嗜酸性粒细胞性食管炎

嗜酸性粒细胞性食管炎是一种免疫/抗原介导的慢性食管炎症,以食管黏膜嗜酸性粒细胞浸润为主及食管功能障碍相关症状为临床病理特点.其发病机制尚未明确,普遍认为系由IgE和非IgE联合介导引起的变态反应.其诊断主要依据典型的临床表现及食管组织病理学改变,并排除胃食管反流病(gastroesophageal reflux disease,GRED)及其他可引起食管黏膜嗜酸性粒细胞浸润等疾病.其治疗方法主要包括饮食调节、药物治疗、食管扩张等.     

Eosinophilic esophagitis

Since Kelly's article appeared in press in 1995, EoE has become an increasingly recognized body. While isolated case reports suggesting EoE have been printed in the adult literature since 1977, many more reports have been published in the pediatric literature over the past 7 years. Recently, [table: see text] several excellent reviews have been written on the subject of EoE [2,25,59,60]. These reviews coupled with the past reports and increasing incidence of EoE provide a sound background for further research on the etiology, epidemiology and treatment of EoE.     

Eosinophilic esophagitis

Eosinophilic esophagitis is increasingly recognized in adults. The diagnosis is based on the presence of both typical symptoms and pathologic findings on esophageal biopsy. Patients usually present with dysphagia, food impaction and/or reflux-like symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power field. In addition, it is essential to exclude the presence of known causes of tissue eosinophilia such as gastroesophageal reflux disease, infections, malignancy, collagen vascular diseases, hypersensitivity, and inflammatory bowel disease. There are no standardized protocols for the therapy of eosinophilic esophagitis. A variety of therapeutic approaches including acid suppression, dietary modifications, topical corticosteroids and endoscopic dilation can be used alone or in combination.     

Eosinophilic esophagitis

BackgroundEsophagitis is an increasingly diagnosed disease. Patients with gastroesophagic reflux, dysphagia, vomiting or abdominal pain, with a torpid response to the treatment, could be suffering from it.Material and methodsA 37 year-old male patient with background of gastroesophagic reflux and dysphagia for solids since 2002, self-limited diarrhea episodes and intolerance to alcoholic drinks due to epigastric pain. Skin prick tests, specific IgE, histamine release test and basophil activation test were carried out.ResultsSkin prick test to the usual allergens with negative result; prick-prick tests to egg white and yolk, milk and apple with positive result to egg white; total serum IgE within normal levels, specific IgE to egg white with positive result; histamine release test (HRT) and basophil activation test (BAT) with positive result to egg white and yolk.ConclusionThe patient was diagnosed eosinophilic esophagitis. The commercial food extracts have a great variability in their allergenic composition, which could result in false negative results in the prick test. Prick-prick with the natural food is a more sensitive technique than prick in the diagnosis of food allergy. There are other useful in vitro techniques, apart from specific IgE, in the diagnosis of food allergy. In our case, an exclusion diet of the involved food was more effective than other treatments for remission of the symptoms.     

Eosinophilic esophagitis in adults

Eosinophilic esophagitis in adults is a disease characterized by eosinophilic infiltration of the esophageal mucosa and symptoms of long-standing solid food dysphagia and food impactions. First described in 1978, this syndrome is being recognized increasingly in the developed world, with multiple case series reported from the United States, Europe, and Australia during the past decade. Diagnosis requires the presence of greater than or equal to 15 eosinophils/high-power field on esophageal biopsies. Successful treatment in adults has been reported with the use of systemic and topical swallowed steroids. Endoscopic treatment has been associated with increased an risk for tears and perforations.     

Eosinophilic esophagitis]

Eosinophilic esophagitis (EE) is characterized by eosinophilic infiltration of the esophageal wall including mucosa, submucosa, and muscle proper. EE is a condition involving both pediatrics and adults. Patients with EE are predominantly young males, commonly related to atopy. The typical clinical presentation includes dysphasia, food impaction, and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination reveals mucosal fragility, ring or corrugated mucosa, whitish plaques, or small caliber esophagus. Histologic finding of >20 eosinophils/HPF (high power field) is the diagnostic hallmark of EE. Elemental formula, systemic or topical corticosteroid, anti-inflammatory drugs such as leukotriene receptor antagonists, anti-interleukin (IL)-5, and anti-IL-13 monoclonal antibodies have been used to manage EE. Esophageal dilation is considered in adult patients with severe obstructive symptoms due to stricture.     

Eosinophilic esophagitis-like endoscopic findings in patients with erosive esophagitis

Background

Eosinophilic esophagitis (EoE) is diagnosed on the basis of the presence of dysphagia and intraepithelial eosinophilic infiltration of ≥15 cells per high-power field; nevertheless, it is important to identify the endoscopic findings of EoE in general practice. EoE should be distinguished from gastroesophageal reflux disease (GERD); however, the associations between EoE and GERD are controversial. Herein, we aimed to determine the prevalence of EoE-like endoscopic findings and associations between an EoE-like endoscopic appearance and erosive esophagitis.

