Eosinophilic Esophagitis in Children and Adolescents

2017 ◽  
Author(s):  
Elizabeth J Hait
Keyword(s):  
Eosinophilic Esophagitis ◽  
Failure To Thrive ◽  
Inflammatory Disorder ◽  
Esophageal Mucosa ◽  
Older Children ◽  
High Power Field ◽  
Interleukin 5 ◽  
Adolescents And Adults ◽  
History Of ◽  
Seasonal Allergies

Eosinophilic esophagitis (EoE) is an inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction in association with histologic evidence of eosinophilic infiltration of the esophageal mucosa. The diagnosis is based on esophageal biopsies showing more than 15 eosinophils per high-power field in the absence of pathologic gastroesophageal reflux. It can present with a wide array of upper gastrointestinal tract symptoms. Babies and toddlers typically present with feeding intolerance or refusal, vomiting, and failure to thrive. Older children often present with abdominal pain and reflux symptoms, whereas adolescents and adults typically present with solid-food dysphagia and/or food impaction. Diagnosis is also supported by a family history of EoE and other allergy-based disorders, such as asthma, seasonal allergies, and atopy. Topical corticosteroids and dietary elimination are acceptable first-line treatment approaches. This review contains 7 figures, 5 tables, and 51 references. Key words: dysphagia, elimination diets, endoscopic dilation, eosinophilic esophagitis, eotaxin-3, feeding dysfunction, interleukin-5, proton pump inhibitor–responsive esophageal eosinophilia, swallowed fluticasone, viscous budesonide

Eosinophilic Esophagitis in Children and Adolescents

2017 ◽  
Author(s):  
Elizabeth J Hait
Keyword(s):  
Eosinophilic Esophagitis ◽  
Failure To Thrive ◽  
Inflammatory Disorder ◽  
Esophageal Mucosa ◽  
Older Children ◽  
High Power Field ◽  
Interleukin 5 ◽  
Adolescents And Adults ◽  
History Of ◽  
Seasonal Allergies

Eosinophilic esophagitis (EoE) is an inflammatory disorder of the esophagus characterized by symptoms of esophageal dysfunction in association with histologic evidence of eosinophilic infiltration of the esophageal mucosa. The diagnosis is based on esophageal biopsies showing more than 15 eosinophils per high-power field in the absence of pathologic gastroesophageal reflux. It can present with a wide array of upper gastrointestinal tract symptoms. Babies and toddlers typically present with feeding intolerance or refusal, vomiting, and failure to thrive. Older children often present with abdominal pain and reflux symptoms, whereas adolescents and adults typically present with solid-food dysphagia and/or food impaction. Diagnosis is also supported by a family history of EoE and other allergy-based disorders, such as asthma, seasonal allergies, and atopy. Topical corticosteroids and dietary elimination are acceptable first-line treatment approaches. This review contains 7 figures, 5 tables, and 51 references. Key words: dysphagia, elimination diets, endoscopic dilation, eosinophilic esophagitis, eotaxin-3, feeding dysfunction, interleukin-5, proton pump inhibitor–responsive esophageal eosinophilia, swallowed fluticasone, viscous budesonide

Eosinophilic Esophagitis in a Kitten

2017 ◽  
Vol 53 (4) ◽  
pp. 214-220
Author(s):  
Julie Pera ◽  
Douglas Palma ◽  
Taryn A. Donovan
Keyword(s):  
Eosinophilic Esophagitis ◽  
Clinical Signs ◽  
Failure To Thrive ◽  
Eosinophilic Infiltration ◽  
Dietary Modification ◽  
Esophageal Mucosa ◽  
Intact Male ◽  
High Power Field ◽  
Significant Clinical Improvement ◽  
Dry Food

