Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis

Muir, Amanda B.; Merves, Jamie; Liacouras, Chris A.

doi:10.1016/j.giec.2015.08.006

Cited by 27 publications

(26 citation statements)

References 75 publications

(105 reference statements)

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“…The current methods of evaluating for fibrostenosis include: 1) visual endoscopic evaluation, 2) esophagogram, and 3) histologic evaluation [93]. Visual inspection by endoscopy can identify rings and more severe narrow caliber esophagi, however esophagogram may be more sensitive at detecting more subtle esophageal narrowing [94].…”

Section: Clinical Evaluation Of Remodeling In Eoementioning

confidence: 99%

Epithelial-stromal crosstalk and fibrosis in eosinophilic esophagitis

2018

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Eosinophilic esophagitis (EoE) is a food allergen-induced inflammatory disorder. EoE is increasingly recognized as a cause of swallowing dysfunction, food impaction and esophageal stricture. Inflammation of the esophageal mucosa involves immune cell infiltrate, reactive epithelial changes and fibroblast activation, culminating in robust tissue remodeling toward esophageal fibrosis characterized by excess collagen deposition in the subepithelial lamina propria. Fibrosis contributes to a unique mechanical property of the EoE-affected esophagus that is substantially stiffer than the normal esophagus. There is a great need to better understand the processes behind esophageal fibrosis in order to foster improved diagnostic tools and novel therapeutics for EoE-related esophageal fibrosis. In this review, we discuss the role of esophageal inflammatory microenvironment that promotes esophageal fibrosis, with specific emphasis upon cytokines-mediated functional epithelial-stromal interplays, recruitment and activation of a variety of effector cells, and tissue stiffness. We then explore the current state of clinical methodologies to detect and treat the EoE-related esophageal stricture.

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Section: Clinical Evaluation Of Remodeling In Eoementioning

confidence: 99%

Epithelial-stromal crosstalk and fibrosis in eosinophilic esophagitis

2018

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“…[3] EoE can be triggered by food antigen or aero-antigen. [1] Although the index case did not have any atopic symptoms prior to admission, but discontinuation of antihistamines during active phase resulted in melena, indicating its immunological basis.…”

Section: Discussionmentioning

confidence: 92%

“…At the time of diagnosis patients can have myriad of lesions like edema, exudate, furrows, and stricture of the esophagus. [1,2] Herein, we report an adolescent girl who presented with profuse upper GI bleeding.…”

Section: Introductionmentioning

confidence: 98%

Profuse Upper GI Bleeding Secondary to Eosinophilic Esophagitis

Aydın

Beşer

2017

APSP J Case Rep

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Eosinophilic esophagitis is a chronic disease with immunoallergic etiology. In this condition infiltration of the esophagus with eosinophils, results in esophageal dysfunction. A sixteen years old girl was admitted to the emergency department with profuse hematemesis. Patient needed multiple blood transfusions. Endoscopy ruled out surgical causes of upper GI bleed and esophageal punch biopsy revealed eosinophilic esophagitis. Patient responded well to anti-allergic treatment.

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“…The recommendation is to collect at least 2-4 biopsies of the upper and lower third of the esophagus because it usually shows a patchy involvement, and of the gastric antrum and duodenum to rule out eosinophilic gastroenteritis. 1,12 The histological marker of EoE is the presence of 15 or more eosinophils per hpf, with a 100% sensitivity and a 96% specificity. Eosinophil degranulation, eosinophil microabscesses, basal cell hyperplasia, and lamina propria fibrosis may also occur 7,10 ( Figure 3).…”

Section: Eosinophilic Esophagitismentioning

confidence: 99%

“…Other causes of esophageal eosinophilia include GERD, PPI-REE, fungal or bacterial infection, Crohn's disease, celiac disease, vasculitis, hypereosinophilic syndrome, and connective tissue disorders. 7,8,12 The treatment goals are complete resolution of clinical symptoms, eosinophilic inflammation, and esophageal remodeling. To this end, dietary and pharmacologic interventions are used: 1,7,10 …”

Section: Eosinophilic Esophagitismentioning

confidence: 99%

Eosinophilic esophagitis and esophageal atresia: coincidence or causality?

Salgado

Rocca

2018

Arch Argent Pediatr

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Eosinophilic esophagitis is an immune-mediated chronic disease of the esophagus characterized by symptoms related to esophageal dysfunction and tissue eosinophilia. In the endoscopy, the esophageal mucosa may appear normal or show exudates, rings, edema, furrows, and strictures. Its management is based on elimination diet, topical corticosteroids and/or esophageal dilation. Atresia is the most common congenital alteration of the esophagus; it requires surgical repair and poses potential complications, such as gastroesophageal reflux, strictures, and esophageal dysmotility. Up to 2015, 48 cases of eosinophilic esophagitis and esophageal atresia were reported, with dysmotility, reflux, and long-term acid suppression involvement. Prevalent clinical signs include dysphagia, difficulty eating, and reflux symptoms, so an esophagogastroduodenoscopy with biopsy is recommended to rule out associated eosinophilic esophagitis in patients with esophageal atresia and persistent symptoms before performing an esophageal dilation and/or anti-reflux surgery. If eosinophilic esophagitis is confirmed, it should be managed with the corresponding drugs, and the subsequent therapeutic approach will depend on its clinical course.

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Role of Endoscopy in Diagnosis and Management of Pediatric Eosinophilic Esophagitis

Cited by 27 publications

References 75 publications

Epithelial-stromal crosstalk and fibrosis in eosinophilic esophagitis

Epithelial-stromal crosstalk and fibrosis in eosinophilic esophagitis

Profuse Upper GI Bleeding Secondary to Eosinophilic Esophagitis

Eosinophilic esophagitis and esophageal atresia: coincidence or causality?

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