Activated Mucosal Mast Cells Differentiate Eosinophilic (Allergic) Esophagitis From Gastroesophageal Reflux Disease

Abstract

Intraepithelial MC counts and IgE-bearing cells may help to differentiate EE and GERD and to define a subset of GERD patients in which an allergic component is present. The findings support a role for a MC-mediated hypersensitivity reaction in the pathogenesis of EE.

Esophageal Remodeling Develops as a Consequence of Tissue Specific IL-5-Induced Eosinophilia

“…10-14 Although EE clinically mimics gastroesophageal reflux disease, it is distinguished by the magnitude of eosinophils and basal layer hyperplasia and the lack of response to antireflux medication. 15,16 Evidence from animal models suggests that eosinophils may have a role in tissue remodeling through the release of lipid mediators, cytokines, and cytotoxic proteins, 17-19 yet their role in esophageal remodeling has been largely unexplored. Therefore, we focused the present study on understanding the role of eosinophils in the induction of esophageal tissue remodeling such as basal layer thickening and collagen accumulation.…”

Mast Cells Distinguish Eosinophilic Esophagitis in Pediatric Patients

“…Kirsch et al observed that mast cell count was greater in the esophageal epithelium of pediatric EoE patients, in comparison to GERD patients (10) . Those authors did not consider PPI-responsive eosinophilic esophagitis, defined and reported in the literature 1 year before their publication (17) .…”

“…Several studies have investigated the role of special staining to identify inflammatory mediators and eosinophil derived elements, aimed at increasing the predictive value of the differential diagnosis. Some reports have indicated that a higher count of mast cells in the esophageal mucosa may be a diagnostic marker for EoE and PPI-responsive eosinophilic esophagitis (1,4,10,18,19,22) . The aim of this study was to confirm that the presence of mast cells in the esophageal epithelium of children, identified by immunohistochemistry for tryptase, may be associated with EoE and/or PPI-responsive eosinophilic esophagitis and can be useful in the differential diagnosis with RE.…”

Adult versus pediatric eosinophilic esophagitis: important differences and similarities for the clinician to understand

“…These include mast cells, which exhibit increased density in both pediatric [61][62][63][64] and adult patients [6,57,65,66], a feature that has been proposed as a differentiating element from GERD [67]. Intraepithelial CD3 + T lymphocytes are also significantly increased in both children [55,68] and adults [69] with EoE.…”