ABSTRACT A 4 mo old intact male kitten was presented for chronic regurgitation and failure to thrive after weaning to dry food. Esophageal dilatation and severe diffuse proliferative lesions of the esophageal mucosa were found via radiography and esophagoscopy, respectively. Histopathologic examination revealed severe, chronic, diffuse, hyperplastic eosinophilic and mastocytic esophagitis. Eosinophilic infiltrates were prominent, with a mean of 29.8 eosinophils per high power field, supportive of eosinophilic esophagitis (EoE). Significant clinical improvement was seen with dietary modification using a hydrolyzed diet. The addition of glucocorticoids did not result in further improvement in clinical signs. Repeat histopathology showed near resolution of eosinophilic infiltration. EoE is an uncommon and rarely reported condition in dogs and cats. Diagnosis involves histopathologic confirmation and exclusion of other causes of eosinophilic infiltration within the esophagus. This case report demonstrates the importance of biopsy in identification of EoE and the efficacy of dietary modification in the treatment of this disease in a kitten.

224 A RETROSPECTIVE CASE–CONTROL STUDY ASSESSING THE CLINICAL AND ENDOSCOPIC CHARACTERISTICS OF EOSINOPHILIC ESOPHAGITIS IN JAPAN

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Kazumi Imamura ◽  
Ken Haruma ◽  
Hiroshi Matsumoto ◽  
Yasuhiko Maruyama ◽  
Maki Ayaki ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Japanese Population ◽  
Case Control Study ◽  
High Power Field ◽  
Retrospective Case ◽  
Male Predominance ◽  
Endoscopic Findings ◽  
History Of ◽  
Endoscopic Characteristics ◽  
Control Study

Abstract   Eosinophilic esophagitis (EoE) is an allergy-associated clinicopathologic condition gaining an increasing amount of recognition in various areas of the world. While the clinical definition and characteristics may differ depending on country and region, sufficient studies have not yet been performed in Japan. To assess the prevalence of EoE among the Japanese population and the clinical features and the prognosis associated with the disease. Methods Medical data from January 2012 to October 2018 was gathered from nine Japanese clinical institutes. EoE, defined as more than 15 intraepithelial eosinophils per high power field, was determined based on esophageal biopsies. Clinical and endoscopic patterns in the cases with EoE were investigated and compared with 186 age- and sex-matched controls. We also analyzed the treatment and prognosis of an individual patient. Results From 130,013 upper endoscopic examinations, 66 cases of EoE were identified (0.051%; mean age: 45.2 years (range 7-79); 45 males). Patients with EoE had more symptoms (69.7 vs. 10.8%; P < 0.01) such as dysphagia and food impaction, and more allergies (63.6 vs. 23.7%; P < 0.01) compared with the controls. The prevalence of atrophic gastritis was lower in EoE patients than in the controls (20.0% vs. 33.3%). In 55 patients analyzed, 32 patients (78.0%) received proton pump inhibitors with or without swallowed topical corticosteroids. During the follw-up period (mean 23 months), no patient got worse regarding clinical and endoscopic findings. Conclusion The prevalence of EoE in the Japanese population was 0.051% which was comparable with previous reports in Japan. Male predominance, a history of allergies, and the absence of Helicobacter pylori infection might be risk factors for EoE. Our study also indicated that the prognosis of EoE might be relatively good in Japanese populations.

scholarly journals Eosinofilik Esofagitis

2013 ◽  
Vol 2 (3) ◽  
pp. 183
Author(s):  
Yusri Dianne Jurnalis ◽  
Yorva Sayoeti ◽  
Widiasteti Widiasteti
Keyword(s):  
Food Allergy ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Eosinophilic Esophagitis ◽  
High Power ◽  
Reflux Disease ◽  
Eosinophil Infiltration ◽  
Esophageal Mucosa ◽  
High Power Field ◽  
Histologic Diagnosis

