scholarly journals Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Natalia Vernon ◽  
Divyanshu Mohananey ◽  
Ehsan Ghetmiri ◽  
Gisoo Ghaffari
Keyword(s):  
Eosinophilic Esophagitis ◽  
Esophageal Perforation ◽  
Rare Complication ◽  
Esophageal Mucosa ◽  
Esophageal Rupture ◽  
Food Impaction ◽  
Initial Manifestation ◽  
Esophageal Lumen ◽  
History Of ◽  
Esophageal Dysfunction

Eosinophilic esophagitis (EoE) is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave’s syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children) and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

scholarly journals Esophageal perforation in eosinophilic esophagitis: five cases in children

2020 ◽  
Vol 08 (07) ◽  
pp. E830-E833
Author(s):  
Camille Donnet ◽  
Sylvie Destombe ◽  
Alain Lachaux ◽  
Laurent Michaud ◽  
Valérie Triolo ◽  
...  
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Eosinophilic Esophagitis ◽  
Esophageal Perforation ◽  
Reflux Disease ◽  
Esophageal Mucosa ◽  
Immune Disease ◽  
Esophageal Lumen ◽  
Boerhaave Syndrome ◽  
Esophageal Dysfunction

Abstract Background and study aims Eosinophilic esophagitis (EoE) is a chronic immune disease with increasing incidence. It is clinically defined by symptoms of esophageal dysfunction and histologically by eosinophilic polynuclear cell infiltration of the esophageal mucosa. Symptoms are not specific and include gastroesophageal reflux disease (GERD), dysphagia, vomiting or dietary blockages. Chronic inflammation of the mucosa may lead to narrowing of the esophageal lumen responsible for impactions. Extraction procedures can be complicated by dissection and perforation. Rare spontaneous ruptures of the esophagus known as Boerhaave syndrome are also possible. We report five cases of esophageal perforation in children with EoE, three with spontaneous rupture and two after an endoscopic procedure. The evolution was favorable under medical treatment.

scholarly journals Death Resulting from Pneumocephalus Complicating Endoscopic Food Bolus Retrieval in a Patient with Eosinophilic Esophagitis

2016 ◽  
Vol 6 (4) ◽  
pp. 703-708 ◽  
Author(s):  
Amy K. Fuhs ◽  
Joseph A. Prahlow
Keyword(s):  
Eosinophilic Esophagitis ◽  
Rare Complication ◽  
Flexible Endoscopy ◽  
Brain Parenchyma ◽  
Esophageal Mucosa ◽  
Food Bolus ◽  
Patient Death ◽  
Injury Death ◽  
Computed Tomography Scanning ◽  
The Brain

Pneumocephalus is a rare complication of esophagogastroduodenoscopy (EGD), but existing literature does not discuss pneumocephalus surrounding endoscopic food bolus retrieval. We present a death involving pneumocephalus complicating endoscopic food removal from the esophagus. A 40-year-old man presented with dysphagia and suprasternal discomfort 12 hours following chicken ingestion. On flexible endoscopy, chicken was visualized in the distal esophagus. After successful retrieval, a mucosal laceration was noted where the chicken had been lodged. He was unarousable following the procedure and was emergently transported to a hospital, where computed tomography scanning showed pneumocephalus. He was later declared brain dead. The case was referred for medicolegal autopsy. The brain was examined first, revealing rare air bubbles within meningeal vessels and numerous, diffuse petechiae-like hemorrhages within the brain parenchyma. The esophageal mucosa had focal discoloration and a partial thickness laceration; microscopic examination revealed eosinophilic esophagitis. Eosinophilic esophagitis is a known risk factor for food bolus impaction and should be suspected in such patients. Pneumocephalus is a rare possible complication of EGD for food bolus retrieval. In patients unresponsive after endoscopy, radiographic detection of potential pneumocephalus should be encouraged to enable timely therapy and improved outcomes, or to supplement autopsy in the event of patient death. Forensic pathologists should understand that pneumocephalus is a potential mechanism of injury/death in patients experiencing esophageal trauma, including injury incurred during EGD.

scholarly journals Co-Occurrence of Rarest Type of Dysphagia Lusoria (Type N-1) and Eosinophilic Esophagitis in a Cognitively Disabled Individual

