Benign and precursor lesions in the esophagus

Akiyama, Junichi; Bertelè, A.; Brock, Christina; Hvid-Jensen, Frederik; Ichiya, Tamaki; Krarup, Anne Lund; Majewski, Marek; Rubio, Carlos A.; Sarosiek, Jerzy; Scarpignato, Carmelo; Schmidt, Peter T.; Teich, Steven; Triadafilopoulos, George; Wallner, Grzegorz

doi:10.1111/nyas.12534

Cited by 9 publications

(8 citation statements)

References 67 publications

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“…Despite a contrary opinion of the American Gastroenterological Association [86], current evidence suggests that standard PPI therapy is unable to normalize esophageal exposure to acid in the vast majority of patients with Barrett’s esophagus. Profound and individually tailored maximal acid suppression is needed not only to control GER, but also in the hope to achieve a better chemopreventive effect [89]. …”

Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

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323

288

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BackgroundThe introduction of proton pump inhibitors (PPIs) into clinical practice has revolutionized the management of acid-related diseases. Studies in primary care and emergency settings suggest that PPIs are frequently prescribed for inappropriate indications or for indications where their use offers little benefit. Inappropriate PPI use is a matter of great concern, especially in the elderly, who are often affected by multiple comorbidities and are taking multiple medications, and are thus at an increased risk of long-term PPI-related adverse outcomes as well as drug-to-drug interactions. Herein, we aim to review the current literature on PPI use and develop a position paper addressing the benefits and potential harms of acid suppression with the purpose of providing evidence-based guidelines on the appropriate use of these medications.MethodsThe topics, identified by a Scientific Committee, were assigned to experts selected by three Italian Scientific Societies, who independently performed a systematic search of the relevant literature using Medline/PubMed, Embase, and the Cochrane databases. Search outputs were distilled, paying more attention to systematic reviews and meta-analyses (where available) representing the best evidence. The draft prepared on each topic was circulated amongst all the members of the Scientific Committee. Each expert then provided her/his input to the writing, suggesting changes and the inclusion of new material and/or additional relevant references. The global recommendations were then thoroughly discussed in a specific meeting, refined with regard to both content and wording, and approved to obtain a summary of current evidence.ResultsTwenty-five years after their introduction into clinical practice, PPIs remain the mainstay of the treatment of acid-related diseases, where their use in gastroesophageal reflux disease, eosinophilic esophagitis, Helicobacter pylori infection, peptic ulcer disease and bleeding as well as, and Zollinger–Ellison syndrome is appropriate. Prevention of gastroduodenal mucosal lesions (and symptoms) in patients taking non-steroidal anti-inflammatory drugs (NSAIDs) or antiplatelet therapies and carrying gastrointestinal risk factors also represents an appropriate indication. On the contrary, steroid use does not need any gastroprotection, unless combined with NSAID therapy. In dyspeptic patients with persisting symptoms, despite successful H. pylori eradication, short-term PPI treatment could be attempted. Finally, addition of PPIs to pancreatic enzyme replacement therapy in patients with refractory steatorrhea may be worthwhile.ConclusionsOverall, PPIs are irreplaceable drugs in the management of acid-related diseases. However, PPI treatment, as any kind of drug therapy, is not without risk of adverse effects. The overall benefits of therapy and improvement in quality of life significantly outweigh potential harms in most patients, but those without clear clinical indication are only exposed to the risks of PPI prescription. Adhering with evidence-based ...

