scholarly journals Distal esophagus is the most commonly involved site for strictures in patients with eosinophilic esophagitis

2019 ◽  
Vol 33 (2) ◽  
Author(s):  
Swathi Eluri ◽  
Manaswita Tappata ◽  
Kevin Z Huang ◽  
Nathaniel T Koutlas ◽  
Benjamin S Robey ◽  
...  
Keyword(s):  
Treatment Response ◽  
Eosinophilic Esophagitis ◽  
Gastroesophageal Junction ◽  
Distal Esophagus ◽  
Symptom Duration ◽  
Topical Steroids ◽  
Esophageal Strictures ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection ◽  
Few Data

SUMMARY While strictures are common in eosinophilic esophagitis (EoE), there are few data on stricture distribution and characteristics. Our primary aim was to characterize strictures by location in the esophagus in EoE and associated clinical, endoscopic, and histologic features. This was a retrospective study from the UNC EoE Clinicopathologic Database of subjects with esophageal strictures or narrowing from 2002 to 2017. Strictures were categorized as distal esophagus/gastroesophageal junction, mid-esophagus, proximal esophagus, or diffusely narrowed. Stricture location was assessed and compared with clinical, endoscopic, and histologic features, and also with treatment response to diet or topical steroids. Efficacy of combination therapy with dilation and intralesional steroid injection was assessed in a sub-group of patients with strictures. Of 776 EoE cases, 219 (28%) had strictures, 45% of which were distal, 30% were proximal, 5% were mid-esophageal, and 20% had diffuse narrowing. Those with mid-esophageal strictures were younger (P = 0.02) and had shorter symptom duration (P < 0.01). Those with diffuse esophageal narrowing were more likely to be women (57%) and have abdominal pain (25%). There was no association between other clinical, endoscopic, and histologic findings and treatment response based on stricture location. Fourteen patients (8%) received intralesional triamcinolone injection and subsequently achieved a higher mean dilation diameter after injection (13.7 vs. 15.5 mm; P < 0.01). In conclusion, almost half of strictures in EoE patients were in the distal esophagus. Therefore, EoE should be a diagnostic consideration in patients with focal distal strictures and not presumed to be secondary to gastroesophageal reflux disease.

Fr193 OLDER PATIENTS WITH EOSINOPHILIC ESOPHAGITIS HAVE HIGH RATES OF TREATMENT RESPONSE TO TOPICAL STEROIDS

2021 ◽  
Vol 160 (6) ◽  
pp. S-259-S-260
Author(s):  
Corey J. Ketchem ◽  
Kisan Thakkar ◽  
Zeyun Xue ◽  
Sumana Reddy ◽  
Lior Abramson ◽  
...  
Keyword(s):  
Treatment Response ◽  
Eosinophilic Esophagitis ◽  
Older Patients ◽  
Topical Steroids

Intralesional steroid injection in benign esophageal strictures resistant to bougie dilation

2004 ◽  
Vol 19 (12) ◽  
pp. 1388-1391 ◽  
Author(s):  
ENGIN ALTINTAS ◽  
SABITE KACAR ◽  
BILGE TUNC ◽  
ORHAN SEZGIN ◽  
ERKAN PARLAK ◽  
...  
Keyword(s):  
Steroid Injection ◽  
Esophageal Strictures ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection

Older patients with eosinophilic esophagitis have high treatment response to topical steroids

2021 ◽  
Author(s):  
Corey J. Ketchem ◽  
Kisan P. Thakkar ◽  
Angela Xue ◽  
Sumana Reddy ◽  
Lior Abramson ◽  
...  
Keyword(s):  
Treatment Response ◽  
Eosinophilic Esophagitis ◽  
Older Patients ◽  
Topical Steroids ◽  
High Treatment

DOZ047.57: Eosinophilic esophagitis in an infant with repaired esophageal atresia and tracheoesophageal fistula

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
A Mustafa ◽  
A AlKhabaz ◽  
A A Mallik ◽  
S Kumar
Keyword(s):  
Esophageal Atresia ◽  
Eosinophilic Esophagitis ◽  
Tracheoesophageal Fistula ◽  
Gastroesophageal Junction ◽  
Elimination Diet ◽  
Topical Steroids ◽  
Contrast Study ◽  
Esophageal Dysmotility ◽  
Asymptomatic Children ◽  
Repeat Endoscopy

Abstract Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) requires early surgical intervention in life, following which symptoms related to esophageal dysmotility, gastroesophageal reflux, and strictures may develop. Eosinophilic esophagitis (EoE) is an immune-mediated disorder presents with vomiting and dysphagia. The appearance of exudates, rings, and furrows during endoscopy and the presence of >15 eosinophils/HPF in biopsy confirm the diagnosis. Treatment options include elimination diet, proton pump inhibitors (PPI), and topical steroids. We report a full-term male who had EA and TEF repaired in the second day of life. At 11 months of age, he developed progressive vomiting, contrast study showed esophageal dysmotility with slow emptying and no stricture. The initial endoscopy showed a mild nonobstructive narrowing 5 cm above the gastroesophageal junction, below which the mucosa was erythematous, biopsies showed >25 eosinophils/HPF. Started treatment with PPI and endoscopy repeated three months later showed same endoscopic features and biopsies showed >45 eosinophils/HPF. Allergy testing was positive for milk, wheat, oat, and rice. Topical steroids and elimination diet were added to PPI. At 32 months of age, the child was asymptomatic, not on elimination diet and treatment was stopped. Repeat endoscopy showed longitudinal furrows and erosions of the lower esophagus, no stricture, and biopsies showed >15 eosinophils/HPF. Steroids, PPI, and elimination diet were all resumed. Despite moderate esophagitis due to EoE and poor compliance to treatment, our patient shows normal growth, development, and symptoms resolution. Asymptomatic children with repaired EA and treated EoE may require close follow-up and repeat endoscopy.

