9 years of recurrent dysphagia

Basavaraju, K P; Hunt, Charlie; Ahluwalia, N K

doi:10.1016/s0140-6736(07)60819-8

Cited by 5 publications

(7 citation statements)

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“…Eosinophilic oesophagitis (EoE) has evolved over the last 15 years from a rare entity to one whose incidence rates are approaching that of inflammatory bowel disease. It is now recognised as one of the most common causes of dysphagia and recurrent food bolus impaction necessitating urgent endoscopic intervention . The histological hallmark of EoE is a dense intraepithelial eosinophilic infiltrate .…”

Section: Introductionmentioning

confidence: 99%

The rising incidence of eosinophilic oesophagitis is associated with increasing biopsy rates: a population‐based study

Syed

Andrews

Shaffer

et al. 2012

Aliment Pharmacol Ther

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Section: Introductionmentioning

confidence: 99%

The rising incidence of eosinophilic oesophagitis is associated with increasing biopsy rates: a population‐based study

Syed

Andrews

Shaffer

et al. 2012

Aliment Pharmacol Ther

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“…Symptoms of the condition include chest pain, intermittent dysphagia, and food bolus obstruction. Patients are often mislabeled as having gastroesophageal reflux disease (GERD), leading to several years of diagnostic delay and uncontrolled symptoms 21,22 …”

Section: Introductionmentioning

confidence: 99%

Is the etiology of eosinophilic esophagitis in adults a response to allergy or reflux injury? Study of cellular proliferation markers

Lewis

Lamb

Kanakala

et al. 2009

Diseases of the Esophagus

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Recent research suggests that allergy may be the key factor in the etiology of eosinophilic esophagitis (EE); however, historically, the condition was hypothesized as related to reflux injury to the esophageal mucosa. We studied this hypothesis by comparing markers of inflammation and cellular proliferation in EE and reflux esophagitis. Lower esophageal biopsies of adult patients with EE (n = 10), reflux esophagitis (n = 8), and normal controls (n = 13) were assessed quantitatively for the expression of the cyclooxygenase-2 (COX-2) enzyme, cellular proliferation, and oncogenic resistance to apoptosis using monoclonal antibodies for COX-2, Ki-67, and Bcl-2, respectively. Normal esophageal epithelium demonstrated weak diffuse uptake of COX-2 stain in the basal layer. No COX-2 expression was demonstrated in the EE group, significantly less than the control and reflux groups (P < 0.01 and P < 0.001, respectively). Cellular proliferation measured by Ki-67 expression was higher in EE and reflux compared with control (P < 0.001 and P < 0.01). Ki-67 expression, and thus degree of hyperplasia, appeared greater in EE than reflux, but was not statistically significant (P = 0.228). The degree of apoptosis was similar in all study groups. EE and reflux esophagitis are proliferative conditions expressing Ki-67 in higher concentrations than control. Mucosal proliferation in reflux esophagitis is COX-2 dependent. This novel research in EE has demonstrated downregulation of COX-2 expression compared with reflux esophagitis and control. We hypothesize that the allergy-related cytokine IL-13 known to inhibit COX-2 expression and found in high concentrations in EE as responsible for this. The pathogenesis of EE is likely dependent on allergy rather than reflux injury to the esophagus.

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“…Side effects included nausea in four patients and myalgia in one patient. The subjective improvement of symptoms in both paediatric and adult patients has also been replicated in a case report and smaller case series (46,49,76).…”

Section: Pharmacological Therapymentioning

confidence: 68%

“…Oesophageal stenosis with food impaction is a consistent feature in EO patients. Recent reports of improving dysphagia as well reversibility of the endoscopically impassable oesophageal strictures with steroid therapy alone, support an inflammatory rather than fibrotic nature of these strictures (31,46,52). Schatzki’s ring may result in dysphagia in EO patients (43,51,52).…”

Section: Mechanisms Of Tissue Injury and Dysphagiamentioning

confidence: 99%

“…Systemic steroids have consistently been shown to be effective in inducing symptomatic as well as histological improvement (6,9,13,25,46,60,76,79), even in patients with severe oesophageal strictures and to reduce the need for repeated dilatations. The major drawback with this treatment is the recurrence of symptoms after cessation of therapy.…”

Section: Systemic Corticosteroidsmentioning

confidence: 99%

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Eosinophilic oesophagitis: a common cause of dysphagia in young adults?

Basavaraju

Wong

2008

International Journal of Clinical Practice

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Eosinophilic oesophagitis (EO) is an increasingly recognised chronic, relapsing inflammatory condition of the oesophagus. There has been a mini-epidemic of EO in the last decade. The incidence of this condition is higher in children and is commoner in males. There is either a family or personal history of atopic conditions present in a significant number of patients and can also be familial in up to 10%. The classical symptom in an adult is chronic, intermittent solid-food dysphagia and food impaction, often necessitating emergency endoscopic removal. Despite the history of dysphagia for a number of years, patients remain well with no weight loss, which can mislead clinicians to diagnose a functional problem with a resulting delay in the diagnosis. There are various endoscopic features of EO; commonly multiple rings and linear furrows, though these can be subtle and the mucosa may be macroscopically normal. The hallmark of this condition is the histological presence of > or =15 eosinophils/high power field (HPF) in the oesophageal mucosa. Therapeutic options include avoidance of dietary allergens, topical or systemic steroids, Montelukast, Mepolizumab (anti-IL-5 antibody) and endoscopic dilation of strictures unresponsive to medical therapy.

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9 years of recurrent dysphagia

Cited by 5 publications

References 0 publications

The rising incidence of eosinophilic oesophagitis is associated with increasing biopsy rates: a population‐based study

The rising incidence of eosinophilic oesophagitis is associated with increasing biopsy rates: a population‐based study

Is the etiology of eosinophilic esophagitis in adults a response to allergy or reflux injury? Study of cellular proliferation markers

Eosinophilic oesophagitis: a common cause of dysphagia in young adults?

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