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Section: Resultsmentioning

confidence: 99%

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Scarpignato

Gatta

Zullo³

et al. 2016

BMC Med

Self Cite

323

288

View full text Add to dashboard Cite

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“…Experienced pathologists analyzed all biopsies according to standard routines and all biopsies were assessed for numbers of eosinophils using chromatic staining and lymphocytes using immunohistochemistry for the pan-T cell marker CD3 according to standard protocols [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…The presence of ≥15 eosinophils/hpf in the esophageal mucosa was considered as eosinophilic esophagitis (EoE) and that with 8–15 eosinophils/hpf as eosinophilic infiltration (Eo-inf). The finding of ≥40 intraepithelial lymphocytes (IELs) per hpf was considered as lymphocytic esophagitis (LyE) and that with 20–40 IELs/hpf as lymphocytic infiltration (L-inf) [ 14 ].…”

Section: Methodsmentioning

confidence: 99%

“…LyE patients clinically present with dysphagia, abdominal pain, heartburn, and nausea [ 13 ]. The diagnosis of LyE is considered when more than 40 intraepithelial lymphocytes/hpf are present and there are no or only occasional CD15+ intraepithelial granulocytes [ 12 , 14 ]. Endoscopic features of LyE can be similar to EoE including esophageal rings, furrows, exudates, narrow lumen, or stenosis but in one-third of patients the esophageal mucosa appears macroscopically normal [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Eosinophilic Esophagitis and Lymphocytic Esophagitis in Adults with Esophageal Food Bolus Impaction

Truskaite

Dlugosz

2016

Gastroenterology Research and Practice

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Background. The relation of esophageal food bolus impaction (FBI) to eosinophilic esophagitis (EoE) and lymphocytic esophagitis (LyE) is unclear. The aim of this study was to determine the prevalence of EoE and LyE among adults with FBI. Methods. In this retrospective study we analyzed data from all patients referred for gastroscopy during the past 5 years, because of a present or recent episode of FBI. Results. We found 238 patients with FBI (median age 51 (17–96), 71% males). Endoscopic therapy was required in 143 patients. Esophageal biopsies were obtained in 185 (78%) patients. All biopsies were assessed for numbers of eosinophils and lymphocytes. EoE was found in 18% of patients who underwent biopsy. We found 41 patients (22%) who fulfilled the criteria for both EoE and LyE (EoE/LyE). LyE was found in the 9% of patients with FBI. EoE together with EoE/LyE was the leading cause of FBI in patients ≤50 years (64%). GERD was the leading cause of FBI among patients older than 50 years (42%). Conclusions. Our study showed that EoE was the leading cause of FBI in particular among young adults. Our study highlights the need for esophageal biopsies in any patient with FBI.

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“…LyE patients clinically present with dysphagia, abdominal pain, heartburn and nausea [5]. The diagnosis of LyE is considered when more than 40 intraepithelial lymphocytes/hpf are present, and none or only occasional CD15+ intraepithelial granulocytes [4,6]. Endoscopic features of LyE can be similar to EoE including esophageal rings, furrows, exudates, narrow lumen or stenosis but in one-third of patients the esophageal mucosa appears macroscopically normal [5].…”

Section: Introduction and Discussionmentioning

confidence: 99%

Untitled

2016

GHOA

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Eosinophilic esophagitis (EoE) and lymphocytic esophagitis (LyE) are inflammatory disorders of esophagus characterized clinically by dysphagia or food impaction. Endoscopical findings like esophageal rings, exudates, furrows and strictures might indicate the presence of these conditions, however, these findings have also been described in other esophageal disorders and endoscopic appearance may be normal in up to 25-30% patients. Inflammation may display a patchy distribution and multiple biopsies from different parts during an endoscopy procedure are required to ensure diagnostic accuracy. Determination of the most appropriate site of the esophagus to obtain a biopsy specimen for diagnosis of EoE or LyE is considered critical. This article highlights issues related to optimal approach to obtaining mucosal biopsies for assessment of EoE and LyE.

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Benign and precursor lesions in the esophagus

Cited by 9 publications

References 67 publications

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Effective and safe proton pump inhibitor therapy in acid-related diseases – A position paper addressing benefits and potential harms of acid suppression

Prevalence of Eosinophilic Esophagitis and Lymphocytic Esophagitis in Adults with Esophageal Food Bolus Impaction

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