Eosinophilic esophagitis and asymptomatic esophageal eosinophilia display similar immunohistological profiles

Kitamura, Hiroyuki; Tanaka, Fumio; Nadatani, Yuji; Otani, Koji; Hosomi, Shuhei; Kamata, Noriko; Taira, Koichi; Nagami, Yasuaki; Tanigawa, Tetsuya; Fukumoto, Shinya; Watanabe, Toshio; Kawada, Norifumi; Fujiwara, Yasuhiro

doi:10.3164/jcbn.20-49

Cited by 12 publications

(11 citation statements)

References 25 publications

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“…The limitations of our study included the small number of cases and its retrospective nature. However, the mean age, ratio of men to women, and percentage of previous allergic disease were consistent with previous reports of EoE from other institutions in Japan, and there was no bias ( 39 ). Second, not all patients were tested for autoantibodies or had seen a gynecologist; therefore, some patients might have had undiagnosed hypothyroidism or endometriosis.…”

Section: Discussionsupporting

confidence: 90%

Prevalence of Autoimmune Disease in Patients with Eosinophilic Esophagitis: A Cross-sectional Study of Three Hospitals in Japan

et al. 2021

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Objective Recent studies have found higher rates of autoimmune diseases, such as celiac disease, Crohn's disease, and ulcerative colitis, in patients with eosinophilic esophagitis (EoE) than in the general population. This study investigated the concomitant rate of autoimmune disease among Japanese patients with EoE and evaluated the clinicopathological characteristics of EoE patients with autoimmune disease. Methods The medical records of patients diagnosed with EoE between April 1, 2016, and June 30, 2020, were reviewed. We analyzed the concomitant rate of autoimmune diseases in patients with EoE and compared the clinical and histological differences between patients with and without autoimmune disease. Results Sixty-four patients with EoE were enrolled. Of them, 1 had ulcerative colitis (1.6%), 1 had autoimmune polyendocrine syndrome type 2 (1.6%), and 6 had endometriosis (28.5% of women, 44.4% of reproductive-aged women). No significant differences in the clinical course or histological findings were found between EoE patients with and without autoimmune diseases. No complications, including stenosis, were seen in EoE with autoimmune disease, and most patients with EoE and autoimmune diseases were responsive to proton pump inhibitors (PPIs). Conclusion In this study, 8 out of 64 patients with EoE had an autoimmune-related disease, including ulcerative colitis (n=1, 1.6%), autoimmune polyendocrine syndrome type 2 (n=1, 1.6%), or endometriosis (n=6, 44.4% of women of reproductive age), which is higher than that previously reported in the general population. Further investigations are required to clarify the relationship between EoE and autoimmune diseases.

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Section: Discussionsupporting

confidence: 90%

Prevalence of Autoimmune Disease in Patients with Eosinophilic Esophagitis: A Cross-sectional Study of Three Hospitals in Japan

et al. 2021

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“…Furthermore, recent studies have reported on asymptomatic oesophageal eosinophilia (aEE), which has endoscopic and histological findings similar to those of EoE, but does not have oesophageal dysfunction. 28 , 29 EoE and aEE may have the same pathogenesis, but it is still unclear if aEE should be treated or not, and further investigation is needed. 29 When using the broad definition, we may include patients with aEE, although most of the patients undergoing an upper gastrointestinal endoscopy will have upper gastrointestinal symptoms as an indication for the procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Prevalence of oesophageal eosinophilia (EoE) in Denmark 2008-2018 using the broad definition of EoE, that is EoE with no alternative cause of oesophageal eosinophilia. (a) Prevalence of EoE stratified by age groups, (b) Prevalence of EoE stratified by sex, and (c) Prevalence of EoE stratified by region histological findings similar to those of EoE, but does not have oesophageal dysfunction 28,29. EoE and aEE may have the same pathogenesis, but it is still unclear if aEE should be treated or not, and further investigation is needed 29.…”