AbstrakEosinofilik esofagitis merupakan gangguan dimana terjadi infiltrasi eosinofil pada mukosa superfisial esophagus yang berhubungan dengan alergi makanan dan kondisi atopi seperti asma, dermatitis atopi, rhinitis alergika dan sering bersamaan dengan Gastroesophageal Reflux Disease (GERD). Diperkirakan insiden tahunan 43 per 10.000 pada anak. Gejala klinis mirip dengan GERD yaitu muntah, regurgitasi, nausea, nyeri dada atau epigastrium, disfagia dan hematemesis. Sekitar 50% pasien memiliki gejala alergi dan lebih 50% pasien memiliki orang tua dengan riwayat alergi. Diagnosis dapat ditegakkan berdasarkan pemeriksaan endoskopi dan histologis. Gambaran endoskopi yang ditemukan antara lain feline esophagus, corrugated esophagus, ringed esophagus, atau concentric mucosal rings, eksudat putih, vesikel atau papul dan hilangnya pola vaskular menunjukkan area fokus infiltrasi eosinofil. Diagnosis secara histologis sangat penting dimana kriteria eosinofilik esofagitis adalah jika ditemukan eosinofil >20/HPF (High Power Field). Terapi yang diberikan adalah terapi diet, farmakologis seperti kortikosteroid sistemik atau topikal, penghambat reseptor leukotrin dan anti IL-5.Kata kunci: eosinofilik esofagitis, alergi makanan, atopiAbstractEosinophilic esophagitis is a disorder which there is eosinophil infiltration on superficial esophageal mucosa. It’s correlated with food allergy and atopy condition such as asthma, atopy dermatitis, rhinitis allergic and often in conjunction with Gastroesophageal Reflux Disease ( GERD). The incidence approximately 43/10.000 in children. The symptoms are similar with GERD, which one vomit, regurgitation, nausea, chest or epigastrium pain, dysphagia and hematemesis. About 50% patient has allergic symptoms and more than 50% parent of the patient has allergic history. The diagnose can be made base on endoscopic and histological examination. Endoscopic examination shows feline esophagus, corrugated esophagus or concentric mucosal rings, white exudates, vesikel or papul and diminished of vascular pattern, showing eosinophyl infiltration focus area. Histologic diagnosis is very important where the criteria for eosinophilic esophagitis is found eosinophils > 20 / HPF (High Power Field) within the superficial esophageal mucosa. Therapy eosinophilic esophagitis are diet therapy, pharmacological therapy with systemic or topical corticosteroid, leucotriene receptor antagonist and anti IL-5.Keywords:Eosinophilic esophagitis, food allergy, atopy

scholarly journals Eosinophilic Esophagitis: Atopy Conditions of the Esophagus

2021 ◽  
Vol 2 (3) ◽  
pp. 154-166
Author(s):  
Puspa Zuleika
Keyword(s):  
United States ◽  
Food Allergy ◽  
Eosinophilic Esophagitis ◽  
The United States ◽  
Esophageal Stenosis ◽  
Esophageal Mucosa ◽  
High Power Field ◽  
Immune Mediated ◽  
Food Antigens ◽  
Delays In Diagnosis

Eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental) characterized by major symptoms of esophagealdysphagia and eosinophil-predominant inflammation of the esophageal mucosathat affects both pediatric and adult patients. EoE is an immune-mediated diseaseby which environmental and food antigens stimulate the Th2 inflammatorycascade. It is correlated with food allergy and atopy condition such as asthma, atopydermatitis, rhinitis allergic and often in conjunction with Gastroesophageal RefluxDisease (GERD). Eosinophilic esophagitis (EoE) was first described in the 1990s,showing an increasing incidence and prevalence since then, in the United States isestimated to be approximately 57 per 100,000 persons being the leading cause offood impaction and the major cause of dysphagia. Its symptoms, which includeheartburn, regurgitation, and esophageal stenosis. This symptomps similar to thoseof gastroesophageal reflux disease, causing delays in diagnosis and treatment. Theendoscopic findings such as furrows, esophageal mucosa trachealization, andwhitish exudates, this diagnosis should be confirmed histologically confirmed bybiopsy on the presence of more than 15 eosinophils per high-power field and theexclusion of other causes of eosinophilia. Management includes medications, diet,and surgical dilatation.

