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

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.

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Eosinophilic Esophagitis: Atopy Conditions of the Esophagus

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i3.25 ◽

2021 ◽

Vol 2 (3) ◽

pp. 154-166

Author(s):

Puspa Zuleika

Keyword(s):

United States ◽

Food Allergy ◽

Eosinophilic Esophagitis ◽

The United States ◽

Esophageal Stenosis ◽

Esophageal Mucosa ◽

High Power Field ◽

Immune Mediated ◽

Food Antigens ◽

Delays In Diagnosis

Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental) characterized by major symptoms of esophagealdysphagia and eosinophil-predominant inflammation of the esophageal mucosathat affects both pediatric and adult patients. EoE is an immune-mediated diseaseby which environmental and food antigens stimulate the Th2 inflammatorycascade. It is correlated with food allergy and atopy condition such as asthma, atopydermatitis, rhinitis allergic and often in conjunction with Gastroesophageal RefluxDisease (GERD). Eosinophilic esophagitis (EoE) was first described in the 1990s,showing an increasing incidence and prevalence since then, in the United States isestimated to be approximately 57 per 100,000 persons being the leading cause offood impaction and the major cause of dysphagia. Its symptoms, which includeheartburn, regurgitation, and esophageal stenosis. This symptomps similar to thoseof gastroesophageal reflux disease, causing delays in diagnosis and treatment. Theendoscopic findings such as furrows, esophageal mucosa trachealization, andwhitish exudates, this diagnosis should be confirmed histologically confirmed bybiopsy on the presence of more than 15 eosinophils per high-power field and theexclusion of other causes of eosinophilia. Management includes medications, diet,and surgical dilatation.

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Eosinophilic esophagitis: clinical, endoscopic, histologic and therapeutic differences and similarities between children and adults

Therapeutic Advances in Gastroenterology ◽

10.1177/1756284820980860 ◽

2021 ◽

Vol 14 ◽

pp. 175628482098086

Author(s):

Pierfrancesco Visaggi ◽

Edoardo Savarino ◽

Giusi Sciume ◽

Teresa Di Chio ◽

Francesco Bronzini ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Diagnostic Delay ◽

Clinical Manifestations ◽

T Helper ◽

Therapeutic Approaches ◽

Dietary Interventions ◽

Immune Mediated ◽

Esophageal Dysfunction ◽

The Mean

In the absence of secondary causes, eosinophilic esophagitis (EoE) is a chronic, local, progressive, T-helper type 2 immune-mediated disorder characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In the last 20 years, the incidence and prevalence of EoE have risen sharply, and the chances of encountering affected patients in clinics and endoscopy rooms have increased. Nevertheless, it is estimated that the mean diagnostic delay of EoE is 4–6 years in both children and adults. Unfortunately, the longer the disease stays unrecognized, the likelier it is for the patient to have persistent or increased esophageal eosinophilic inflammation, to complain of non-resolving symptoms, and to develop fibrotic complications. Early detection depends on the recognition of initial clinical manifestations that vary from childhood to adulthood and even among patients of the same age. The disease phenotype also influences therapeutic approaches that include drugs, dietary interventions, and esophageal dilation. We have herein reviewed epidemiologic, clinical, endoscopic, and histologic features and therapeutic options of EoE focusing on differences and similarities between children and adults that may certainly serve in daily clinical practice.

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Eosinophilic Esophagitis in a Kitten

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6367 ◽

2017 ◽

Vol 53 (4) ◽

pp. 214-220

Author(s):

Julie Pera ◽

Douglas Palma ◽

Taryn A. Donovan

Keyword(s):

