Eosinophilic esophagitis in adults: An emerging problem with unique esophageal features

Potter, Jon W; Saeian, Kia; Staff, David; Massey, Benson T.; Komorowski, Richard; Shaker, Reza; Hogan, Walter J.

doi:10.1016/s0016-5107(03)02713-5

Cited by 265 publications

(229 citation statements)

References 19 publications

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“…5,7,8 Among adults with eosinophilic esophagitis, studies report personal or family histories of allergies ranging from 50 to 90%, including up to 60% with asthma and up to 25% with food allergies. [9][10][11] A disproportionate number of our eosinophilic esophagitis patients also had asthma (at least 15%); our study may underestimate the prevalence of asthma among eosinophilic esophagitis patients, as specific reporting of allergy histories was often omitted from the clinical record.…”

Section: Discussionmentioning

confidence: 93%

“…5,9,11 Recently, Straumann et al have suggested that fragile esophageal mucosa, so-called 'crepe paper', which tears easily with minor trauma, may be pathognomic for eosinophilic esophagitis. 12 In our study, rings were more commonly reported in eosinophilic esophagitis patients vs patients with gastroesophageal reflux disease; consequently, these findings likely represent intermittent circular muscle contraction rather than true congenital rings.…”

Section: Discussionmentioning

confidence: 99%

“…Other endoscopy studies have also suggested that exudates may be less frequently seen in adults, as compared to children, with eosinophilic esophagitis. 9,11 Further studies correlating the presence of white exudates with eosinophilic microabscesses and superficially distributed eosinophils in adults with eosinophilic esophagitis are necessary to clarify the relationship between these endoscopic and histological features. As our study demonstrates, esophageal changes in eosinophilic esophagitis appear to occur in the absence of mucosal erosion or ulceration, in contradistinction to gastroesophageal reflux disease.…”

Section: Discussionmentioning

confidence: 99%

“…While many studies have used 415-20 eosinophils/hpf as a diagnostic cutoff, others have used thresholds as low as 45/hpf and as high as 430/hpf (Table 1). 5,[8][9][10][11]13 Rothenberg et al 2,14 suggest that eosinophil counts o7/hpf, 7-24/hpf and 424/hpf indicate gastroesophageal reflux disease, gastroesophageal reflux disease combined with allergy and primary eosinophilic esophagitis respectively. Although eosinophilic esophagitis patients in our study had an average of nearly 40 eosinophils/ hpf, many biopsies showed a patchy distribution and multiple hpfs within a single biopsy often lacked eosinophils.…”

Section: Discussionmentioning

confidence: 99%

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Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients

et al. 2006

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Eosinophilic esophagitis in adults is a recently described entity occurring in young males with dysphagia, in whom esophageal biopsies show eosinophilic infiltration. This study defines the clinical and histological features of patients with eosinophilic esophagitis, distinguishing it from gastroesophageal reflux disease. Esophageal biopsies from patients with dysphagia or esophagitis were reviewed blindly, and assessed for: epithelial eosinophil counts, presence of eosinophilic microabscesses, edema, basal zone hyperplasia, lamina propria papillae elongation, eosinophils and fibrosis. Clinical and endoscopic findings were obtained. Eosinophilic esophagitis was diagnosed with epithelial eosinophils Z15 in Z2 high-power fields (hpfs) or Z25 in any hpf. Analysis was performed with Mann-Whitney, v 2 and ANOVA tests. Of 157 cases, 41 had eosinophilic esophagitis. Male gender (81%) and age r45 (54%) were commoner in patients with eosinophilic esophagitis (P ¼ 0.001, 0.010, respectively). Dysphagia was more common in eosinophilic esophagitis patients (63%, Po0.001); heartburn was more common in noneosinophilic esophagitis patients (53%, Po0.001). Endoscopic rings were more common in eosinophilic esophagitis patients (27%, P ¼ 0.023); hiatus hernia was more common in noneosinophilic esophagitis patients (11%, P ¼ 0.022). Eosinophils were more numerous in eosinophilic esophagitis biopsies (mean 39/hpf, Pr0.001). Only eosinophilic esophagitis biopsies had eosinophilic microabscesses (42%, Pr0.001). Edema, basal zone hyperplasia, lamina propria papillae elongation and lamina propria eosinophils were commoner in eosinophilic esophagitis (P ¼ o0.001-0.002), while lamina propria fibrosis was specific for eosinophilic esophagitis (39%, Po0.001). Eosinophilic esophagitis is a disease with a predilection for young males with dysphagia and rings on endoscopy. Biopsies in eosinophilic esophagitis have high epithelial eosinophil counts, averaging nearly 40/hpf. Increased awareness of eosinophilic esophagitis is necessary, since treatment with allergen elimination or antiinflammatory therapy may be more effective than acid suppression.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients

et al. 2006

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“…Longitudinal furrowing, white exudates, esophageal trachealization, esophageal narrowing and strictures, Schatzki's ring, and friability described as "crepe paper" mucosa, though not pathognomonic, are endoscopic signs of EoE (1). However, Pot-ENSAR‹ et al (8) commented that when a patient had both esophageal narrowing and trachealization, a physicians-should strongly suspect a diagnosis of EoE. On the other hand, normal endoscopy may be observed in 26 to 32% of children with EoE (9, 10).…”

Section: Discussionmentioning

confidence: 99%