DOZ047.76: Eosinophilic esophagitis and esophageal atresia. Is there an association?

2019 ◽  
Vol 32 (Supplement_1) ◽  
Author(s):  
L García ◽  
C Giné ◽  
A Laín ◽  
M Martín ◽  
J A Molino ◽  
...  
Keyword(s):  
Gastroesophageal Reflux ◽  
Diagnostic Criteria ◽  
Esophageal Atresia ◽  
Eosinophilic Esophagitis ◽  
Esophageal Mucosa ◽  
Early Puberty ◽  
High Power Field ◽  
Esophageal Biopsy ◽  
Macroscopic Appearance

Abstract Aim of the Study Eosinophilic esophagitis (EoE) is a recently diagnosed entity and seems to be more prevalent in patients with esophageal atresia (EA). It can mimic dysphagia and gastroesophageal reflux (GER) symptoms frequently observed in EA, but treatment is different. Methods Retrospective review (2002–2019) of patients with EA who underwent esophagogastroduodenoscopy (EGD) and esophageal biopsy was performed. EGD was performed in symptomatic patients and in all patients at 12–15 years. Diagnostic criteria for EoE included >15 eosinophils for a high-power field in the esophageal mucosa. Main Results From a total of 110 patients with EA, 27 lost follow-up. In the remaining 83, 56 patients (67, 5%) underwent EGD because of dysphagia or gastroesophageal reflux (GER) studies. Esophageal biopsies were performed in 35 patients and the diagnostic criteria for EoE were achieved in 5 (14,3%). The mean age at diagnosis of EoE was 10 + 2 years and the indication for EGD was GER symptoms (3) or dysphagia (2). In one case an antireflux surgery was previously performed but symptoms slightly persisted, while in 4 cases contrast studies and pH-metry showed no or minimal GER. EGD demonstrated light distal esophagitis in 2 cases, white exudates in 2, and was completely normal in the remaining one. On follow-up, 4 patients remain asymptomatic with proton pump inhibitor medication, and periodic EGD shows macroscopic improvement with a decreased eosinophilic peak on esophageal biopsies. Conclusions Patients with EA seem to have a higher risk of developing EoE at early puberty. EGD on follow-up should be focused not only on studying GER or Barrett, but also on actively search for EoE with an esophageal biopsy, even when the macroscopic appearance is normal.

scholarly journals Eosinophilic Esophagitis in a Developing Country: Is It Different from Developed Countries?

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Abdulrahman Al-Hussaini ◽  
Toufic Semaan ◽  
Imad El Hag
Keyword(s):  
Saudi Arabia ◽  
Developing Country ◽  
Eosinophilic Esophagitis ◽  
Failure To Thrive ◽  
Developed Countries ◽  
Response To Therapy ◽  
Dietary Manipulation ◽  
Older Children ◽  
Allergy Testing ◽  
Food Sensitization

Background and Objective. Despite the extensive reporting of eosinophilic esophagitis (EoE) from industrialized developed countries, reports from developing countries are rare. The aim of our study was to determine the epidemiological, clinical, and endoscopic features of EoE and response to therapy in children and adults from a developing country, Saudi Arabia.Methods. We identified patients diagnosed with EoE in our center from 2004 to 2011. EoE was defined as esophageal mucosal infiltration with a peak eosinophil count ≥15 eosinophils/high-powered field.Results. Forty-five patients were diagnosed with EoE (37 children and 8 adults; 36 males; median age 10.5 years, range from 1–37 years). Feeding difficulty, vomiting/regurgitation, and failure to thrive predominated in young children, whereas dysphagia and food impactions predominated in older children and adults. Allergy testing revealed food sensitization in 12 of 15 patients (80%); 3 responded to elemental formula, while 8 failed to respond to dietary manipulation after the allergy testing. Thirty-nine patients achieved remission by swallowed inhaled fluticasone. The majority of patients experienced a recurrence of symptoms upon the discontinuation of fluticasone.Conclusion. Our data indicate that EoE is increasingly recognized in Saudi Arabia and show many similarities to data from North America and Europe.

