Eosinophilic esophagitis: A potential complication of sublingual immunotherapy

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.

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SUPPORTING THERAPY IN EOSINOPHILIC ESOPHAGITIS: WHY, WHOM, HOW?

Kuban Scientific Medical Bulletin ◽

10.25207/1608-6228-2018-25-3-167-172 ◽

2018 ◽

Vol 25 (3) ◽

pp. 167-172

Author(s):

N. V. KOROCHANSKAYA ◽

S. N. SERIKOVA ◽

M. A. BASENKO ◽

S. S. SERIKOV

Keyword(s):

Corticosteroid Therapy ◽

Eosinophilic Esophagitis ◽

Selection Criteria ◽

Clinical Course ◽

Morphological Changes ◽

Histological Study ◽

Elimination Diet ◽

Esophageal Wall ◽

History Of ◽

The Right

Aim. To demonstrate peculiarities of clinic features, difficulties of diagnostics and treatment of eosinophilic esophagitis using a clinic case.Materials and methods. The investigation of the clinic case in young woman with eosinophilic esophagitis is presented. The diagnosis was established 6 years after the manifestation of the disease on the stage of complications developed (esophageal stricture). A complex examination included endoscopy, morphologic methods and consultations with adjacent specialists (llergologist, ENT). Drug therapy was carried out by system and topical corticosteroids according to recommendations of Russian gastroenterological association from 2013.Results. The right diagnosis was established by the assessment of the clinic feature of dysphagia with revealing of mucosal eosinophilic infiltration during histological study of esophageal mucosal biopsies. The elimination diet and corticosteroid therapy improved the clinic course of the disease considerably. However, there were no signs of morphological changes of esophageal wall recovery. As a result, the patient needed to be treated and managed constantly. Based on the literature data the authors described variations of natural history of the disease, discussed the approaches to supporting therapy, and revealed group selection criteria of the patients most of all needed to anti-relapsing therapy.Conclusion. Eosinophilic esophagitis is a chronic immune-antigendependent inflammatory disease of the esophagus with insufficiently investigated etiopathogenesis. A number of questions concerning this disease need to be studied (clinical course, possibility of long-lasted remission and self-recovery, duration of corticosteroid therapy, etc).

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Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

Case Reports in Medicine ◽

10.1155/2014/673189 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 8

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.

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

Russian Journal of Gastroenterology Hepatology Coloproctology ◽

10.22416/1382-4376-2018-28-6-84-98 ◽

2019 ◽

Vol 28 (6) ◽

pp. 84-98 ◽

Cited By ~ 4

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.

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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—established facts and new horizons

Seminars in Immunopathology ◽

10.1007/s00281-021-00855-y ◽

2021 ◽

Author(s):

Luc Biedermann ◽

Alex Straumann ◽

Thomas Greuter ◽

Philipp Schreiner

Keyword(s):

Eosinophilic Esophagitis ◽

Treatment Options ◽

Dietary Treatment ◽

Trigger Factor ◽

Success Rates ◽

Patient Centered ◽

Relative Contribution ◽

Inflammatory Conditions ◽

Immune Mediated ◽

Clinical Presentations

AbstractDespite dramatic advances in our understanding of the pathogenesis and course of disease in the relatively short timeframe since the discovery and first description of eosinophilic esophagitis (EoE) less than three decades ago, many open questions remain to be elucidated. For instance, we will need to better characterize atypical clinical presentations of EoE and other forms of esophageal inflammatory conditions with often similar clinical presentations, nut fulfilling current diagnostic criteria for EoE and to determine their significance and interrelationship with genuine EoE. In addition, the interrelationship of EoE with other immune-mediated diseases remains to be clarified. Hopefully, a closer look at the role of environmental factors and their interaction with genetic susceptibility often in context of atopic predisposition may enable identifying the candidate substances/agents/allergens and potentially earlier (childhood) events to trigger the condition. It appears plausible to assume that in the end—comparable to current concepts in other immune-mediated chronic diseases, such as for instance inflammatory bowel disease or asthma bronchiale—we will not be rewarded with the identification of a “one-and-only” underlying pathogenetic trigger factor, with causal responsibility for the disease in each and every EoE patient. Rather, the relative contribution and importance of intrinsic susceptibility, i.e., patient-driven factors (genetics, aberrant immune response) and external trigger factors, such as food (or aero-) allergens as well as early childhood events (e.g., infection and exposure to antibiotics and other drugs) may substantially differ among given individuals with EoE. Accordingly, selection and treatment duration of medical therapy, success rates and extent of required restriction in dietary treatment, and the need for mechanical treatment to address strictures and stenosis require an individualized approach, tailored to each patient. With the advances of emerging treatment options, the importance of such an individualized and patient-centered assessment will increase even further.

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Applications of SEM/EDXA in cement clinker investigation

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100177489 ◽

1990 ◽

Vol 48 (4) ◽

pp. 870-871

Author(s):

Arezki Tagnit-Hamou ◽

Shondeep L. Sarkar

Keyword(s):

Mineralogical Composition ◽

Physicochemical Characteristics ◽

Cement Clinker ◽

Accurate Information ◽

Phase Identification ◽

History Of ◽

Bulk Chemical ◽

Resolution Imaging ◽

Proven Method ◽

Instantaneous Chemical

All the desired properties of cement primarily depend on the physicochemical characteristics of clinker from which the cement is produced. The mineralogical composition of the clinker forms the most important parameter influencing these properties.Optical microscopy provides reasonably accurate information pertaining to the thermal history of the clinker, while XRDA still remains the proven method of phase identification, and bulk chemical composition of the clinker can be readily obtained from XRFA. Nevertheless, all these microanalytical techniques are somewhat limited in their applications, and SEM/EDXA combination fills this gap uniquely by virtue of its high resolution imaging capability and possibility of instantaneous chemical analysis of individual phases.Inhomogeneities and impurities in the raw meal, influence of kiln conditions such as sintering and cooling rate being directly related to the microstructure can be effectively determined by SEM/EDXA. In addition, several physical characteristics of cement, such as rhcology, grindability and hydraulicity also depend on the clinker microstructure.

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An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

Perspectives in Surgery ◽

10.33699/pis.2019.98.8.326-327 ◽

2019 ◽

Vol 98 (8) ◽

pp. 326-327 ◽

Cited By ~ 1

Keyword(s):

Liver Cirrhosis ◽

Abdominal Pain ◽

Case Report ◽

Portal Hypertension ◽

Liver Disease ◽

Epigastric Pain ◽

Umbilical Vein ◽

History Of ◽

Clinically Significant ◽

Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

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