Is it possible to diagnose infectious oesophagitis without seeing the causative organism? A histopathological study

Demır, Derya; Doğanavşargıl, Başak; Sarsık, Banu; Sezak, Murat; Tunçyürek, Müge

doi:10.5152/tjg.2014.4967

Cited by 11 publications

(13 citation statements)

References 12 publications

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“…In patients with normal immune function, cytomegalovirus esophagitis mainly presents with chest pain, swallowing pain, hematemesis, and melena, as well as patients with weight loss, difficulty in swallowing, etc. Cytomegalovirus esophagitis in immunocompetent patients and immunodeficient patients showed similar clinical symptoms, which is consistent with previous reports [10]. Endoscopic manifestations of esophageal mucosal erosion, ulcers, erosions and ulcers often occur in the lower esophagus, but also occur in the upper esophagus.…”

Section: Discussionsupporting

confidence: 91%

A Case Report of Cytomegalovirus Esophagitis in an Immune-competent Patient

Pooja¹,

Sabreen²,

Zhang³

2018

IJCRR

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Cytomegalovirus (CMV) esophagitis usually occurs in immunocompromised individuals. Cases of Cytomegalovirus esophagitis in immunocompetent patients have not been reported yet in China. This report is mainly based on a case study and the relevant literature review to summarize the clinical manifestations, endoscopic characteristics, diagnosis and treatment of cytomegalovirus esophagitis in immunocompetent patients.

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Section: Discussionsupporting

confidence: 91%

A Case Report of Cytomegalovirus Esophagitis in an Immune-competent Patient

Pooja¹,

Sabreen²,

Zhang³

2018

IJCRR

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“…In addition, desquamated tissue fragments and detached yeast may be lost as a result of prior cytological brushings or during tissue processing 11,31 . In these situations, other histological changes, such as reactive epithelial changes or intraepithelial neutrophils, may be helpful diagnostic clues 2,30,32 . However, approximately one‐quarter of the patients in our study had oesophageal biopsies that showed fungal invasion of the squamous epithelium unaccompanied by neutrophil‐rich inflammation.…”

Section: Discussionmentioning

confidence: 90%

“…Although these data suggest that asymptomatic Candida oesophagitis is of little clinical significance in some patients, criteria for distinguishing patients who require therapy from those who do not remain unclear; asymptomatic patients can certainly have endoscopically apparent oesophagitis with exudates and fungi in oesophageal biopsy samples. Oesophageal biopsies with Candida are usually described as containing budding yeast and/or pseudohyphae, variably present neutrophilic and/or lymphocytic infiltrates, superficial exudates of desquamated epithelial cells, and reactive squamous epithelial changes that may mimic other types of oesophagitis 5,19,30 . Historically, many pathologists have required the presence of pseudohyphae and/or fungal invasion of intact epithelium to establish a diagnosis of clinically significant infection, but our data show that patients with clinically significant infections often lack these features.…”

Section: Discussionmentioning

confidence: 99%

The diagnosis of clinically significant oesophagealCandidainfections: a reappraisal of clinicopathological findings

et al. 2020

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Aims Distinguishing true oesophageal Candida infections from oral contaminants is a common diagnostic issue. Historically, histological features believed to indicate true infection included epithelial invasion by pseudohyphae and intraepithelial neutrophils. Whether or not these features correlate with endoscopic lesions, symptoms and response to therapy has never been tested in a large cohort. The aim of this study was to determine whether specific histological features correlate with clinical and endoscopic findings when Candida is found in oesophageal biopsies. Methods and results We reviewed 271 biopsies in which Candida was detected. Cases were evaluated for the presence of desquamated epithelial cells, location/type of fungal forms, neutrophils, and ulceration. Medical records were reviewed for clinical history, endoscopic lesions, and response to antifungal therapy. Statistical analysis was used to determine whether any histological features significantly correlated with clinical variables. There were 120 males and 151 females with a mean age of 42 years. Fifty‐nine per cent had symptoms referable to the oesophagus, particularly dysphagia (36%). Most (73%) patients had abnormal endoscopic findings, with plaques, ulcers, or macroscopic evidence of oesophagitis. Seventy‐one per cent of patients with documented antifungal therapy showed symptomatic improvement. Overall, there was no statistically significant correlation between any histological feature and presenting symptoms, endoscopic findings, or response to therapy. Importantly, the lack of pseudohyphae, demonstrable invasion of intact epithelium or neutrophilic infiltrates did not exclude clinically significant infection. Conclusions We conclude that detection of Candida in oesophageal biopsies is always potentially clinically significant. Treatment decisions should be made on the basis of an integration of clinical, endoscopic and histological findings.

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“…13 The role of lymphocytes in relation to neutrophils and eosinophils has also been studied in the context of infectious esophagitis. 14 A few lymphocytes are normally present in the esophageal squamous mucosa, however, a normal number is not defined. An early study by 16 Intraepithelial lymphocytes in the esophagus have also been reported in association with inflammatory bowel disease, 17,18 although an association specifically between lymphocytic esophagitis and inflammatory bowel disease has not been a universal finding.…”

Section: Discussionmentioning

confidence: 99%

Post-ablation lymphocytic esophagitis in Barrett esophagus with high grade dysplasia or intramucosal carcinoma

et al. 2016

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In patients who have undergone ablation therapy for treatment of Barrett's esophagus with dysplasia, histologic features of eosinophilic esophagitis, but not lymphocytic esophagitis, have been described. We evaluated for histologic evidence of eosinophilic esophagitis and lymphocytic esophagitis and correlated with endoscopic findings in this population. A single-institution Barrett's esophagus registry was searched for patients who had received radiofrequency ablation, cryotherapy, or both for treatment of Barrett's esophagus with dysplasia. Clinical and endoscopic data were collected and biopsies were reviewed for inflammation and reactive changes at three time points: pre-intervention, first surveillance after ablation therapy, and most recent surveillance. Of the 173 patients initially identified, 102 met the inclusion criteria. Intraepithelial eosinophils were increased at first surveillance (60%, P = 0.096) and last surveillance (69%, P = 0.048) compared with pre-intervention (50%), although histologic evidence of post-ablation eosinophilic esophagitis was not significant. Prevalence of lymphocytic esophagitis was significantly higher at first surveillance (17%, P = 0.02) and at last surveillance (43%, Po 0.001), compared with pre-intervention (7%). Smoking, hyperlipidemia, and cryotherapy were identified as independent risk factors for developing histologic lymphocytic esophagitis. This is the first report that histologic evidence of lymphocytic esophagitis increased over time in patients undergoing ablation for Barrett's esophagus with dysplasia. Though the pathophysiology of lymphocytic esophagitis remains unknown, patients in our study with a history of smoking, hyperlipidemia, or cryotherapy were more likely to develop post-ablation lymphocytic esophagitis.

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Is it possible to diagnose infectious oesophagitis without seeing the causative organism? A histopathological study

Cited by 11 publications

References 12 publications

A Case Report of Cytomegalovirus Esophagitis in an Immune-competent Patient

A Case Report of Cytomegalovirus Esophagitis in an Immune-competent Patient

The diagnosis of clinically significant oesophagealCandidainfections: a reappraisal of clinicopathological findings

Post-ablation lymphocytic esophagitis in Barrett esophagus with high grade dysplasia or intramucosal carcinoma

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