Methods

Prospective endoscopic examination was performed in 804 consecutive cases. Cases with EoE-like endoscopic findings such as furrows, rings, white exudate, stricture, and mucosal tearing were examined by esophageal biopsy. Erosive esophagitis, hiatal hernia, atrophic gastritis, and gastroesophageal flap valve were assessed endoscopically, and clinical data, including age, gender, smoking and drinking habits, and presence of allergic diseases and symptoms such as dysphagia and heartburn, were analyzed.

Results

Of the 804 cases, 36 (4.5 %) showed an EoE-like endoscopic appearance, and 80 (10 %) had erosive esophagitis. Among the 36 cases with an EoE-like appearance, only 4 (0.5 %) showed significant esophageal eosinophilic infiltration with erosive esophagitis in 3 cases. Further, 28 % of the patients with erosive esophagitis had an EoE-like endoscopic appearance, while 61 % of those with an EoE-like endoscopic appearance had erosive esophagitis. There were no significant differences between the clinical characteristics and other endoscopic findings in cases of an EoE-like endoscopic appearance and erosive esophagitis.

Conclusion

Erosive esophagitis and an EoE-like endoscopic appearance frequently showed overlapping features; thus, we believe they might have common pathogenic factors.     

Eosinophilic esophagitis investigated by upper gastrointestinal endoscopy in Japanese patients

Background  

The prevalence of eosinophilic esophagitis (EE) is increasing rapidly in Western countries. Several case series of EE have also been reported in Japan. However, the prevalence of EE in Japanese patients as investigated by upper gastrointestinal endoscopy is unknown. Therefore, we carried out a prospective multicenter study to address this issue.     

Eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia

Esophageal atresia (EA) is defined as a discontinuity of the lumen of the esophagus repaired soon after birth. Dysphagia is a common symptom in these patients, usually related to stricture, dysmotility or peptic esophagitis. We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of Eosinophilic esophagitis (EoE) was made, ages ranging from 9 to 16 years. Although our patients were on acid suppression years after their EA repair, they presented with acute worsening of dysphagia. Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with EoE. Two of 4 patients improved symptomatically with the topical steroids. It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies. One of our patients developed recurrent anastomotic strictures that improved with the treatment of the EoE. A previous case report linked the recurrence of esophageal strictures in patients with EA repair with EoE. Once the EoE was treated the strictures resolved. On the other hand, based on our observation, EoE could be present in patients without recurrent anastomotic strictures. There appears to be a spectrum in the disease process. We are suggesting that EoE is a frequent concomitant problem in patients with history of congenital esophageal deformities, and for this reason any of these patients with refractory reflux symptoms or dysphagia (with or without anastomotic stricture) may benefit from an endoscopic evaluation with biopsies to rule out EoE.     

Eosinophilic esophagitis: update 2012

Eosinophilic esophagitis (EoE) with adults, as a new disease emerging during the last decade, is a clinicopathologic disorder of the esophagus characterized by a dense esophageal eosinophilic infiltration and typical esophageal symptoms. As numerous studies about EoE had been reported during last several years, updated consensus of EoE was reported in July 2011. The conceptual definition of EoE is coming. EoE is defined as a chronic, immune/antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominat inflammation. Other important addition is genotyping feature that implicates thymic stromal lymphopoietin genes or filagrrin as EoE susceptibility genes. The majority of patients has the concurrent allergic disease, especially food or aeroallergen sensitization. Main therapeutic options include topical steroids and dietary modification. Recent issues of EoE include a new concept for proton pump inhibitor-responsive esophageal eosinophilia that it should be excluded to diagnose EoE.     

Eosinophilic esophagitis: an update

Eosinophilic esophagitis (EE) is a disease that is being recognized with increasing frequency. In children it is responsible for feeding disorders, vomiting, reflux symptoms and abdominal pain and in adults it causes dysphagia and esophageal food impactions. The diagnosis requires the histologic finding of > 20 eosinophils per high powered field in esophageal squamous mucosa. The most common treatment regimens in children and adults involve the ingestion of topical corticosteroids. Symptomatic relapse after one treatment course is common, and many patients require repeated courses of treatment. The long-term prognosis of EE is largely unknown.     

