scholarly journals Disease activity in eosinophilic esophagitis is associated with impaired esophageal barrier integrity

2017 ◽  
Vol 313 (3) ◽  
pp. G230-G238 ◽  
Author(s):  
Marijn J. Warners ◽  
Bram D. van Rhijn ◽  
Joanne Verheij ◽  
Andreas J. P. M. Smout ◽  
Albert J. Bredenoord
Keyword(s):  
Disease Activity ◽  
Eosinophilic Esophagitis ◽  
High Power ◽  
High Power Field ◽  
Predictive Values ◽  
Impedance Measurements ◽  
Barrier Integrity ◽  
Mucosal Integrity ◽  
Esophageal Eosinophilia ◽  
Active Disease

In eosinophilic esophagitis (EoE), the esophageal barrier integrity is impaired. Integrity can be assessed with different techniques. To assess the correlations between esophageal eosinophilia and various measures of mucosal integrity and to evaluate whether endoscopic impedance measurements can predict disease activity, endoscopies and mucosal integrity measurements were performed in adult EoE patients with active disease (≥15 eosinophils/high-power field) at baseline ( n = 32) and after fluticasone ( n = 15) and elemental dietary treatment ( n = 14) and in controls ( n = 19). Mucosal integrity was evaluated during endoscopy using electrical tissue spectroscopy (ETIS) measuring mucosal impedance and transepithelial electrical resistance (TER) and transepithelial molecule-flux through biopsy specimens in Ussing chambers. We included 61 measurements; 32 of patients at baseline and 29 after treatment, 3 patients dropped out. After treatment, 20 patients were in remission (≤15 eosinophils/high-power field) and these measurements were compared with 41 measurements of patients with active disease (at baseline or after failed treatment). All four mucosal integrity measures showed significant impairment in active EoE compared with remission. Eosinophilia was negatively correlated with ETIS and TER and positively with transepithelial molecule flux ( P ≤ 0.001). The optimal ETIS cutoff to predict disease activity was 6,000 Ω·m with a sensitivity of 79% [95% confidence interval (CI) 54–94%], specificity of 84% (95% CI 69–94%), positive predictive values of 89% (95% CI 77–95%) and negative predictive values of 71% (95% CI 54–84%). In EoE patients, markers of mucosal integrity correlate with esophageal eosinophilia. Additionally, endoscopic mucosal impedance measurements can predict disease activity. NEW & NOTEWORTHY In adult patients with eosinophilic esophagitis (EoE), the mucosal integrity, measured by making use of four different parameters, correlates strongly with esophageal eosinophilia. The accuracy of endoscopically measured mucosal impedance to distinguish active disease from remission was acceptable with moderate specificity and sensitivity. Mucosal impedance measurements can predict disease activity in adult EoE patients.

Febrile Infants at Low Risk for Serious Bacterial Infection—An Appraisal of the Rochester Criteria and Implications for Management

PEDIATRICS ◽  
1994 ◽  
Vol 94 (3) ◽  
pp. 390-396 ◽  
Author(s):  
Julie A. Jaskiewicz ◽  
Carol A. McCarthy ◽  
Amy C. Richardson ◽  
Kathleen C. White ◽  
Donna J. Fisher ◽  
...  
Keyword(s):  
Confidence Interval ◽  
High Power ◽  
Microscopic Examination ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Low Risk ◽  
High Power Field ◽  
Urine Sediment ◽  
Predictive Values ◽  
Risk Criteria

Objective. Prospective studies were conducted to test the hypothesis that infants unlikely to have serious bacterial infections (SBI) can be accurately identified by low risk criteria. Methods. Febrile infants (rectal T ≥ 38°C) ≤60 days of age were considered at low risk for SBI if they met the following criteria: 1) appear well; 2) were previously healthy; 3) have no focal infection; 4) have WBC count 5.0-15.0 x 109 cells/L (5000-15 000/mm3), band form count≤ 1.5 x 109 cells/L (≤1500/mm3), ≤10 WBC per high power field on microscopic examination of spun urine sediment, and ≤5 WBC per high power field on microscopic examination of a stool smear (if diarrhea). The recommended evaluation included the culture of specimens of blood, cerebrospinal fluid, and urine for bacteria. Outcomes were determined. The negative predictive values of the low risk criteria for SBI and bacteremia were calculated. Results. Of 1057 eligible infants, 931 were well appearing, and, of these, 437 met the remaining low risk criteria. Five low risk infants had SBI including two infants with bacteremia. The negative predictive value of the low risk criteria was 98.9% (95% confidence interval, 97.2% to 99.6%) for SBI, and 99.5% (95% confidence interval, 98.2% to 99.9%) for bacteremia. Conclusions. These data confirm the ability of the low risk criteria to identify infants unlikely to have SBI. Infants who meet the low risk criteria can be carefully observed without administering antimicrobial agents.

