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.

scholarly journals Increased Mast Cell Counts and Degranulation in Microscopic Colitis

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Zhikai Chi ◽  
Jing Xu ◽  
Romil Saxena
Keyword(s):  
Mast Cell ◽  
Cell Count ◽  
Cell Activation ◽  
Collagenous Colitis ◽  
Microscopic Colitis ◽  
Mast Cell Activation ◽  
Mucosal Inflammation ◽  
High Power Field ◽  
Cell Counts ◽  
Mast Cell Count

Objectives. Microscopic colitis (MC) is characterized by chronic diarrhea, normal colonoscopy findings, and mucosal inflammation in colonic biopsies and can be classified as collagenous colitis (CC) or lymphocytic colitis (LC). However, the pathogenesis of MC is largely unknown. In this study, we aimed to study mast cell counts and activation in MC. Methods. We investigated 64 biopsy samples from the surgical pathology database of Indiana University Health, which met the diagnostic criteria for CC or LC along with 20 control samples collected from 2014 to 2015. The specimens were used for the quantification of mast cells by examining the presence of intracellular and extracellular tryptase by immunohistochemistry. Results. In the lamina propria, the mast cell count was higher in both CC and LC groups than the control (mean highest count, 39/high-power field (HPF) vs. 30/HPF vs. 23/HPF; P<0.01). Extracellular tryptase was present in 10% of control subjects as compared to 41% of CC (P<0.05) and 60% of LC (P<0.001) patients. When LC patients were stratified into two groups with either <80% or >80% of fragments affected by inflammation, increased mast cell counts are only observed in the >80% involvement group compared with the control, but not the <80% involvement group. Conclusions. The increased mast cell count and degranulation are identified in MC, suggesting that mast cell activation might be involved in the pathogenesis of MC.

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.

Tu1139 Food Impaction Risk in Adult Patients With Eosinophilic Esophagitis Versus Proton Pump Inhibitor-Responsive Esophageal Eosinophilia

2015 ◽  
Vol 148 (4) ◽  
pp. S-800
Author(s):  
Alison Goldin ◽  
Shikha Mangla ◽  
Jason L. Hornick ◽  
Matthew J. Hamilton ◽  
Wai-Kit Lo ◽  
...  
Keyword(s):  
Proton Pump Inhibitor ◽  
Proton Pump ◽  
Eosinophilic Esophagitis ◽  
Adult Patients ◽  
Food Impaction ◽  
Esophageal Eosinophilia

scholarly journals A Clinical Perspective on the Dietary Therapies for Pediatric Eosinophilic Esophagitis: The Gap Between Research and Daily Practice

2021 ◽  
Vol 12 ◽  
Author(s):  
Liselot De Vlieger ◽  
Lieselot Smolders ◽  
Lisa Nuyttens ◽  
Sophie Verelst ◽  
Christine Breynaert ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Elemental Diet ◽  
Daily Practice ◽  
Elimination Diet ◽  
Treatment Modalities ◽  
Dietary Advice ◽  
High Power Field ◽  
Dietary Counseling ◽  
Allergy Test ◽  
Food Antigens

Pediatric eosinophilic esophagitis (ped-EoE) is an immune-mediated pathology affecting 34 per 100.000 children. It is characterized by an esophageal inflammation caused by an immune response towards food antigens that come into contact with the esophageal lining. Depending on the age of the child, symptoms can vary from abdominal pain, vomiting and failure to thrive to dysphagia and food impaction. The diagnosis of this chronic disease is based on the symptoms of esophageal dysfunction combined with an infiltration of more than 15 eosinophils per high-power field and the exclusion of secondary causes. The treatment modalities include the 3Ds: Drugs, allergen avoidance by Diet and/or esophageal Dilation. In this review we focused on the efficacy of dietary approaches in ped-EoE, which currently include the elemental diet (amino acid-based diet), the empiric elimination diet and the allergy test-directed elimination diet. Although several reviews have summarized these dietary approaches, a lack of consistency between and within the elimination diets hampers its clinical use and differences in subsequent reintroduction phases present a barrier for dietary advice in daily clinical practice. We therefore conducted an analysis driven from a clinician’s perspective on these dietary therapies in the management of ped-EoE, whereby we examined whether these variations within dietary approaches, yet considered to be similar, could result in significant differences in dietary counseling.

scholarly journals Eosinophilic Esophagitis: Atopy Conditions of the Esophagus

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.

scholarly journals Dietary Management of Eosinophilic Esophagitis: Tailoring the Approach

Nutrients ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1630
Author(s):  
Pierfrancesco Visaggi ◽  
Lucia Mariani ◽  
Veronica Pardi ◽  
Emma Maria Rosi ◽  
Camilla Pugno ◽  
...  
Keyword(s):  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
Immunoglobulin E ◽  
Wheat Gluten ◽  
Skin Tests ◽  
Dietary Therapy ◽  
Dietary Management ◽  
High Power Field ◽  
Advantages And Disadvantages

Eosinophilic esophagitis (EoE) is a unique form of non-immunoglobulin E-mediated food allergy, restricted to the esophagus, characterized by esophageal eosinophil-predominant inflammation and dysfunction. The diagnosis requires an esophago-gastroduodenoscopy with esophageal biopsies demonstrating active eosinophilic inflammation with 15 or more eosinophils/high-power field, following the exclusion of alternative causes of eosinophilia. Food allergens trigger the disease, withdairy/milk, wheat/gluten, egg, soy/legumes, and seafood the most common. Therapeutic strategies comprise dietary restrictions, proton pump inhibitors, topical corticosteroids, biologic agents, and esophageal dilation when strictures are present. However, avoidance of trigger foods remains the only option targeting the cause, and not the effect, of the disease. Because EoE relapses when treatment is withdrawn, dietary therapy offers a long-term, drug-free alternative to patients who wish to remain off drugs and still be in remission. There are currently multiple dietary management strategies to choose from, each having its specific efficacy, advantages, and disadvantages that both clinicians and patients should acknowledge. In addition, dietary regimens should be tailored around each individual patient to increase the chance of tolerability and long-term adherence. In general, liquid elemental diets devoid of antigens and elimination diets restricting causative foods are valuable options. Designing diets on the basis of food allergy skin tests results is not reliable and should be avoided. This review summarizes the most recent knowledge regarding the clinical use of dietary measures in EoE. We discussed endpoints, rationale, advantages and disadvantages, and tailoring of diets, as well as currently available dietary regimens for EoE.

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.

864 BARRIER DYSFUNCTION IN EOSINOPHILIC ESOPHAGITIS IS ASSOCIATED WITH MAST CELL ACTIVATION

2020 ◽  
Vol 158 (6) ◽  
pp. S-177-S-178
Author(s):  
Lorena A. Ostilla ◽  
Amanda A. Wenzel ◽  
Ming Wang ◽  
Brooke Boyer ◽  
Kaitlyn Keeley ◽  
...  
Keyword(s):  
Mast Cell ◽  
Eosinophilic Esophagitis ◽  
Cell Activation ◽  
Mast Cell Activation ◽  
Barrier Dysfunction

Eosinophilic Esophagitis: Atopy Conditions of the Esophagus

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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