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confidence: 99%

Eosinophilic oesophagitis in Denmark: Population‐based incidence and prevalence in a nationwide study from 2008 to 2018

et al. 2022

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Background Eosinophilic oesophagitis (EoE) is a chronic immune‐mediated or antigen‐mediated oesophageal disease characterised by symptoms related to oesophageal dysfunction and eosinophil‐predominant inflammation. Objective We aimed to estimate the incidence and prevalence of EoE in Denmark during the period 2008–2018. Methods Based on data from nationwide registers we identified cases of EoE using two definitions: a broad definition based solely on oesophageal biopsies registered in the Danish Pathology Register and a narrow definition also including symptoms of oesophageal dysfunction registered in the Danish National Patient Registry. The annual incidence and prevalence were standardised by sex and age in 5‐year intervals to the 2013 study population. Results From 2008 to 2011, the standardised incidence of EoE was stable, but from 2011 to 2018 it increased from 3.9 (95% CI 3.3–4.4) to 11.7 (95% CI 10.8–12.6) per 100,000 person‐years. Similar temporal trends were observed when using the narrow EoE definition. The increase in incidence was most pronounced in men and in individuals above 40 years of age. In children, the EoE incidence was a fourth of the incidence in adults aged 40–64 years: 4.4 (95% CI 3.2–5.6) versus 17.6 (95% CI 15.7–19.5) per 100,000 person‐years. The EoE incidence varied substantially across the five regions in Denmark. Overall, the biopsy rate as well as the proportion of oesophageal biopsies with detected eosinophilia increased during the study period. Conclusion This study of the entire population of Denmark during the period 2008 to 2018 shows that the incidence and prevalence of EoE is not yet plateauing and that EoE could be severely underdiagnosed, especially in children.

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“…The severity of symptoms does not necessarily correlate with the extent of eosinophilic inflammation, and symptoms alone are insufficient for a diagnosis or assessment of the response to treatment ( 16 , 17 ). It is also suggested that EoEs and aEE display similar immunohistological profiles ( 18 ). Thus, aEE and symptomatic EoE may have the same pathogenesis and lie on the same spectrum of disease pathology ( 19 ).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Differences between Eosinophilic Esophagitis and Asymptomatic Esophageal Eosinophilia

et al. 2022

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Objective According to consensus guidelines, eosinophilic esophagitis (EoE) is defined as a clinicopathological entity whose symptoms and histology must always be considered together. However, endoscopic findings typical of EoE are often seen in asymptomatic esophageal eosinophilia (aEE). We aimed to clarify the clinicopathological features of aEE. Methods We retrospectively compared cases of aEE and those of symptomatic EoE. Patients or MaterialsWe reviewed 146 patients who underwent upper gastrointestinal endoscopy and were confirmed histopathologically to have esophageal eosinophil infiltration of at least 15 eosinophils per highpower field. They were divided into the aEE group (n=75) and the EoE group (n=71). Patients' clinicopathological findings were then collected and examined. ResultsThe EoE group experienced dysphagia (47.9%), heartburn (40.8%), food impaction (40.8%), chest pain (16.9%), and other symptoms (8.5%). There was no significant difference between the two groups with regard to age, sex, current smoking status, or alcohol consumption. The aEE group had a significantly higher body mass index (p<0.01) and significantly lower frequency of concurrent allergic diseases (p<0.01) than the EoE group. No significant differences were found between the two groups with regard to the mean peripheral blood eosinophil count, non-specific immunoglobulin E concentration, peak eosinophil infiltration in the biopsy specimens, EoE histology scoring system, phenotype and location of typical endoscopic findings of EoE, or thickness of the esophagus wall or the mucosal and submucosal layer as measured by endoscopic ultrasonography. Two patients in the aEE group who were followed up without treatment subsequently developed esophageal symptoms. Conclusions aEE and EoE may have the same clinicopathological features.

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Eosinophilic esophagitis and asymptomatic esophageal eosinophilia display similar immunohistological profiles

Cited by 12 publications

References 25 publications

Prevalence of Autoimmune Disease in Patients with Eosinophilic Esophagitis: A Cross-sectional Study of Three Hospitals in Japan

Prevalence of Autoimmune Disease in Patients with Eosinophilic Esophagitis: A Cross-sectional Study of Three Hospitals in Japan

Eosinophilic oesophagitis in Denmark: Population‐based incidence and prevalence in a nationwide study from 2008 to 2018

Clinicopathological Differences between Eosinophilic Esophagitis and Asymptomatic Esophageal Eosinophilia

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