scholarly journals Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors

2019 ◽  
Vol 07 (04) ◽  
pp. E433-E439 ◽  
Author(s):  
Akinari Sawada ◽  
Atsushi Hashimoto ◽  
Risa Uemura ◽  
Koji Otani ◽  
Fumio Tanaka ◽  
...  
Keyword(s):  
Proton Pump ◽  
Eosinophilic Esophagitis ◽  
Acid Reflux ◽  
Diffuse Type ◽  
High Power Field ◽  
Lower Esophagus ◽  
Small Areas ◽  
Endoscopic Findings ◽  
Esophageal Eosinophilia ◽  
Asymptomatic Patients

Abstract Background and study aims Endoscopic findings of esophageal eosinophilia sometimes localize to small areas of the esophagus. A previous study suggested that pathogenesis of localized-type eosinophilic esophagitis (LEoE) was associated with acid reflux. However, LEoE treatment outcomes have not been studied. We aimed to analyze the clinical and histologic significance of LEoE in comparison with diffuse-type eosinophilic esophagitis (DEoE). Patients and methods This study included 106 patients with esophageal eosinophilia. Esophageal eosinophilia was defined as a condition where the maximum number of intraepithelial eosinophils was ≥ 15 per high-power field. LEoE was defined as an endoscopic lesion confined to one-third of the esophagus: upper, middle, or lower. Esophageal eosinophilia encompassing more than two-thirds of the esophagus was defined as DEoE. We retrospectively compared LEoE and DEoE in terms of clinical characteristics, histologic findings, and proportion of proton pump inhibitor (PPI) responders. Results Of 106 patients, 12 were classified as having LEoE and 94 were classified as having DEoE. The proportion of asymptomatic patients was significantly higher in the LEoE group than the DEoE group (42 % vs 7 %, P < 0.01). In the LEoE group, 10 patients (84 %) had endoscopic lesions in the lower esophagus. The maximum number of eosinophils did not differ between the groups (54 [24 – 71] for LEoE, 40 [20 – 75] for DEoE, P = 0.65). The prevalence of PPI responders was significantly higher in the LEoE group than the DEoE group (100 % vs 63 %, P = 0.01). Conclusion LEoE can be a sign of good responsiveness to PPI therapy.

Isolated Hematuria and Sterile Pyuria May Indicate Systemic Lupus Erythematosus Activity

2015 ◽  
Vol 42 (3) ◽  
pp. 437-440 ◽  
Author(s):  
Jonathan Y.C. Ding ◽  
Dominique Ibañez ◽  
Dafna D. Gladman ◽  
Murray B. Urowitz
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Disease Activity ◽  
High Power ◽  
Lupus Erythematosus ◽  
Blood Cells ◽  
White Blood Cells ◽  
Systemic Lupus ◽  
High Power Field ◽  
Renal Manifestation ◽  
Tract Infections

Objective.To identify patients presenting with isolated hematuria and/or pyuria in the absence of other systemic lupus erythematosus (SLE) disease activity, describe their demographics, and determine whether they present with evidence of SLE flare in a period adjacent to the presentation.Methods.We studied patients followed at the University of Toronto Lupus Clinic between 1970 and 2012. An episode of isolated hematuria (> 5 red blood cells per high power field) and/or pyuria (> 5 white blood cells per high power field) was defined as 2 consecutive visits with these findings in the absence of other concurrent SLE manifestations such as proteinuria, casts, or azotemia. We then excluded patients whose findings might be explained by urinary tract infections, menstruation, urolithiasis, and/or anticoagulation. Only patients presenting with no other SLE disease activity were included.Results.Isolated hematuria and/or pyuria were identified in 49 patients, of whom 17 were excluded according to the criteria above, leaving 32. Twenty-four patients had another renal manifestation 1 year before and/or after the occurrence; 27 had a non-renal manifestation 1 year before and/or after the occurrence; 3 patients had a biopsy in the same time frame, all with evidence of active lupus nephritis. Therefore the majority of patients with an occurrence of isolated hematuria and/or pyuria had evidence of renal or other non-renal SLE disease activity at a time adjacent to this presentation.Conclusion.Although not proven, our results suggest that these manifestations were associated with SLE activity, either before or after the episode, and therefore may represent a phase of active disease.

scholarly journals Eosinofilik Esofagitis

2013 ◽  
Vol 2 (3) ◽  
pp. 183
Author(s):  
Yusri Dianne Jurnalis ◽  
Yorva Sayoeti ◽  
Widiasteti Widiasteti
Keyword(s):  
Food Allergy ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Eosinophilic Esophagitis ◽  
High Power ◽  
Reflux Disease ◽  
Eosinophil Infiltration ◽  
Esophageal Mucosa ◽  
High Power Field ◽  
Histologic Diagnosis