Eosinophilic Esophagitis ◽

Clinical Signs ◽

Failure To Thrive ◽

Eosinophilic Infiltration ◽

Dietary Modification ◽

Esophageal Mucosa ◽

Intact Male ◽

High Power Field ◽

Significant Clinical Improvement ◽

Dry Food

ABSTRACT A 4 mo old intact male kitten was presented for chronic regurgitation and failure to thrive after weaning to dry food. Esophageal dilatation and severe diffuse proliferative lesions of the esophageal mucosa were found via radiography and esophagoscopy, respectively. Histopathologic examination revealed severe, chronic, diffuse, hyperplastic eosinophilic and mastocytic esophagitis. Eosinophilic infiltrates were prominent, with a mean of 29.8 eosinophils per high power field, supportive of eosinophilic esophagitis (EoE). Significant clinical improvement was seen with dietary modification using a hydrolyzed diet. The addition of glucocorticoids did not result in further improvement in clinical signs. Repeat histopathology showed near resolution of eosinophilic infiltration. EoE is an uncommon and rarely reported condition in dogs and cats. Diagnosis involves histopathologic confirmation and exclusion of other causes of eosinophilic infiltration within the esophagus. This case report demonstrates the importance of biopsy in identification of EoE and the efficacy of dietary modification in the treatment of this disease in a kitten.

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Eosinophilic Esophagitis: Atopy Conditions of the Esophagus

Archives of The Medicine and Case Reports ◽

10.37275/amcr.v2i1.27 ◽

2021 ◽

Vol 2 (1) ◽

pp. 146-157

Author(s):

Puspa Zuleika

Keyword(s):

Eosinophilic Esophagitis ◽

Reflux Disease ◽

The United States ◽

Esophageal Stenosis ◽

Esophageal Mucosa ◽

High Power Field ◽

Inflammatory Cascade ◽

Immune Mediated ◽

Food Antigens ◽

Delays In Diagnosis

A B S T R A C TEosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental) characterized by major symptoms of esophagealdysphagia and eosinophil-predominant inflammation of the esophageal mucosa thataffects both pediatric and adult patients. EoE is an immune-mediated disease bywhich environmental and food antigens stimulate the Th2 inflammatory cascade. It iscorrelated with food allergy and atopy condition such as asthma, atopy dermatitis,rhinitis allergic and often in conjunction with Gastroesophageal Reflux Disease(GERD). Eosinophilic esophagitis (EoE) was first described in the 1990s, showing anincreasing incidence and prevalence since then, in the United States is estimated tobe approximately 57 per 100,000 persons being the leading cause of food impactionand the major cause of dysphagia. Its symptoms, which include heartburn,regurgitation, and esophageal stenosis. This symptomps similar to those ofgastroesophageal reflux disease, causing delays in diagnosis and treatment. Theendoscopic findings such as furrows, esophageal mucosa trachealization, and whitishexudates, this diagnosis should be confirmed histologically confirmed by biopsy onthe presence of more than 15 eosinophils per high-power field and the exclusion ofother causes of eosinophilia. Management includes medications, diet, and surgicaldilatation.

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Do Eosinophil Numbers Differentiate Eosinophilic Esophagitis from Gastroesophageal Reflux Disease?

Archives of Pathology & Laboratory Medicine ◽

10.5858/134.6.815 ◽

2010 ◽

Vol 134 (6) ◽

pp. 815-825

Author(s):

Muriel Genevay ◽

Laura Rubbia-Brandt ◽

Anne-Laure Rougemont

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Eosinophilic Esophagitis ◽

Reflux Disease ◽

Eosinophilic Infiltration ◽

Treatment Modalities ◽

Esophageal Mucosa ◽

American Gastroenterological Association ◽

National Library

Abstract Context.—Although the healthy esophageal mucosa contains no eosinophils, eosinophilic infiltration is observed in 2 major clinicopathologic settings: gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EE). The prevalence of EE is increasing in many countries, and this increase seems only partly to be due to a better awareness of the pathology, following the relatively recent description of EE. Gastroesophageal reflux disease and EE represent 2 entities that do not respond to the same treatment modalities and, thus, need to be distinguished. However, diagnostic criteria of EE have been defined arbitrarily, and the more recent articles tend to prove that the overlap with GERD is probably greater than initially believed, leading the authors to advise strict exclusion of GERD before considering the diagnosis of EE. Objectives.—To provide pathologists with the currently proposed histologic criteria of GERD and EE, to stress the need to combine these criteria with clinical data and endoscopic findings, and to outline the remaining controversies. Data Sources.—This review is based on selected articles identified by a PubMed (US National Library of Medicine, Bethesda, Maryland) search of the literature in English for GERD and EE, a recent review by the American Gastroenterological Association (Bethesda), the Proceedings of the First International Gastrointestinal Eosinophil Research Symposium, and the authors' experience. Conclusions.—Proper identification of the etiology of eosinophilic infiltration of the esophagus allows accurate medical or surgical treatment and follow-up. Eosinophilic esophagitis and GERD diagnoses require integration of the histologic findings with the clinical and endoscopic data.

