Abstract:BACKGROUND: TREATMEN The contribution of eosinophilic esophagitis (EoE) to refractory gastroesophageal reflux disease (GERD) remains unknown. When EoE and GERD overlap, the clinical, endoscopic and histological findings are nonspecific and cannot be used to distinguish between the two disorders. Limited data are available on this topic, and the interaction between EoE and GERD is a matter of debate.AIM:We have conducted a prospective study of adult patients with refractory GERD to evaluate the overlap of reflu… Show more
“…Eosinophilic oesophagitis is increasingly diagnosed in patients with oesophageal symptoms, especially dysphagia and GORD-like symptoms 67 68. The estimated prevalence of eosinophilic oesophagitis based on a multicentre study in Japan was 17.1/100 00069 persons compared with 56.7/100 00070 persons in the USA.…”
“…Eosinophilic oesophagitis is increasingly diagnosed in patients with oesophageal symptoms, especially dysphagia and GORD-like symptoms 67 68. The estimated prevalence of eosinophilic oesophagitis based on a multicentre study in Japan was 17.1/100 00069 persons compared with 56.7/100 00070 persons in the USA.…”
“… 87 – 90 In one study of 130 patients with persistent heartburn and/or regurgitation despite receiving 6 weeks of omeprazole treatment, only one patient was found to have lesions on upper endoscopy suggestive of EoE. 89 Similarly, a study of 105 patients with PPI-resistant heartburn found that only 0.9% of patients had EoE on upper endoscopy. 90 Overall, EoE is a relatively uncommon disorder and unlikely to be a cause of GERD symptoms that do not respond to PPI therapy.…”
A significant percentage of patients with gastroesophageal reflux disease (GERD) will not respond to proton pump inhibitor (PPI) therapy. The causes of PPI-refractory GERD are numerous and diverse, and include adherence, persistent acid, functional disorders, nonacid reflux, and PPI bioavailability. The evaluation should start with a symptom assessment and may progress to imaging, endoscopy, and monitoring of esophageal pH, impedance, and bilirubin. There are a variety of pharmacologic and procedural interventions that should be selected based on the underlying mechanism of PPI failure. Pharmacologic treatments can include antacids, prokinetics, alginates, bile acid binders, reflux inhibitors, and antidepressants. Procedural options include laparoscopic fundoplication and LINX as well as endoscopic procedures, such as transoral incisionless fundoplication and Stretta. Several alternative and complementary treatments of possible benefit also exist.
“…Other less common symptoms include chest pain, dysphagia, dyspepsia, epigastric pain, nausea, bloating, belching, chronic cough, asthma, laryngitis and other respiratory symptoms[ 45 - 48 ]. Whilst dysphagia is infrequent in GORD, it is the most common presenting symptom for EoE along with food bolus impaction[ 1 , 10 , 49 ]. Approximately 50% of patients who present with food bolus impaction and up to 15% of patients who undergo endoscopy for non-obstructive dysphagia will have EoE[ 6 , 50 ].…”
Section: Epidemiology and Clinical Presentationmentioning
confidence: 99%
“…Fifty to eighty percent of EoE patients have a prior history of atopic symptoms[ 21 ]. Other non-specific symptoms include chest pain, heartburn, regurgitation, dyspepsia, nausea and vomiting, odynophagia, abdominal pain and non-specific throat symptoms[ 1 , 10 , 31 , 33 , 49 , 52 ].…”
Section: Epidemiology and Clinical Presentationmentioning
Eosinophilic oesophagitis (EoE) and gastro-oesophageal reflux disease (GORD) are the most common causes of chronic oesophagitis and dysphagia associated with oesophageal mucosal eosinophilia. Distinguishing between the two is imperative but challenging due to overlapping clinical and histological features. A diagnosis of EoE requires clinical, histological and endoscopic correlation whereas a diagnosis of GORD is mainly clinical without the need for other investigations. Both entities may exhibit oesophageal eosinophilia at a similar level making a histological distinction between them difficult. Although the term proton-pump inhibitor responsive oesophageal eosinophilia has recently been retracted from the guidelines, a relationship between EoE and GORD still exists. This relationship is complex as they may coexist, either interacting bidirectionally or are unrelated. This review aims to outline the differences and potential relationship between the two conditions, with specific focus on histology, immunology, pathogenesis and treatment.
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