APPSPGHAN 2022

Ichiro Nomura

Chief, Division of Eosinophilic Gastrointestinal Disorders, National Research Institute for Child Health and Development

Japan

Major Research Interest:

Eosinophilic Gastrointestinal Disorders
Non-IgE-mediated gastrointestinal food allergy
Hypereosinophilic syndrome
Severe-protein-loss in atopic dermatitis
Pediatric Allergy

Academy Memberships

American Achademy of Asthma, Allergy and Immunology
Japanese Allergology Society - 1993
Japanese Pediatric Society - 1986

Honors and Awards

Ichiro Nomura as a research representative, 2010-2022; Health and Labor Sciences Research Grants, Research on intractable diseases from Ministry of Health, Labor and Welfare in Japan
Ichiro Nomura as one of “the Best Doctors in Japan” 2012-2022.
The 2018 AAAAI/APFED (American partnership for Eosinophilic Disorders) Best Abstracts on EGIDs, Ichiro Nomura, MD PhD.
Ichiro Nomura as a research representative, 2007-2009, Grant-in-Aid for Clinical Research from the National Hospital Organization in Japan
Ichiro Nomura as a research representative, 2007, Grant-in-Aid for Clinical Research from the National Center Network for Child Health and Development in Japan
2003, American Achademy of Asthma, Allergy and Immunology, Sepracor Research Excellence Awards.

EGIDs in Asian children: Are they uncommon, or are we missing them?

Gastro Symposium : Potpourri of GI disorders

13 October 2022 (1100-1300) @ Sipadan Hall 1

Eosinophilic gastrointestinal disorders (EGIDs) are chronic inflammatory gastrointestinal disorders characterized by marked accumulation of eosinophils in the GI mucosa. EGIDs can be divided into two main groups: eosinophilic esophagitis (EoE) and non-EoE-EGIDs. In EoE, inflammation is confined to the esophagus only, while in non-EoE-EGIDs, inflammation may be present anywhere in the stomach, small intestine, or colon. In Europe and the U.S., EoE patients are far more common than non-EoE-EGID patients, and some have severe disease. EoE is being studied in depth. For this reason, EoE is clearly perceived as a more important disease than non-EoE-EGIDs.

A few population-based studies have been conducted in Asia, but unlike in Europe and the U.S., most of them seem to be focused on non-EoE-EGIDs. We conducted a nationwide survey in Japan and found more non-EoE-EGID cases than EoE cases (Yamamoto M et al., J Allergy Clin Immunol Pract 2021). In terms of age of onset, EoE was concentrated in middle age and later, while childhood-onset EoE was very rare. On the other hand, non-EoE-EGIDs were common in children, and the decline in quality of life was more severe than in EoE patients.

We know that the various sections of the gastrointestinal tract have very different, specialized functions. The stomach and duodenum digest food and the small intestine then absorbs the important nutrients. Finally, the large intestine absorbs water. When those functions are compromised, the impact on the human body will be greater than when just the esophagus is compromised.

Treatment of childhood EoE in Japan is not very difficult. PPIs and oral budesonide are often sufficient. Non-EoE-EGIDs, on the other hand, require systemic steroids. Significant use of systemic steroids over several months often leads to short stature, Cushing's syndrome, diabetes, osteoporosis, and depression. Dietary therapy may help prevent or mitigate those undesirable outcomes.

Another important medical issue in Japan is non-IgE-mediated gastrointestinal allergies in newborns and infants. I really want to learn about the situation in Malaysia and the other Asia-Pacific Countries in regard to EoE and non-EoE-EGIDs and also non-IgE-mediated gastrointestinal allergies in neonates and infants.

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