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Eosinophilic esophagitis and achalasia – just a coincidence?

Zeitschrift für Gastroenterologie ◽

10.1055/a-0808-5043 ◽

2019 ◽

Vol 57 (02) ◽

pp. 151-155 ◽

Cited By ~ 1

Author(s):

Thomas Frieling ◽

Jürgen Heise ◽

Christian Kreysel ◽

Michael Blank ◽

Bernhard Hemmerlein ◽

...

Keyword(s):

Eosinophilic Esophagitis ◽

Esophageal Achalasia ◽

Eosinophilic Infiltration ◽

Barium Swallow ◽

Pneumatic Dilation ◽

Noncardiac Chest Pain ◽

High Power Field ◽

Eckardt Score ◽

Impedance Testing ◽

Diagnostic Work

Abstract Background Eosinophilic esophagitis (EoE) is detected frequently in dysphagia and noncardiac chest pain. Management of patients with EoE may be complicated because EoE is associated frequently with esophageal motility disorders. We present the rare case of esophageal achalasia (EA) associated with eosinophilic infiltration and a literature review. Material and methods A patient with dysphagia and eosinophilic infiltration referred to our clinic underwent standardized diagnostic work-up including symptom questionnaire, esophagogastroduodenoscopy (EGD) with esophageal biopsies, barium swallow, high-resolution esophageal manometry, and combined intraluminal 24-hour pH-impedance testing (pH/MII). Results The patient had an Eckardt score of 8. EGD and mucosal biopsies showed typical EoE with > 15 eosinophil leucocytes per high-power field. Barium swallow revealed typical sign of achalasia. HREM indicated EA type 2 according to the Chicago classification. PH/MII was normal. Oral and systemic corticoid therapy were without effect. After successful treatment by pneumatic dilation of the cardia, symptoms relieved and eosinophilic infiltration returned to normal. Conclusion The results suggest that the patient had primary EA associated with eosinophilic infiltration and that the combined occurrence of these rare diseases is not just a coincidence.

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Role of Mucosal Inflammation in Eosinophilic Esophagitis: Review of the Literature

ISRN Gastroenterology ◽

10.5402/2011/468073 ◽

2011 ◽

Vol 2011 ◽

pp. 1-7 ◽

Cited By ~ 1

Author(s):

Ghulamullah Shahzad ◽

Paul Mustacchia ◽

Marianne Frieri

Keyword(s):

Eosinophilic Esophagitis ◽

Acid Suppression ◽

Treatment Modalities ◽

Mucosal Inflammation ◽

Esophageal Mucosa ◽

Immune Mediated ◽

Acid Suppression Therapy ◽

Clear Differentiation ◽

Histological Confirmation

Eosinophilic esophagitis (EE) is increasingly recognized in adults. It is an inflammatory disease of the esophageal mucosa, with variable presentation, unresponsive to acid suppression therapy. The diagnosis requires histological confirmation of intense eosinophilic infiltration on esophageal biopsy specimen, however exact criteria required to make a diagnosis of EE is still being debated and a clear differentiation from gastroesophageal reflux disease (GERD) is important. Allergen elimination or anti-inflammatory therapy may be effective in such patients. The imperfect diagnostic criteria for EE mandate an understanding of the immunology and the pathophysiology of the disease. It may facilitate the introduction of novel treatment modalities in an individual unresponsive to acid suppression therapy. This paper describes basic elements of the immune-mediated injury to the esophageal mucosa and management aspects to provide a better understanding of the condition.