Eosinophilic esophagitis in children with celiac disease

Background and Aims:  Eosinophilic esophagitis and celiac disease are distinct gastrointestinal disorders. The present study in children highlights the possible coexistence of these two conditions. This study also analyzes the epidemiological and clinical profiles of these patients.
Methods:  The medical records of patients diagnosed with celiac disease from 1 April 1999 to 31 March 2007 were reviewed. Patients with coincident histological diagnosis of eosinophilic esophagitis were retrospectively identified. The presenting symptoms, laboratory evaluations, endoscopic and histopathological findings, and treatment and follow-up outcomes of these patients were analyzed.
Results:  Of the 221 patients with celiac disease, seven (3.2%) were also diagnosed with eosinophilic esophagitis. A majority (6/7) presented with periumbilical pain and diarrhea. None had dysphagia. Each patient had abnormal celiac screening tests. Three patients had peripheral blood eosinophilia and elevated eosinophil cationic protein. Endoscopic changes of eosinophilic esophagitis and celiac disease were apparent in the majority of patients (6/7). A gluten-free diet was instituted in every patient. Topical corticosteroid therapy was started in one patient at diagnosis and in another patient after repeat endoscopic and histopathological evaluations.
Conclusions:  Awareness of the potential coexistence of eosinophilic esophagitis and celiac disease should promote optimal diagnosis of these conditions. Routine esophageal biopsies may be warranted when investigating for celiac disease.     

Eosinophilic esophagitis in children: clinical manifestations

During the past decade, the increasing number of recognized cases of eosinophilic esophagitis in children and adults has resulted in a dramatic expansion of the medical literature surrounding it. Clinical and basic research has contributed to a better, but still incomplete, body of knowledge regarding its clinical and histologic manifestations, as well as its immunologic and genetic pathogenesis. This article provides a broad framework for recognizing the remarkable variety of clinical manifestations of eosinophilic esophagitis in children, which must be considered as part of the differential diagnosis in many different clinical situations.     

Eosinophilic esophagitis in adults: An update

Eosinophilic esophagitis is a worldwide chronic allergic disease of the esophagus.In the last decade,there is an epidemic of this entity in the western world.Mostly seen in children and young adults,patients present with dysphagia or food impaction in the emergency room.Characteristic endoscopic findings,esophageal eosinophilia and non-responsiveness to proton pump inhibitors help make the diagnosis.Avoidance of foodallergens,administration of steroidal anti-inflammatory medications and dilation of the esophagus are the mainstays of treatment.Investigations are ongoing for mucosal healing and optimum maintenance treatment.     

Eosinophilic esophagitis in children with esophageal atresia

Eosinophilic esophagitis (EoE) has only rarely been reported in esophageal atresia (EA) patients. A retrospective case analysis of all EA patients born at our center between January 1999 and April 2012 was performed. A total of 113 of patients were identified; 10 patients were excluded as a result of inadequate data. Eighteen patients (17%) were diagnosed with EoE. The average number of eosinophilis was 30/high‐power field (HPF) (19/HPF–80/HPF). The median age for diagnosis of EoE was 1 year and 6 months (8 months–8 years and 7 months). Children with EoE had a significantly greater incidence of reflux symptoms, dysphagia, tracheomalacia, and ‘hypoxic spells’ (P < 0.05). EoE patients also underwent significantly more surgery including fundoplication and aortopexy when compared with those without EoE (P < 0.0001). Although the incidence of gastrostomy was greater in the EoE group (33% vs. 13%), this was not statistically significant. Half of the EoE patients had a coexisting atopic condition at time of diagnosis. The commonest condition was asthma 7/18 (38%) followed by specific food allergy 6/18 (33%). EoE was treated in 11 patients with either swallowed fluticasone or budesonide slurry. All improved clinically. Histologically, five had complete resolution and six had partial improvement. Six children with EoE were treated with acid suppression alone. All improved clinically, and 5/6 had subsequent histological resolution. One child who received acid suppression and an exclusion diet also improved. Seven patients (38%) had an esophageal stricture at time of EoE diagnosis. Five were dilated at time of the initial endoscopy, prior to the diagnosis of EoE being available. Two patients had resolution of their strictures on medical treatment of their EoE alone and did not require further dilatation. EoE was seen in 17% of children with EA in this study. EoE should be considered in EA patients with persistent symptoms on standard reflux treatment, increasing dysphagia, and recurrent strictures.     

Eosinophilic esophagitis: Case report.

Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It is a condition mainly affecting children; the adult form has only recently gained recognition as a distinct entity. The major symptom among adults with eosinophilic esophagitis is dysphagia. It is often misdiagnosed as gastroesophageal reflux disease because of the similarity in symptoms. An endoscopic biopsy is required to distinguish between the conditions. The cause of eosinophilic esophagitis is poorly understood, but food allergy has been implicated. Topical steroids are the most effective and convenient method for the treatment of eosinophilic esophagitis in adults. The long-term prognosis of eosinophilic esophagitis is uncertain; however, data suggests a benign course. We herein present two eosinophilic esophagitis cases that were the first to be diagnosed in our clinic.     

Eosinophilic esophagitis: 3 case reports

Eosinophilic esophagitis is a rare entity, characterized by eosinophilic infiltration of the oesophagal mucosae, with no gastroesophageal reflux. Food allergies are often involved. We report 3 paediatric cases of eosinophilic esophagitis, revealed by dysphagia, with or without stricture. Eosinophilic esophagitis is a rare disease, but its frequency is probably underestimated. Symptoms are sometimes unusual. Oesogastroscopy with biopsy is essential for the diagnosis. Food allergies can be involved and must be systematically investigated.