AbstrakEosinofilik esofagitis merupakan gangguan dimana terjadi infiltrasi eosinofil pada mukosa superfisial esophagus yang berhubungan dengan alergi makanan dan kondisi atopi seperti asma, dermatitis atopi, rhinitis alergika dan sering bersamaan dengan Gastroesophageal Reflux Disease (GERD). Diperkirakan insiden tahunan 43 per 10.000 pada anak. Gejala klinis mirip dengan GERD yaitu muntah, regurgitasi, nausea, nyeri dada atau epigastrium, disfagia dan hematemesis. Sekitar 50% pasien memiliki gejala alergi dan lebih 50% pasien memiliki orang tua dengan riwayat alergi. Diagnosis dapat ditegakkan berdasarkan pemeriksaan endoskopi dan histologis. Gambaran endoskopi yang ditemukan antara lain feline esophagus, corrugated esophagus, ringed esophagus, atau concentric mucosal rings, eksudat putih, vesikel atau papul dan hilangnya pola vaskular menunjukkan area fokus infiltrasi eosinofil. Diagnosis secara histologis sangat penting dimana kriteria eosinofilik esofagitis adalah jika ditemukan eosinofil >20/HPF (High Power Field). Terapi yang diberikan adalah terapi diet, farmakologis seperti kortikosteroid sistemik atau topikal, penghambat reseptor leukotrin dan anti IL-5.Kata kunci: eosinofilik esofagitis, alergi makanan, atopiAbstractEosinophilic esophagitis is a disorder which there is eosinophil infiltration on superficial esophageal mucosa. It’s correlated with food allergy and atopy condition such as asthma, atopy dermatitis, rhinitis allergic and often in conjunction with Gastroesophageal Reflux Disease ( GERD). The incidence approximately 43/10.000 in children. The symptoms are similar with GERD, which one vomit, regurgitation, nausea, chest or epigastrium pain, dysphagia and hematemesis. About 50% patient has allergic symptoms and more than 50% parent of the patient has allergic history. The diagnose can be made base on endoscopic and histological examination. Endoscopic examination shows feline esophagus, corrugated esophagus or concentric mucosal rings, white exudates, vesikel or papul and diminished of vascular pattern, showing eosinophyl infiltration focus area. Histologic diagnosis is very important where the criteria for eosinophilic esophagitis is found eosinophils > 20 / HPF (High Power Field) within the superficial esophageal mucosa. Therapy eosinophilic esophagitis are diet therapy, pharmacological therapy with systemic or topical corticosteroid, leucotriene receptor antagonist and anti IL-5.Keywords:Eosinophilic esophagitis, food allergy, atopy

Eosinophilic esophagitis

2019 ◽  
Vol 40 (6) ◽  
pp. 462-464
Author(s):  
Melissa M. Watts ◽  
Carol Saltoun ◽  
Paul A. Greenberger
Keyword(s):  
Eosinophilic Esophagitis ◽  
Cell Activation ◽  
Erosive Esophagitis ◽  
Mast Cell Activation ◽  
Dietary Therapy ◽  
Pharmacologic Therapy ◽  
Food Impaction ◽  
High Power Field ◽  
Esophageal Eosinophilia ◽  
Food Antigens

Eosinophilic esophagitis (EoE) is defined by symptoms related to esophageal dysfunction, persistent esophageal eosinophilia, and exclusion of other etiologies that may be contributing to the condition. EoE is different from erosive esophagitis. In children, symptoms vary by age groups, such as feeding disorders in 2 year olds; vomiting in 8 year olds; and abdominal pain, dysphagia, and/or food impaction in adolescents. Most adults present with dysphagia, food impaction, heartburn, or chest pain. Common endoscopic features in adults with EoE include linear furrows (creases that orient longitudinally), mucosal rings (esophageal “trachealization”), small-caliber esophagus, white plaques or exudates (which are microabscesses of eosinophils), and strictures. Children often present with similar endoscopic features, yet one-third of pediatric patients with EoE have a normal result in an endoscopic examination. Histologic features of EoE include increased intramucosal eosinophils in the esophagus (≥15 eosinophils per high power field), without similar findings in the stomach or duodenum. There also may be eosinophilic microabscesses. In addition to evidence of mast cell activation, mucosa from patients with EoE have increased levels of interleukin 5; supporting eosinophilia; and upregulation of gene expression of eotaxin-3, a chemokine important in eosinophil migration. The majority of patients have evidence of either aeroallergen and/or food sensitization. Dietary therapy is considered first-line therapy for patients with EoE because it is inexpensive and effective, without requiring pharmacologic therapy. Removal of food antigens has been shown to improve symptoms in patients with EoE. Topical corticosteroids improve esophageal eosinophilia and symptoms, and have become the criterion standard of pharmacotherapy.

