Caracterización y manejo de los pacientes con esofagitis eosinofílica en el Hospital Nacional de Niños, “Dr. Carlos Sáenz Herrera” del 1 de enero del 2019 al 31 de diciembre del 2024
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Abstract
Introducción. La Esofagitis Eosinofílica (EoE) es una patología crónica, mediada principalmente por el sistema inmune, caracterizada por sintomatología de disfunción esofágica, inflamación e infiltración eosinofílica. El diagnóstico es histológico y se hace con un conteo igual o mayor a 15 eosinófilos por campo de alto poder. El tratamiento se basa en esteroides deglutidos, inhibidores de bomba de protones o dieta. Recientemente, se ha evidenciado el impacto positivo que ha tenido el uso del anticuerpo monoclonal en el control de la enfermedad. Este es el primer estudio retrospectivo en niños en Costa Rica.
Objetivo. Describir las características demográficas, clínicas, endoscópicas e histológicas y el tratamiento utilizado en los pacientes con Esofagitis Eosinofílica en el Hospital Nacional de Niños, del 1 de enero de 2019 al 31 de diciembre del 2024.
Metodología. Se trata de un estudio descriptivo y retrospectivo. Para el análisis de datos la información se recolectó en Excel (versión 16.101.1) y se analizó con R 4.5.1(R Core Team, 2025).
Resultados. Se analizaron 39 pacientes, de ellos, 26 (66.6 %) eran del sexo masculino y 22 (56.4 %) provenían de San José. Solamente 9 (23 %) niños, se presentaron con desnutrición al momento del diagnóstico. Los antecedentes personales patológicos más prevalentes fueron asma y rinitis, en 20 (51.3 %) de la totalidad de los pacientes; n=12 (30.8 %) padecían ambas enfermedades. En casi la mitad de los casos estudiados, n=19 (48.7 %), se presentó, como síntoma más predominante, el reflujo gastroesofágico. La endoscopía inicial fue macroscópicamente normal en 6 (15.4 %) niños. Se observó que el hallazgo endoscópico predominante fue la presencia de surcos longitudinales en 27 (69.2 %) de los 39 casos totales. A 37 (95 %) niños se les hizo el diagnóstico con las biopsias de esófago distal. El manejo inicial, en la mayoría de los pacientes n=23 (60.5 %), fue la dieta de exclusión e IBP. En 35 (87.5 %) pacientes se encontró la primera biopsia control y solo n=17 (48.57 %) hicieron remisión con el tratamiento inicial.
Conclusión. La EoE es una enfermedad que ha evolucionado en el diagnóstico y tratamiento en los últimos años. Se debe tomar en cuenta que no siempre hay alteraciones en la endoscopía inicial, pero sí cambios a nivel histológico. Las opciones terapéuticas utilizadas al momento del diagnóstico solo alcanzaron remisión en menos del 50 % de los pacientes estudiados. Por lo anterior, es necesario crear un lineamiento de manejo institucional, basado en las guías internacionales, con el objetivo de lograr que los pacientes alcancen la remisión.
Introduction. Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by symptoms of esophageal dysfunction, inflammation, and eosinophilic infiltration. The diagnosis is histological, established by a count of 15 or more eosinophils per high-power field. Treatment is based on swallowed viscous steroids, proton pump inhibitors, or elimination diet. Recently, the positive impact of monoclonal antibody use on disease control has been demonstrated. This is the first retrospective study in children in Costa Rica. Aim. To describe the demographic, clinical, endoscopic and histological characteristics, and the treatment used in patients with eosinophilic esophagitis at the National Children’s Hospital, from January 1, 2019, to December 31, 2024. Methods. This is a descriptive, retrospective study. For data analysis, information was collected in Excel version 16.101.1 and analyzed with R 4.5.1(R Core Team, 2025). Results. Thirty-nine patients were analyzed, 26 (66.6 %) of whom were male and 22 (56.4 %) came from San José. Only 9 (23 %) children were malnourished at the time of diagnosis. The most prevalent past medical history was asthma and rhinitis, each found in 20 (51.3 %) patients, 12 children had both. In nearly half of the cases studied, n=19 (48.7 %), the predominant symptom was gastroesophageal reflux. The initial endoscopy was macroscopically normal in 6 (15.4 %) patients. The most frequent endoscopic finding was the presence of longitudinal furrows in 27 (69.2 %) of the 39 patients. In 37 (95 %) children, the diagnosis was made with distal esophageal biopsies. The initial management for most patients, n=23 (59 %) was an elimination diet and a PPI. In 35 (89.7 %) patients, the first follow up biopsy was documented, and among these, only 17 (48.6 %) achieved remission with the initial treatment. Conclusion. EoE is a disease that has evolved in both diagnosis and treatment in recent years. It is important to highlight that the endoscopy could be normal, although histological changes are present. The therapeutic options used at the time of diagnosis achieved remission in less than 50% of the studied patients. Therefore, it is necessary to establish an institutional management protocol based on international guidelines to help patients achieve remission.
Introduction. Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease characterized by symptoms of esophageal dysfunction, inflammation, and eosinophilic infiltration. The diagnosis is histological, established by a count of 15 or more eosinophils per high-power field. Treatment is based on swallowed viscous steroids, proton pump inhibitors, or elimination diet. Recently, the positive impact of monoclonal antibody use on disease control has been demonstrated. This is the first retrospective study in children in Costa Rica. Aim. To describe the demographic, clinical, endoscopic and histological characteristics, and the treatment used in patients with eosinophilic esophagitis at the National Children’s Hospital, from January 1, 2019, to December 31, 2024. Methods. This is a descriptive, retrospective study. For data analysis, information was collected in Excel version 16.101.1 and analyzed with R 4.5.1(R Core Team, 2025). Results. Thirty-nine patients were analyzed, 26 (66.6 %) of whom were male and 22 (56.4 %) came from San José. Only 9 (23 %) children were malnourished at the time of diagnosis. The most prevalent past medical history was asthma and rhinitis, each found in 20 (51.3 %) patients, 12 children had both. In nearly half of the cases studied, n=19 (48.7 %), the predominant symptom was gastroesophageal reflux. The initial endoscopy was macroscopically normal in 6 (15.4 %) patients. The most frequent endoscopic finding was the presence of longitudinal furrows in 27 (69.2 %) of the 39 patients. In 37 (95 %) children, the diagnosis was made with distal esophageal biopsies. The initial management for most patients, n=23 (59 %) was an elimination diet and a PPI. In 35 (89.7 %) patients, the first follow up biopsy was documented, and among these, only 17 (48.6 %) achieved remission with the initial treatment. Conclusion. EoE is a disease that has evolved in both diagnosis and treatment in recent years. It is important to highlight that the endoscopy could be normal, although histological changes are present. The therapeutic options used at the time of diagnosis achieved remission in less than 50% of the studied patients. Therefore, it is necessary to establish an institutional management protocol based on international guidelines to help patients achieve remission.
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Keywords
Esofagitis eosinofilica, disfagia, pediatría