Eosinophilic esophagitis in patients with typical gastroesophageal reflux disease symptoms refractory to proton pump inhibitor

Abstract

BACKGROUND: TREATMEN The contribution of eosinophilic esophagitis (EoE) to refractory gastroesophageal reflux disease (GERD) remains unknown. When EoE and GERD overlap, the clinical, endoscopic and histological findings are nonspecific and cannot be used to distinguish between the two disorders. Limited data are available on this topic, and the interaction between EoE and GERD is a matter of debate.AIM:We have conducted a prospective study of adult patients with refractory GERD to evaluate the overlap of reflux and EoE.METHODS:Between July 2006 and June 2008, we consecutively and prospectively enrolled 130 male and female patients aged 18 to 70 years old who experienced persistent heartburn and/or regurgitation more than twice a week over the last 30 days while undergoing at least six consecutive weeks of omeprazole treatment (at least 40 mg once a day). The patients underwent an upper digestive endoscopy with esophageal biopsy, and intraepithelial eosinophils were counted after hematoxylin/eosin staining. The diagnosis of EoE was based on the presence of 20 or more eosinophils per high-power field (eo/HPF) in esophageal biopsies.RESULTS:Among the 103 studied patients, 79 (76.7%) were females. The patients had a mean age of 45.5 years and a median age of 47 years. Endoscopy was normal in 83.5% of patients, and erosive esophagitis was found in 12.6%. Only one patient presented lesions suggestive of EoE. Histological examination revealed >20 eo/HPF in this patient.CONCLUSION:Our results demonstrated a low prevalence of EoE among patients with refractory GERD undergoing omeprazole treatment.

Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus

“…Eosinophilic oesophagitis is increasingly diagnosed in patients with oesophageal symptoms, especially dysphagia and GORD-like symptoms 67 68. The estimated prevalence of eosinophilic oesophagitis based on a multicentre study in Japan was 17.1/100 00069 persons compared with 56.7/100 00070 persons in the USA.…”

Proton pump inhibitor-refractory gastroesophageal reflux disease: challenges and solutions

“… 87 – 90 In one study of 130 patients with persistent heartburn and/or regurgitation despite receiving 6 weeks of omeprazole treatment, only one patient was found to have lesions on upper endoscopy suggestive of EoE. 89 Similarly, a study of 105 patients with PPI-resistant heartburn found that only 0.9% of patients had EoE on upper endoscopy. 90 Overall, EoE is a relatively uncommon disorder and unlikely to be a cause of GERD symptoms that do not respond to PPI therapy.…”

Gastro-oesophageal reflux disease and eosinophilic oesophagitis: What is the relationship?

“…Other less common symptoms include chest pain, dysphagia, dyspepsia, epigastric pain, nausea, bloating, belching, chronic cough, asthma, laryngitis and other respiratory symptoms[ 45 - 48 ]. Whilst dysphagia is infrequent in GORD, it is the most common presenting symptom for EoE along with food bolus impaction[ 1 , 10 , 49 ]. Approximately 50% of patients who present with food bolus impaction and up to 15% of patients who undergo endoscopy for non-obstructive dysphagia will have EoE[ 6 , 50 ].…”

“…Fifty to eighty percent of EoE patients have a prior history of atopic symptoms[ 21 ]. Other non-specific symptoms include chest pain, heartburn, regurgitation, dyspepsia, nausea and vomiting, odynophagia, abdominal pain and non-specific throat symptoms[ 1 , 10 , 31 , 33 , 49 , 52 ].…”