Symptom-based diagnostic approach for eosinophilic esophagitis

Fujiwara, Yasuhiro

doi:10.1007/s00535-020-01701-y

Cited by 20 publications

(19 citation statements)

References 74 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A younger age and diffuse disease distribution at the first detection in endoscopic findings are considered to be risk factors for progression to symptomatic EE in aEE patients ( 10 , 20 ). Recent review articles have suggested the utility of a symptom-based diagnostic and therapeutic approach for EoEs ( 21 , 22 ).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological Differences between Eosinophilic Esophagitis and Asymptomatic Esophageal Eosinophilia

et al. 2022

View full text Add to dashboard Cite

Objective According to consensus guidelines, eosinophilic esophagitis (EoE) is defined as a clinicopathological entity whose symptoms and histology must always be considered together. However, endoscopic findings typical of EoE are often seen in asymptomatic esophageal eosinophilia (aEE). We aimed to clarify the clinicopathological features of aEE. Methods We retrospectively compared cases of aEE and those of symptomatic EoE. Patients or MaterialsWe reviewed 146 patients who underwent upper gastrointestinal endoscopy and were confirmed histopathologically to have esophageal eosinophil infiltration of at least 15 eosinophils per highpower field. They were divided into the aEE group (n=75) and the EoE group (n=71). Patients' clinicopathological findings were then collected and examined. ResultsThe EoE group experienced dysphagia (47.9%), heartburn (40.8%), food impaction (40.8%), chest pain (16.9%), and other symptoms (8.5%). There was no significant difference between the two groups with regard to age, sex, current smoking status, or alcohol consumption. The aEE group had a significantly higher body mass index (p<0.01) and significantly lower frequency of concurrent allergic diseases (p<0.01) than the EoE group. No significant differences were found between the two groups with regard to the mean peripheral blood eosinophil count, non-specific immunoglobulin E concentration, peak eosinophil infiltration in the biopsy specimens, EoE histology scoring system, phenotype and location of typical endoscopic findings of EoE, or thickness of the esophagus wall or the mucosal and submucosal layer as measured by endoscopic ultrasonography. Two patients in the aEE group who were followed up without treatment subsequently developed esophageal symptoms. Conclusions aEE and EoE may have the same clinicopathological features.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinicopathological Differences between Eosinophilic Esophagitis and Asymptomatic Esophageal Eosinophilia

et al. 2022

View full text Add to dashboard Cite

show abstract

“…28 Fujiwara analyzed symptoms in 886 EoE cases in Japanese adults and divided the symptoms into the following three categories: (i) typical symptoms, such as dysphagia (53%); (ii) other upper GI symptoms (40%); and (iii) no symptoms found during screening or medical examinations, i.e., "asymptomatic esophageal eosinophilia" (19%). 29 Questions arise as to whether the pathology of EoE would be different depending on the presence or absence of symptoms and whether it could be possible to objectively evaluate subjective symptoms. Muroi et al, who won the Young Investigator Award at the 98th symposium, conducted a unique study using endoscopic ultrasonography (EUS) and high-resolution manometry (HRM) to examine the difference in pathological conditions between symptomatic and asymptomatic EoE.…”

Section: Eosinophilic Esophagitis Functional Evaluationmentioning

confidence: 99%

“…34 The natural history of Japanese EoE, especially asymptomatic EoE, has not yet been completely elucidated. 29…”

Section: Asymptomatic Eoementioning

confidence: 99%

The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract)

Nagahara

Shiotani

Iijima

et al. 2021

Digestive Endoscopy

Self Cite

View full text Add to dashboard Cite

The Japan Gastroenterological Endoscopy Society held four serial symposia between 2019 and 2020 on the state-of-the-art of issues related to upper GI inflammatory diseases. This review discusses some of the topics addressed in these symposia. The papers regarding nonerosive reflux disease, recent improvements in intraesophageal pH-impedance monitoring and endoscopic diagnosis using image-enhanced endoscopy have been published. Many publications have addressed its usefulness in endoscopic treatment of gastroesophageal reflux disease such as anti-reflux mucosectomy. In the management of eosinophilic esophagitis, since the symptoms are subjective, objective indicators have been sought, and ultrasonography and highresolution manometry may be useful tools for evaluation. The natural course of this condition, especially of asymptomatic cases, is not well clarified. Some newly developed anti-acid or anti-inflammatory medicines are now under investigation. With regard to autoimmune gastritis, because of widespread medical examinations, diagnosis of asymptomatic cases has been increasing. Recently, its endoscopic characteristics have become clear and the natural history of these conditions is being elucidated. The Kyoto Classification of Gastritis has been reported to be useful not only for Helicobacter pylori diagnosis but also for identification of risks of gastric cancer. Its usefulness is now recognized in Asia and Europe.

show abstract

“…Moreover, the prevalence of esophageal eosinophilia on biopsy in cases with typical endoscopic EoE findings was low (11.1-30.8%) in three previous studies. 13 Therefore, multiple biopsies of esophageal mucosa in cases suspicious of EoE are proposed and are the only modality that can exclude EoE when no significant esophageal eosinophilia is observed.…”

Section: Endoluminal Treatmentsmentioning

confidence: 99%