scholarly journals A14 WIDE VARIATION IN CLINICAL MANAGEMENT OF PAEDIATRIC EOSINOPHILIC ESOPHAGITIS: A CANADIAN EXPERIENCE.

2021 ◽  
Vol 4 (Supplement_1) ◽  
pp. 16-18
Author(s):  
K A Bortolin ◽  
D Ashok ◽  
V Avinashi ◽  
J Barkey ◽  
D Burnett ◽  
...  
Keyword(s):  
Maintenance Therapy ◽  
Eosinophilic Esophagitis ◽  
Online Survey ◽  
Treatment Algorithm ◽  
Elimination Diet ◽  
Practice Variation ◽  
Initial Diagnosis ◽  
Response To Therapy ◽  
Topical Steroids ◽  
Repeat Endoscopy

Abstract Background Eosinophilic esophagitis (EoE) is a chronic disorder treated by food elimination diet (FED), topical steroids and/or proton-pump inhibitors (PPI). Serial endoscopies and biopsies assess response to therapy. EoE management has evolved as guidelines are updated. Aims To identify practice variation among Canadian paediatric gastroenterologists (PG) who care for children with EoE. Methods An online survey using REDCap about decision-making in children with EoE was distributed to PG in Canada in November 2020. Results 62 PG completed the survey (response rate 69%, 62/94). The majority work in academic centres (92%). 3 centers indicated an accrual of >50 new patients per year; 9/16 centres have >100 patients in follow-up. An EoE Clinic is present in 5 centres. Diagnosis: Familiarity with the 2018 AGREE and 2020 AGA EoE guidelines was found to be 57% and 67% respectively. Criteria required to diagnose EoE according to current guidelines were correctly indicated by 42% of PG. (Figure 1). Endoscopy: The majority of PG (95%) adhere to guidelines in terms of required number and location of biopsies for the initial diagnosis. Ideal timing of repeat endoscopy after change in therapy in patients who are not in histological remission was 8–12 weeks by 67% of PG, timing in stable patients on maintenance therapy varied (33% only if patient is symptomatic). 25% used the EREFS Score in reporting endoscopic findings. Therapy: Improvement of symptoms was the highest ranked goal (64%), followed by remission of histologic findings (30%). A treatment algorithm was in place in 4 centers. The majority routinely assess adherence to therapy (73%) and consult a dietitian for FED (77%). Most (87%) do not consult an allergist for initial management. Preferred choices of 1st-line therapy varied among PG (Figure 2). When FED was selected, 32% of PG started with 1 food, 32% started with 2 foods, most frequently excluding dairy, followed by wheat. 14 (26%) start with ≥6 FED. Prescription of budesonide slurry was consistent among PG with doses of 1 and 2 mg/day in children <10 and >10 years, respectively. Conclusions The is the first Canadian study to assess the variation in management of children with EoE by PG. Overall, PG demonstrated good adherence to the guidelines in terms of initial diagnosis, but differences in maintenance therapy choice and timing of endoscopies. The results highlight a need for standardized management algorithms to deliver uniform care to this growing group. Grounding these guidelines in evidence will warrant a significant investment in further paediatric EoE research. Funding Agencies None

scholarly journals Life-Threatening Subglottic Stenosis of Granulomatosis with Polyangiitis: A Case Report

Medicina ◽  
2021 ◽  
Vol 57 (5) ◽  
pp. 423
Author(s):  
Jin An ◽  
Jae-Won Song
Keyword(s):  
Immunosuppressive Therapy ◽  
Granulomatosis With Polyangiitis ◽  
Granulomatous Inflammation ◽  
Subglottic Stenosis ◽  
Emergency Tracheostomy ◽  
Intralesional Steroid ◽  
Intralesional Steroid Injection ◽  
Life Threatening ◽  
Carbon Dioxide Co2 ◽  
Laryngotracheal Resection

Granulomatosis with polyangiitis (GPA) is an autoimmune disease characterized by necrotizing granulomatous inflammation. Subglottic stenosis, which is defined as narrowing of the airway below the vocal cords, has a frequency of 16–23% in GPA. Herein, we present the case of a 39-year-old woman with subglottic stenosis manifesting as life-threatening GPA, which was recurrent under systemic immunosuppressive therapy. The patient underwent an emergency tracheostomy, intratracheal intervention, such as carbon dioxide (CO2) laser surgery and intralesional steroid injection via laryngomicroscopic surgery, and laryngotracheal resection with remodeling. Severe subglottic stenosis treatment requires active intratracheal intervention, surgery, and systemic immunosuppressive therapy.

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