Background Eosinophilic oesophagitis (EoE) is caused by the ingestion of food antigens. Dietary avoidance can result in clinical and histological remission, while food reintroduction can cause recurrence. It is uncertain if food antigen processing and immune activation occurs locally, in the oesophagus. Therefore, we performed a comparative study of the density of cell surface proteins (known to be involved with antigen presentation) on oesophageal tissue prior to, and following food antigen induced disease recurrence. A secondary aim was to consider novel biomarkers. Method Adult patients with a diagnosis of EoE, who had achieved histological remission with an elimination diet (<15 eosinophils per high power field at oesophageal biopsy), and who underwent food challenge with proven recurrence were included. Immunohistochemistry/immunofluorescence for CD1a, CD3, CD28, CD40, CD69, CD80, CD138, CXCR3 and HLA‐DR was performed. Staining intensity of each biomarker (pixels/mm2) was quantified by semi‐automated analysis (Studio‐FL software). Results Fourteen cases of EoE (pre and post food challenge), 6 GORD and 5 healthy controls were included. HLA‐DR, CD3, CD28, CD40 and CD 138 significantly increased with food reintroduction (P = <0.05). CD1a, CD 69, CD 80 and CXCR3 did not measurably change. Conclusion The presence of cell surface proteins typically associated with antigen presentation (following food antigen induced recurrence) suggests immune activation occurs in the oesophagus, and the relative lack of langerhans cells (CD1a) may indicate this cell type is unimportant. The cell surface protein CD 138 increases with disease recurrence, is not elevated in GORD or healthy controls, and has promise as a biomarker.
Common nasopharyngeal and upper gastrointestinal foreign bodies include fish bones, chicken bones, food bolus, coin and dental prosthesis. 1,2 An uncommon cause of foreign body is gossypiboma. Gossypiboma is defined as retained foreign object of textile material, including surgical gauze, following a surgical operation. 3 A 76-year-old man presented to our hospital with breathing difficulty, halitosis and bloody purulent post-nasal secretions in the context of multiple cleft palate operations and a pharyngoplasty with his last operation performed 52 years ago. Upon physical examination, his palate appeared scarred and distorted. There were pinhole apertures in the velopharynx on either side of the dense adhesions,
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