White specks in the esophageal mucosa: an endoscopic manifestation of non-reflux eosinophilic esophagitis in children

Lim, Joel R; Gupta, Sandeep K.; Croffie, Joseph M.; Pfefferkorn, Marian D.; Molleston, Jean P.; Corkins, Mark R.; Davis, Mary M.; Faught, Philip; Steiner, Steven J.; Fitzgerald, Joseph F.

doi:10.1016/s0016-5107(04)00364-5

Cited by 93 publications

(45 citation statements)

References 19 publications

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“…A minimum of 15 eosinophils per high power field is now used as clinical diagnostic criteria for EE (34)(35)(36). Analysis of the EE transcriptome reveals that, the strong accumulation of esophageal eosinophils is not accompanied by an increase in eosinophil specific transcripts (25).…”

Section: Cellular Pathogenesismentioning

confidence: 99%

Basic Pathogenesis of Eosinophilic Esophagitis

Blanchard

Rothenberg

2008

Gastrointestinal Endoscopy Clinics of North America

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Section: Cellular Pathogenesismentioning

confidence: 99%

Basic Pathogenesis of Eosinophilic Esophagitis

Blanchard

Rothenberg

2008

Gastrointestinal Endoscopy Clinics of North America

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“…(12,13) Several studies have described the endoscopic features of EoE in children diagnosed with the condition. (11,14,15) However, those endoscopic features are often subtle and easy to miss. Additionally, even though EoE is thought to be common among Caucasians, a high index of suspicion is recommended regardless of the ethnicity or gender of the patient, so that adequate oesophageal biopsies can be obtained during endoscopy to ensure an accurate diagnosis.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, even though EoE is thought to be common among Caucasians, a high index of suspicion is recommended regardless of the ethnicity or gender of the patient, so that adequate oesophageal biopsies can be obtained during endoscopy to ensure an accurate diagnosis. (11,14,15) There is a lack of detailed paediatric epidemiological data from several parts of the world, including Singapore. We thus aimed to determine the frequency and clinical manifestations of EoE in children who presented to a paediatric unit in Singapore.…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic oesophagitis in children: an uncommon occurrence in a predominantly Chinese population in Singapore

Tan

Srivastava

Teh

et al. 2017

smedj

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RESULTSOf the 88 children who had biopsies during OGD, 4 (4.5%) children (three boys, one girl; three Chinese, one Caucasian) were diagnosed with EoE. Their median age was 9.5 (range 4.0-12.0) years. The main clinical presentations were abdominal pain (in the three older children) and vomiting (in the youngest child). Three children had a history of atopy. Three children were diagnosed with EoE in the original histology reports, while one was diagnosed after the second review following histology demonstrating > 15 eosinophil granulocytes per high power field and microabscess formation. Endoscopy findings revealed oesophagitis in two children, one of whom was already on acid suppression therapy. Although three children were started on acid suppression therapy, they continued to be symptomatic. One child was also treated with swallowed fluticasone and two with food allergen avoidance, resulting in symptom improvement.CONCLUSION Although EoE is uncommon in Singapore, greater awareness is needed among family physicians and general paediatricians. Paediatric gastroenterologists should alert pathologists when sending biopsy specimens that are suspicious for EoE.

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“…Similarly, Salek et al [24] showed that biopsies performed in areas with white plaques and linear furrows demonstrated higher esophageal eosinophil counts. Several studies have reported that white plaques were significantly associated with esophageal eosinophilia in biopsy specimens [29][30][31]. Although we generally obtained biopsies from the sites of abnormal endoscopic findings, some cases showed abnormalities at the same sites in the esophagus because we evaluated endoscopic images retrospectively.…”

Section: Discussionmentioning

confidence: 99%

Optimal Biopsy Protocol to Evaluate Histological Effectiveness of Proton Pump Inhibitor Therapy in Patients with Eosinophilic Esophagitis

et al. 2018

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Objective: Recent guidelines propose that both proton pump inhibitor (PPI) responders and nonresponders are included in eosinophilic esophagitis (EoE). Although multiple biopsies should be required to diagnose EoE because of patchy distribution of esophageal eosinophils, it is unclear whether multiple biopsies are required to evaluate histological effectiveness of PPI therapy. This study aimed to determine the optimal biopsy protocol after PPI therapy in patients with EoE. Methods: Of 110 EoE patients, 22 PPI nonresponders were enrolled. Intraepithelial eosinophils were counted in areas of high density in multiple biopsy specimens after PPI therapy. The prevalence of esophageal eosinophilia and peak eosinophil counts after PPI therapy was analyzed according to the biopsy sites and endoscopic findings. Positive predictive value (PPV) was calculated according to the number of biopsies. Results: Of 124 biopsies, 59 (47.6%) specimens showed esophageal eosinophilia (≥15 per high-power field). Eosinophil counts were significantly higher in specimens from the lower esophagus than in those from the upper esophagus but not in those from the middle esophagus. Prevalence of esophageal eosinophilia was 76.2, 40.9, and 24.3% in the lower, middle, and upper esophagus respectively. PPI nonresponders were diagnosed in all cases with 4 biopsy specimens obtained from the lower and middle esophagus, showing that PPV for non-effectiveness of PPI therapy was 0.910 (95% CI 0.773–1.000). The prevalence of esophageal eosinophilia and peak eosinophil counts was higher in cases with white plaques and linear furrows. Conclusion: Multiple biopsies should be required to evaluate histological effectiveness of PPI therapy in patients with EoE. Four biopsies from the lower and middle esophagus may be sufficient.

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White specks in the esophageal mucosa: an endoscopic manifestation of non-reflux eosinophilic esophagitis in children

Cited by 93 publications

References 19 publications

Basic Pathogenesis of Eosinophilic Esophagitis

Basic Pathogenesis of Eosinophilic Esophagitis

Eosinophilic oesophagitis in children: an uncommon occurrence in a predominantly Chinese population in Singapore

Optimal Biopsy Protocol to Evaluate Histological Effectiveness of Proton Pump Inhibitor Therapy in Patients with Eosinophilic Esophagitis

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