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Kishore Kumar ◽  
Jasbir Makker ◽  
Hassan Tariq ◽  
Ariyo Ihimoyan ◽  
Chime Chukwunonso ◽  
...  
Keyword(s):  
Subclavian Artery ◽  
Eosinophilic Esophagitis ◽  
Previous History ◽  
Food Allergies ◽  
Aberrant Right Subclavian Artery ◽  
Food Impaction ◽  
Diagnostic Challenge ◽  
Dysphagia Lusoria ◽  
Extrinsic Compression ◽  
History Of

Dysphagia is an expressive symptom, described by an individual as “difficulty in swallowing.” Dysphagia due to esophageal compression from an aberrant right subclavian artery is rare, and it is termed as “dysphagia lusoria.” We present a rare case of co-occurrence of dysphagia lusoria with esophageal eosinophilia in a patient with cognitive disability which portends a case with diagnostic challenge and treatment dilemma. A 31-year-old man with intellectual disability, cerebral palsy, previous history of feeding difficulty, and esophageal food impaction presented with esophageal foreign body impaction. He has no known history of atopy and food allergies. There was no laboratory evidence of peripheral eosinophilia. The IgE-mediated allergic test was unremarkable. His prior presentation revealed a diagnosis of eosinophilic esophagitis. The imaging studies showed proximal esophageal dilatation with extrinsic compression at the level of the upper esophagus. The foreign bodies were removed successfully through the help of upper endoscopy. Subsequent evaluation revealed a rare type of dysphagia lusoria (type N-1) due to an aberrant left subclavian artery arising from the right-sided aortic arch. The patient’s family refused further management of artery lusoria. Prolonged stasis of secretions and food in the esophagus can also lead to increased esophageal eosinophils. In our case, it remains undetermined whether increased number of esophageal eosinophils resulted from primary eosinophilic esophagitis or due to prolonged food stasis from esophageal compression caused by an aberrant subclavian artery. However, food impaction right above the compression site makes dysphagia lusoria the likely etiology.

scholarly journals Clinical Guidelines of the Russian Gastroenterological Association on the Diagnostics and Treatment of Eosinophilic Esophagitis

2019 ◽  
Vol 28 (6) ◽  
pp. 84-98 ◽  
Author(s):  
V. T. Ivashkin ◽  
I. V. Maev ◽  
A. S. Trukhmanov ◽  
T. L. Lapina ◽  
D. N. Andreev ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Clinical Manifestations ◽  
Eosinophilic Infiltration ◽  
Esophageal Mucosa ◽  
High Power Field ◽  
Immune Mediated ◽  
Esophageal Dysfunction ◽  
Diagnostic Criterion ◽  
Choice Of Therapy

Aim.This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.Summary.Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.Conclusion.Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology.

scholarly journals Eosinophilic esophagitis: A potential complication of sublingual immunotherapy

2021 ◽  
Vol 27 (1-2) ◽  
pp. 32-39
Author(s):  
Snežana Knežević ◽  
Branimir Dugalić
Keyword(s):  
Eosinophilic Esophagitis ◽  
Sublingual Immunotherapy ◽  
Epigastric Pain ◽  
Treatment Options ◽  
Elimination Diet ◽  
Schatzki Ring ◽  
Immune Mediated ◽  
History Of ◽  
Resolution Imaging ◽  
Esophageal Dysfunction

Introduction. Eosinophilic esophagitis (EoE) represents chronic, a local immune-mediated disease with symptoms of esophageal dysfunction and histologically eosinophil-predominant inflammation and requires immediate endoscopy. Male gender is a strong risk factor. Case report. We presented a case of a 25-year-old young man with a history of allergic rhino-conjunctivitis, asthma, and intermittent severe feeding disturbance. The patient had begun sublingual immunotherapy therapy, containing specific soluble allergens for ambrosia. Six weeks after starting the ambrosia sublingual immunotherapy he developed burning epigastric pain, dysphagia, and odynophagia. Six days later, he was admitted to an emergency department due to choking on a solid of food. Esophageal histopathological findings were in favor of EoE. Sublingual immunotherapy was discontinued. He feels well now. Conclusion. The majority of cases of Eosinophilic esophagitis are diagnosed in spring or fall, 1-2 months following the peak of pollen season. Dysphagia, chest pain, food sticking, and bolus obstruction are the most common symptoms. Endoscopic findings are Schatzki ring, edema, exudates, furrows, and strictures. Six biopsies should be taken from areas with endoscopic mucosal abnormalities, and infiltration of eosinophils (more than 15 eosinophils/HRI) (HRI - high resolution imaging) is necessary for the diagnosis confirmation. Treatment options are proton pump inhibitors - oral dispersible tablets of budesonide or fluticasone propionate, an elimination diet. Sublingual immunotherapy should be discontinued. Family physicians should be aware of this complication in evaluating patients with dysphagia.