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Eosinofilik Esofagitis

Jurnal Kesehatan Andalas ◽

10.25077/jka.v2i3.168 ◽

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

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Anterior hypopituitarism secondary to biopsy-proven IgG4-related hypophysitis in a young man

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-18-0137 ◽

2019 ◽

Vol 2019 ◽

Author(s):

H Joshi ◽

M Hikmat ◽

A P Devadass ◽

S O Oyibo ◽

S V Sagi

Keyword(s):

Clinical Manifestations ◽

Pituitary Hormone ◽

List Type ◽

Igg4 Related Disease ◽

Anterior Pituitary Hormone ◽

Immune Mediated ◽

Learning Points ◽

Term Management

Summary IgG4-related disease (IgG4-RD) is an immune-mediated fibro-inflammatory condition which can affect various organs including the pituitary gland. The true annual incidence of this condition remains widely unknown. In addition, it is unclear whether IgG4 antibodies are causative or the end result of a trigger. With no specific biomarkers available, the diagnosis of IgG4-related hypophysitis remains a challenge. Additionally, there is a wide differential diagnosis. We report a case of biopsy-proven IgG4-related hypophysitis in a young man with type 2 diabetes mellitus. Learning points: IgG4-related hypophysitis is part of a spectrum of IgG4-related diseases. Clinical manifestations result from anterior pituitary hormone deficiencies with or without diabetes insipidus, which can be temporary or permanent. A combination of clinical, radiological, serological and histological evidence with careful interpretation is required to make the diagnosis. Tissue biopsy remains the gold standard investigation. Disease monitoring and long-term management of this condition is a challenge as relapses occur frequently.

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DOZ047.76: Eosinophilic esophagitis and esophageal atresia. Is there an association?

Diseases of the Esophagus ◽

10.1093/dote/doz047.76 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

L García ◽

C Giné ◽

A Laín ◽

M Martín ◽

J A Molino ◽

...

Keyword(s):

Gastroesophageal Reflux ◽

Diagnostic Criteria ◽

Esophageal Atresia ◽

Eosinophilic Esophagitis ◽

Esophageal Mucosa ◽

Early Puberty ◽

High Power Field ◽

Esophageal Biopsy ◽

Macroscopic Appearance

Abstract Aim of the Study Eosinophilic esophagitis (EoE) is a recently diagnosed entity and seems to be more prevalent in patients with esophageal atresia (EA). It can mimic dysphagia and gastroesophageal reflux (GER) symptoms frequently observed in EA, but treatment is different. Methods Retrospective review (2002–2019) of patients with EA who underwent esophagogastroduodenoscopy (EGD) and esophageal biopsy was performed. EGD was performed in symptomatic patients and in all patients at 12–15 years. Diagnostic criteria for EoE included >15 eosinophils for a high-power field in the esophageal mucosa. Main Results From a total of 110 patients with EA, 27 lost follow-up. In the remaining 83, 56 patients (67, 5%) underwent EGD because of dysphagia or gastroesophageal reflux (GER) studies. Esophageal biopsies were performed in 35 patients and the diagnostic criteria for EoE were achieved in 5 (14,3%). The mean age at diagnosis of EoE was 10 + 2 years and the indication for EGD was GER symptoms (3) or dysphagia (2). In one case an antireflux surgery was previously performed but symptoms slightly persisted, while in 4 cases contrast studies and pH-metry showed no or minimal GER. EGD demonstrated light distal esophagitis in 2 cases, white exudates in 2, and was completely normal in the remaining one. On follow-up, 4 patients remain asymptomatic with proton pump inhibitor medication, and periodic EGD shows macroscopic improvement with a decreased eosinophilic peak on esophageal biopsies. Conclusions Patients with EA seem to have a higher risk of developing EoE at early puberty. EGD on follow-up should be focused not only on studying GER or Barrett, but also on actively search for EoE with an esophageal biopsy, even when the macroscopic appearance is normal.

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