Idiopathic eosinophilic esophagitis with stricture formation in a patient with long-standing eosinophilic gastroenteritis

Eosinophilic esophagitis (EoE) is a chronic inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. The incidence of EoE has increased substantially over the past two decades in Europe and North America. The natural course of EoE appears to be progressive with a high risk of stricture formation. The current European guideline recommend swallowed topical corticosteroids, proton-pump inhibitors or dietary intervention for initial and long-term treatment of EoE. Swallowed topical corticosteroids can be considered to be the best studied drug class in EoE, with more than 1000 patients enrolled in randomized clinical trials worldwide. In most of them, fluticasone or budesonide formulations have been used that were originally designed for asthma therapy, thus presumably suboptimal for EoE treatment. The new orodispersible budesonide tablet with effervescent properties is the first approved esophageal-targeted formulation specifically developed for the treatment of EoE, which has become available in many European countries. This article gives an overview of the evolution of topical corticosteroids in EoE and provides an update on recent data from large-scale multicenter trials exploring the efficacy and safety of the orodispersible budesonide tablet with effervescent properties in adult EoE patients.

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Endoscopic findings of gastric lesions in patients with eosinophilic gastrointestinal disorders

Endoscopy International Open ◽

10.1055/a-1268-7312 ◽

2020 ◽

Vol 08 (12) ◽

pp. E1817-E1825

Author(s):

Yasuhiro Fujiwara ◽

Kojiro Tanoue ◽

Akira Higashimori ◽

Yu Nishida ◽

Masatsugu Maruyama ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Submucosal Tumor ◽

Eosinophilic Gastroenteritis ◽

Gastrointestinal Disorders ◽

Gastric Lesions ◽

Pyloric Ring ◽

Eosinophilic Colitis ◽

Endoscopic Findings ◽

Eosinophilic Gastritis ◽

Eosinophilic Gastrointestinal Disorders

Abstract Background and study aims Eosinophilic gastrointestinal disorders are classified into eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, and eosinophilic colitis according to the site of eosinophilic infiltration. Although well established in eosinophilic esophagitis, endoscopic findings in eosinophilic gastritis and eosinophilic gastroenteritis with regard to gastric lesions have not been clearly described. The aim of this study was to identify endoscopic findings of gastric lesions associated with eosinophilic gastrointestinal disorders. Patients and methods Out of 278 patients with eosinophilic gastrointestinal disorders, 18 had eosinophilic gastritis or eosinophilic gastroenteritis confirmed by biopsy; their endoscopic images were analyzed retrospectively. The association between endoscopic findings and number of eosinophils in the gastric mucosa was investigated. Results Erythema was most frequently observed (72 %), followed by ulcers (39 %), discoloration (33 %), erosions (28 %), nodularity (28 %), and polyps (28 %). There were several unique endoscopic findings such as submucosal tumor-like deep large ulcers in three patients, antral Penthorum-like appearances (small nodules radially lined toward the pyloric ring) in three patients, “muskmelon-like appearances” (discolored mucosa-composed mesh pattern) in three patients, multiple white granular elevations in two patients, cracks (appearance of furrows similar to those in eosinophilic esophagitis) in five patients, and antral rings in one patient. No significant association was observed between endoscopic findings and number of gastric eosinophils. Conclusions Several unique endoscopic findings of gastric lesions were observed in patients with eosinophilic gastritis or eosinophilic gastroenteritis. Submucosal tumor-like ulcers, antral Penthorum-like appearances, muskmelon-like appearances, and cracks might be associated with eosinophilic gastrointestinal disorders.

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Serum Biomarkers for the Diagnosis of Eosinophilic Esophagitis and Eosinophilic Gastroenteritis

Internal Medicine ◽

10.2169/internalmedicine.8763-16 ◽

2017 ◽

Vol 56 (21) ◽

pp. 2819-2825 ◽

Cited By ~ 9

Author(s):

Shunji Ishihara ◽

Tetsuo Shoda ◽

Norihisa Ishimura ◽

Shoichiro Ohta ◽

Junya Ono ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Eosinophilic Gastroenteritis ◽

Serum Biomarkers

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T01.02.22 SIX-FOOD ELIMINATION DIET (SFED) IN EOSINOPHILIC ESOPHAGITIS AND EOSINOPHILIC GASTROENTERITIS

Digestive and Liver Disease ◽

10.1016/s1590-8658(20)30654-x ◽

2020 ◽

Vol 52 ◽

pp. S72

Author(s):

M. Di Stefano ◽

C. Frigerio ◽

G. Schembari ◽

F. Lapia ◽

U. Sabatini ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Elimination Diet ◽

Eosinophilic Gastroenteritis ◽

Food Elimination

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Eosinophilic Gastroenteropathies (Eosinophilic Esophagitis, Eosinophilic Gastroenteritis and Eosinophilic Colitis)

Food Allergy ◽

10.1016/b978-1-4377-1992-5.00010-7 ◽

2012 ◽

pp. 129-141

Author(s):

Dan Atkins ◽

Glenn T. Furuta

Keyword(s):

Eosinophilic Esophagitis ◽

Eosinophilic Gastroenteritis ◽

Eosinophilic Colitis

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Idiopathic Eosinophilic Esophagitis and Eosinophilic Gastroenteritis Successfully Treated with Azathioprine or 6-Mercaptopurine

The American Journal of Gastroenterology ◽

10.14309/00000434-200509001-00618 ◽

2005 ◽

Vol 100 ◽

pp. S233-S234

Author(s):

Peter Netzer ◽

Jerzy W. Bielecki ◽

Juergen M. Gschossmann

Keyword(s):

Eosinophilic Esophagitis ◽

Eosinophilic Gastroenteritis

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Clinical relevance of esophageal subepithelial activity in eosinophilic esophagitis

Journal of Gastroenterology ◽

10.1007/s00535-019-01624-3 ◽

2019 ◽

Vol 55 (3) ◽

pp. 249-260 ◽

Cited By ~ 8

Author(s):

Ikuo Hirano

Keyword(s):

Disease Severity ◽

Eosinophilic Esophagitis ◽

Clinical Care ◽

Topical Steroid ◽

Muscularis Propria ◽

Therapeutic Interventions ◽

Stricture Formation ◽

Complete Evaluation ◽

Impedance Planimetry ◽

Esophageal Dysfunction

Abstract Esophageal subepithelial activity (ESEA) is an important determinant of disease severity and complications in eosinophilic esophagitis (EoE). Inflammation and fibrosis of the lamina propria and muscularis propria result in esophageal dysfunction and stricture formation that are clinically manifest by symptoms of dysphagia and food impaction as well as the need for esophageal dilation. Esophageal biopsies that are limited to the evaluation of the esophageal epithelium are an inadequate means to assess overall, clinical disease severity in EoE. Instruments for the assessment of subepithelial activity in EoE are both limited and/or underutilized and thus represent an important unmet clinical need. Studies using endoscopic features, endoscopic ultrasonography, and barium esophagography have demonstrated improvement in ESEA parameters with topical steroid therapy. Impedance planimetry is being evaluated as an objective and quantifiable measure of esophageal distensibility that is a consequence of ESEA. In conjunction with symptom and histologic assessment, evaluation of ESEA provides a more complete evaluation of disease activity in EoE that will enhance clinical care as well as provide insights into the strengths and limitations of therapeutic interventions.

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