They evaluate the potential sequence of treatment for eosinophilic esophagitis in children and adolescents.

This pathology causes chronic inflammation of the esophagus, which significantly affects the patient's quality of life.

They evaluated possible treatment sequences for eosinophilic esophagitis in children and adolescents.

This pathology produces chronic inflammation of the esophagus, which has a great impact on the patient's quality of life.

In just two decades, it has gone from being a rare disease to being the leading cause of swallowing difficulties in children and adolescents.We are talking about eosinophilic esophagitis, a chronic inflammation of the esophagus mediated by immunological mechanisms that is estimated to affect thousands of people in our country.

Now we have good news for these patients, since the pediatric nutrition research group of the Incliva Health Research Center, Hospital of the University of Valencia, has conducted an evaluation of all the possible methods of treatment for eosinophilic esophagitis in children and adolescents, to suggest the most effective in each case, considering their clinical economic cost.

The interest in doing this work arose because of the presence of many potential first-line treatment options, both pharmacological and dietary.This includes the recent extension of dupilumab in children with eosinophilic esophagitis (European Medicines Agency) and the fact that some patients do not respond to therapeutic modalities;According to the currently available evidence, it is mainly used as monotherapy.

The authors of the work, recently published in the Journal of Pediatric Gastroenterology and Nutrition, led by Dr. Martínez Costa, Dr. Cecilia Martínez Costa, professor of pediatrics at the University of Valencia, and coordinator of the study.

Unknown, but on the rise

Eosinophilic esophagitis leads to chronic, sometimes progressive, inflammation of the esophagus and produces symptoms due to problems with the passage of food from the mouth to the stomach.In other words, this disease has two peaks of incidence: on the one hand in school age and adolescence, and on the other hand in younger adults, especially men, although it can occur at any age.

In this context, a recent meta-analysis estimated its global incidence at 5.3 new cases per 100,000 population per year, although it is particularly high in the Iberian Peninsula, where it reaches 10 new cases per 100,000 population per year in children under 15 years of age.

Numerous studies estimate a non-negligible impact on the quality of life of patients with eosinophilic esophagitis in both adults and children and their caregivers.This is due not only to the activity of the disease and the symptoms it produces, but also to problems arising from treatments, especially elimination diets, which tend to produce exhaustion in the patient and, even when effective, can be difficult to maintain in the long term.

Current management guidelines for this pathology suggest three possible treatments, all considered first-line: proton pump inhibitors, empiric food elimination diets, and topical corticosteroids, to promote local drug action on the esophageal mucosa in the latter's viscous formations.

Dupilumb is approved for use in children older than one year after the authorization of this disease or a review of the dialogue (2025).

In a significant number of patients with pediatric eosinophilic esophagitis, there is no medical indication for initiating treatment with any of these specific options, nor is there usually a clear patient preference for any of them.Furthermore, some patients may not respond to the initial treatment and must be treated with another alternative.

In this context, the aim of the study conducted by the Department of Gastroenterology, Hepatology and Pediatric Nutrition was, in the event of continued failure of induction attempts, what would be the most effective sequence of treatment considering its economic cost and clinical effectiveness.This is an economic evaluation study based on computer models whose evaluation is an in-depth systematic review of the best evidence available in the medical manual, while simultaneously using an artificial intelligence-assisted search.

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