Fragility of the esophageal mucosa: A pathognomonic endoscopic sign of primary eosinophilic esophagitis?

Straumann, Alex; Rossi, Livio; Simon, Hans‐Uwe; Heer, Pius; Spichtin, Hanspeter; Beglinger, Christoph

doi:10.1067/mge.2003.123

Cited by 171 publications

(112 citation statements)

References 19 publications

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“…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. Other findings reported to be characteristic of eosinophilic esophagitis include speckled whitish exudates and a small caliber esophagus.…”

Section: Discussionmentioning

confidence: 47%

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: 47%

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

et al. 2006

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“…The safety of dilation is important because dysphagia is the most uniform symptom and common complaint in adults with EoE [12,13,20,27] . Dilation allows for immediate resolution of dysphagia while steroids take more time.…”

Section: When Do Dilations Happenmentioning

confidence: 99%

“…Chronic inflammatory eosinophilic infiltrates often lead to tissue remodeling and fibrosis, which causes luminal narrowing and loss of elasticity [8][9][10] . These morphological changes contribute to symptoms associated with EoE, such as chest pain, heartburn, acid reflux, feeding intolerance, and especially dysphagia and food impaction [11][12] . The methods of management can consist of dietary, pharmacological, and endoscopic interventions.…”

Section: Introductionmentioning

confidence: 99%

“…It also provides relief for patients whose symptoms have not responded to therapy with steroids, and those who do not want to be on long term medications or significantly restrict their diets [1,3,17] . Early descriptions of routine endoscopies and therapeutic interventions, such as dilation, in EoE patients indicated that the fragile and inelastic mucosa associated with the disease increased risks of deep tissue tears, lacerations, and perforations [4,11,12,14,18] . However, more recent studies with larger patient samples have indicated esophageal dilation as a safe therapy in EoE patients [16,[19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

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Esophageal dilations in eosinophilic esophagitis: A single center experience

Ukleja

Shiroky

Agarwal

et al. 2014

WJG

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AIM: To diagnose the clinical and histologic features that may be associated with or predictive of the need for dilation and dilation related complications; examine the safety of dilation in patients with eosinophilic esophagitis (EoE). METHODS:The medical records of all patients diagnosed with EoE between January 2002 and July 2010 were retrospectively reviewed. Esophageal biopsies were reexamined by an experienced pathologist to confirm the diagnosis (≥ 15 eos/hpf per current guidelines). Patients were divided into 2 groups: patients who did not receive dilation therapy and those who did. Demographics, clinical history, the use of pharmacologic therapy, endoscopic and pathology findings, and the number of biopsies and dilations carried out, if any, and their locations were recorded for each patient. The dilation group was further examined based on the interval between diagnosis and dilation, and whether or not a complication occurred. RESULTS:Sixty-one patients were identified with EoE and 22 (36%) of them underwent esophageal dilations for stricture/narrowing. The peak eos/hpf was significantly higher in patients who received a dilation (P = 0.04). Four (18% of pts.) minor complications occurred: deep mucosal tear 1, and small mucosal tears 3. There were no cases of esophageal perforations. Higher peak eos/hpf counts were not associated with increased risk of complications. CONCLUSION:Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate. No correlation was found between the peak of eosinophil count and complication rate. Complications can occur independently of the histologic features. The long-term outcome of EoE treatment, with or without dilation, needs to be determined. © 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Balloon dilation; Dysphagia; Esophagus disorder; Esophageal stricture; Esosinophilic esophagitis Core tip: The field of gastroenterology does not currently have standardized treatment guidelines for eosinophilic esophagitis. Current data on the safety of dilations in patients with eosinophilic esophagitis (EoE) are conflicting and lack information on factors that influence whether or not a patient will require dilation. This study revealed that higher peak eos/hpf counts appear to influence whether or not an EoE patient will require dilation during the course of their treatment. However, complications appear to occur independently of the histologic features. Esophageal dilation appears to be a safe procedure in EoE patients, carrying a low complication rate.

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“…Based on these investigations and on our own experience, we propose that a prudent course for managing symptomatic PEO patients might be outlined as follows: if endoscopy detects neither visible stenosis nor significant resistance, the first line therapy should be medical treatment with topical corticosteroids or with montelukast. Patients who present with a visible stenosis and/or significant resistance during endoscopy should be treated with dilation (45). As this disease is relatively rare and patient numbers are still rather limited, additional studies would be needed to confirm just how effective this proves to be in practice.…”

Section: (37)mentioning

confidence: 99%

The physiological and pathophysiological roles of eosinophils in the gastrointestinal tract

Straumann

Simon

2003

Allergy

107

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Eosinophils and the gastrointestinal tract interact in an intimate and enigmatic relationship. Under healthy conditions, the presence of eosinophils is limited almost exclusively to the digestive tract mucosa where they exert several effector and immunoregulatory functions. While their precise function in the gastrointestinal tract is not completely understood, it is likely that, together with different T cell subsets, eosinophils are involved in maintaining the immunologic homeostastis across the mucosal barrier under resting conditions. Eosinophils also play a role in several inflammatory conditions, such as intestinal infections, hypersensitivity reactions, primary eosinophilic inflammations and several other chronic intestinal disorders. Depending on the responsible trigger, their effects may be beneficial or detrimental. Here, we discuss the available information regarding the physiological and pathological functions of eosinophils within the gastrointestinal tract.

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Fragility of the esophageal mucosa: A pathognomonic endoscopic sign of primary eosinophilic esophagitis?

Cited by 171 publications

References 19 publications

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

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

Esophageal dilations in eosinophilic esophagitis: A single center experience

The physiological and pathophysiological roles of eosinophils in the gastrointestinal tract

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