. Gastrointest Endosc 57(1):30–36. https://doi.org/10.1067/mge.2003.33

    Article  PubMed  Google Scholar 

  26. Dalby K, Nielsen RG, Kruse-Andersen S, Fenger C, Durup J, Husby S (2010) Gastroesophageal reflux disease and eosinophilic esophagitis in infants and children. A study of esophageal pH, multiple intraluminal impedance and endoscopic ultrasound. Scand J Gastroenterol 45(9):1029–1035. https://doi.org/10.3109/00365521.2010.487917

    Article  PubMed  Google Scholar 

  27. Rabinowitz SS, Grossman E, Feng L, Ebigbo N, Lin B, Gupta R et al (2020) Predicting pediatric esophageal wall thickness: an EUS study. Endosc Ultrasound 9(4):259–266. https://doi.org/10.4103/eus.eus_15_20

    Article  PubMed  PubMed Central  Google Scholar 

  28. Lucendo AJ, Molina-Infante J, Arias Á, von Arnim U, Bredenoord AJ, Bussmann C et al (2017) Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United Eur Gastroenterol J 5(3):335–358. https://doi.org/10.1177/2050640616689525

    Article  Google Scholar 

  29. Ahuja N, Weedon J, Schwarz SM, Sklar R, Rabinowitz SS (2020) Applying the eosinophilic esophagitis endoscopic reference scores (EREFS) to different aged children. J Pediatr Gastroenterol Nutr 71(3):328–332. https://doi.org/10.1097/MPG.0000000000002788

    Article  PubMed  Google Scholar 

  30. Schreiber-Dietrich D, Hocke M, Braden B, Carrara S, Gottschalk U, Dietrich C (2019) Pediatric endoscopy, update 2020. Appl Sci 9(23):5036. https://doi.org/10.3390/app9235036

    Article  Google Scholar 

  31. Pierre R, Vieira M, Vázquez R, Ninomiya I, Messere G, Daza W et al (2019) Prevalence of eosinophilic esophagitis: A multicenter study on a pediatric population evaluated at thirty-six Latin American gastroenterology centers. Prevalencia de esofagitis eosinofílica: estudio multicéntrico en población pediátrica evaluada en 36 centros de gastroenterología de América Latina. Rev Gastroenterol Mex (Engl Ed) 84(4):427–433. https://doi.org/10.1016/j.rgmx.2018.08.001

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The study did not receive any funding.

Author information

Authors and Affiliations

  1. Pediatric Gastroenterology Division, Department of Pediatrics, Escola Paulista de Medicina/Universidade Federal de São Paulo, Rua dos Otonis 839, Vila Clementino, São Paulo, 04025-002, Brazil

    Regis Schander Ferrelli, Rodrigo Strehl Machado & Silvio Kazuo Ogata

Authors
  1. Regis Schander Ferrelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rodrigo Strehl Machado
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Silvio Kazuo Ogata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Regis Schander Ferrelli.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ferrelli, R.S., Machado, R.S. & Ogata, S.K. Oesophageal wall thickness assessment at endoscopic ultrasound in children and adolescents with eosinophilic oesophagitis: a case–control study. J Ultrasound 26, 785–791 (2023). https://doi.org/10.1007/s40477-022-00742-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40477-022-00742-8

Keywords

Search

Navigation