Emerging Eosinophilic (Allergic) Esophagitis: Increased Incidence or Increased Recognition?

2007 ◽  
Vol 131 (5) ◽  
pp. 777-779 ◽  
Author(s):  
Andrew D. Vanderheyden ◽  
Robert E. Petras ◽  
Barry R. DeYoung ◽  
Frank A. Mitros
Keyword(s):  
Environmental Change ◽  
Environmental Factor ◽  
Eosinophilic Esophagitis ◽  
Reflux Esophagitis ◽  
High Power ◽  
Similar Group ◽  
High Power Field

Abstract Context.—Eosinophilic esophagitis is a disease of the esophagus with distinct histologic features (prominent intraepithelial eosinophils, particularly superficial with clustering) and characteristic endoscopic features (trachealization, white plaques). The presence of intraepithelial eosinophils had been recognized since 1982 as indicative of reflux esophagitis but little attention was initially paid to their numbers or location. Eosinophilic esophagitis has been recently described and there have been a number of reports that its incidence is on the rise. It had been our impression that eosinophilic esophagitis was being seen more frequently, perhaps resulting from some environmental change. Objective.—To investigate the increased prevalence of eosinophilic esophagitis. Design.—We analyzed a similar group of cases from 2005 (n = 150) as compared with 1990 (n = 115). Consecutive patients with mucosal esophageal biopsies from May through June of the respective years were included in the analysis. Patients with Barrett metaplasia or with carcinoma were excluded. The highest density of intraepithelial eosinophils for each patient was recorded as the number of intraepithelial eosinophils per single high-power field. The patients were categorized by the number of intraepithelial eosinophils per high-power field with those cases with greater than 20 intraepithelial eosinophils per high-power field representing eosinophilic esophagitis. Results.—There was no difference in the incidence of eosinophilic esophagitis between 1990 and 2005. Conclusions.—The apparent increased incidence of eosinophilic esophagitis is largely a result of an increase in recognition rather than an increase in disease resulting from an environmental factor.

Proton Pump Inhibitors Partially Restore Mucosal Integrity in Patients With Proton Pump Inhibitor–Responsive Esophageal Eosinophilia but Not Eosinophilic Esophagitis

2014 ◽  
Vol 12 (11) ◽  
pp. 1815-1823.e2 ◽  
Author(s):  
Bram D. van Rhijn ◽  
Pim W. Weijenborg ◽  
Joanne Verheij ◽  
Marius A. van den Bergh Weerman ◽  
Caroline Verseijden ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump Inhibitors ◽  
Proton Pump ◽  
Eosinophilic Esophagitis ◽  
Mucosal Integrity ◽  
Esophageal Eosinophilia

scholarly journals Platelet association with leukocytes in active eosinophilic esophagitis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250521
Author(s):  
Kelly A. Bartig ◽  
Kristine E. Lee ◽  
Deane F. Mosher ◽  
Sameer K. Mathur ◽  
Mats W. Johansson
Keyword(s):  
Disease Activity ◽  
Eosinophilic Esophagitis ◽  
Area Under The Curve ◽  
Principal Component ◽  
Standard Of Care ◽  
Cell Types ◽  
High Power Field ◽  
Blood Leukocytes ◽  
Before And After ◽  
Blood Eosinophils

We previously demonstrated that the percentage of blood eosinophils that are associated with platelets and thus positive for CD41 (integrin αIIb-subunit) correlates with and predicts peak eosinophil count (PEC) in biopsies of eosinophilic esophagitis (EoE) patients after treatment. Thus, flow cytometric determination of CD41+ eosinophils is a potential measure of EoE disease activity. Determinants of association of platelets with eosinophils and other leukocytes in EoE are largely unknown. The objectives of this study were to test the hypotheses that platelets associate with blood leukocytes other than eosinophils in EoE and that such associations also predict EoE activity. Whole blood flow cytometry was performed on samples from 25 subjects before and after two months of standard of care EoE treatment. CD41 positivity of cells within gates for eosinophils, neutrophils, monocytes, lymphocytes, and natural killer cells was compared. We found that percent CD41+ neutrophils, monocytes, and eosinophils correlated with one another such that principal component analysis of the five cell types identified “myeloid” and “lymphoid” factors. Percent CD41+ neutrophils or monocytes, or the myeloid factor, like CD41+ eosinophils, correlated with PEC after treatment, and CD41+ neutrophils or the myeloid factor predicted PEC < 6/high power field after treatment, albeit with lower area under the curve than for CD41+ eosinophils. We conclude that the processes driving platelets to associate with eosinophils in EoE also drive association of platelets with neutrophils and monocytes and that association of platelets with all three cell types is related to disease activity. Clinicaltrials.gov identifier: NCT02775045.

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