Eosinophilic Esophagitis in Children and Adolescents

2017 ◽  
Author(s):  
Elizabeth J Hait
Keyword(s):  
Eosinophilic Esophagitis ◽  
Failure To Thrive ◽  
Inflammatory Disorder ◽  
Esophageal Mucosa ◽  
Older Children ◽  
High Power Field ◽  
Interleukin 5 ◽  
Adolescents And Adults ◽  
History Of ◽  
Seasonal Allergies

Eosinophilic esophagitis (EoE) is an inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction in association with histologic evidence of eosinophilic infiltration of the esophageal mucosa. The diagnosis is based on esophageal biopsies showing more than 15 eosinophils per high-power field in the absence of pathologic gastroesophageal reflux. It can present with a wide array of upper gastrointestinal tract symptoms. Babies and toddlers typically present with feeding intolerance or refusal, vomiting, and failure to thrive. Older children often present with abdominal pain and reflux symptoms, whereas adolescents and adults typically present with solid-food dysphagia and/or food impaction. Diagnosis is also supported by a family history of EoE and other allergy-based disorders, such as asthma, seasonal allergies, and atopy. Topical corticosteroids and dietary elimination are acceptable first-line treatment approaches. This review contains 7 figures, 5 tables, and 51 references. Key words: dysphagia, elimination diets, endoscopic dilation, eosinophilic esophagitis, eotaxin-3, feeding dysfunction, interleukin-5, proton pump inhibitor–responsive esophageal eosinophilia, swallowed fluticasone, viscous budesonide

scholarly journals Esophageal perforation during endoscopic removal of food impaction in eosinophilic esophagitis: stent well spent?

Endoscopy ◽  
2014 ◽  
Vol 46 (S 01) ◽  
pp. E193-E194 ◽  
Author(s):  
Bram van Rhijn ◽  
Wouter Curvers ◽  
Jacques Bergman ◽  
Joanne Verheij ◽  
Albert Bredenoord
Keyword(s):  
Eosinophilic Esophagitis ◽  
Esophageal Perforation ◽  
Food Impaction ◽  
Endoscopic Removal

Eosinophilic Esophagitis

2017 ◽  
Author(s):  
Walter W Chan ◽  
Vikrant S Jagadeesan
Keyword(s):  
Differential Diagnosis ◽  
Key Words ◽  
Clinical Features ◽  
Eosinophilic Esophagitis ◽  
Clinical Symptoms ◽  
Recent Analysis ◽  
Food Impaction ◽  
Treatment Complications ◽  
Chronic Disorder ◽  
Esophageal Dysfunction

Eosinophilic esophagitis (EoE) is a chronic disorder characterized by eosinophil-predominant inflammation of the esophagus and clinical symptoms of esophageal dysfunction. It is believed to be immune/antigen-mediated, and its diagnosis requires recognition of specific clinical features with appropriate histologic findings on esophageal mucosal biopsies. Over the last 10 years, there has been an increase in the prevalence of EoE worldwide. A recent analysis estimated a prevalence of 56.7 per 100,000 persons, with males more often affected than females. This review covers the epidemiology, pathophysiology and pathogenesis, diagnosis, differential diagnosis, treatment, complications, and prognosis of EoE. This review contains 3 figures, 2 tables, and 46 references. Key words: dysphagia, eosinophilic esophagitis, eotaxin-3, esophageal dysfunction, esophageal eosinophilia, food impaction, inflammation of the esophagus 

Su1508 Endoscopic Features of Eosinophilic Esophagitis and Association With History of Food Impaction

2013 ◽  
Vol 77 (5) ◽  
pp. AB350-AB351
Author(s):  
Shikha Mangla ◽  
Gaurav Singal ◽  
Jason L. Hornick ◽  
Robert Burakoff ◽  
Walter W. Chan
Keyword(s):  
Eosinophilic Esophagitis ◽  
Food Impaction ◽  
History Of
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