scholarly journals Esophageal Rupture as a Primary Manifestation in Eosinophilic Esophagitis

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
Natalia Vernon ◽  
Divyanshu Mohananey ◽  
Ehsan Ghetmiri ◽  
Gisoo Ghaffari
Keyword(s):  
Eosinophilic Esophagitis ◽  
Esophageal Perforation ◽  
Rare Complication ◽  
Esophageal Mucosa ◽  
Esophageal Rupture ◽  
Food Impaction ◽  
Initial Manifestation ◽  
Esophageal Lumen ◽  
History Of ◽  
Esophageal Dysfunction

Eosinophilic esophagitis (EoE) is a chronic inflammatory process characterized by symptoms of esophageal dysfunction and, histologically, by eosinophilic infiltration of the esophagus. In adults, it commonly presents with dysphagia, food impaction, and chest or abdominal pain. Chronic inflammation can lead to diffuse narrowing of the esophageal lumen which may cause food impaction. Endoscopic procedures to relieve food impaction may lead to complications such as esophageal perforation due to the friability of the esophageal mucosa. Spontaneous transmural esophageal rupture, also known as Boerhaave’s syndrome, as a primary manifestation of EoE is rare. In this paper, we present two adult patients who presented with esophageal perforation as the initial manifestation of EoE. This rare complication of EoE has been documented in 13 other reports (11 adults, 2 children) and only 1 of the patients had been previously diagnosed with EoE. A history of dysphagia was present in 1 of our patients and in the majority of previously documented patients. Esophageal perforation is a potentially severe complication of EoE. Patients with a history of dysphagia and patients with spontaneous esophageal perforation should warrant an evaluation for EoE.

scholarly journals Clinical Guidelines of the Russian Gastroenterological Association on the Diagnostics and Treatment of Eosinophilic Esophagitis

2019 ◽  
Vol 28 (6) ◽  
pp. 84-98 ◽  
Author(s):  
V. T. Ivashkin ◽  
I. V. Maev ◽  
A. S. Trukhmanov ◽  
T. L. Lapina ◽  
D. N. Andreev ◽  
...  
Keyword(s):  
Eosinophilic Esophagitis ◽  
Clinical Manifestations ◽  
Eosinophilic Infiltration ◽  
Esophageal Mucosa ◽  
High Power Field ◽  
Immune Mediated ◽  
Esophageal Dysfunction ◽  
Diagnostic Criterion ◽  
Choice Of Therapy

Aim.This paper presents guidelines on the diagnostics and treatment of eosinophilic esophagitis, which can be used by practitioners in their everyday practice.Summary.Eosinophilic esophagitis (EoE) is a chronic immune-mediated disease of the esophagus characterized by the symptoms of esophageal dysfunction and a pronounced eosinophilic infiltration of the esophageal mucosa. The EoE diagnostics is based on the clinical manifestations of the disease (dysphagia, food impaction, chest pain regardless of swallowing), as well as on the combination of endoscopic and histological signs. The diagnostic criterion is the eosinophilic infiltration of the esophageal mucosa with an eosinophil density of ≥ 15 per high power field (×400) in at least one of the biopsy specimens (about 60 eosinophils in 1 mm2). Total IgE levels, peripheral blood eosinophilia and skin allergy tests are considered to be additional diagnostic means. Several approaches are used for the treatment of EoE, including proton pump inhibitors (PPIs) and topical glucocorticosteroids (GCS), as well as elimination diets. The choice of therapy should be individualized, with the mandatory assessment of the treatment efficacy after 6–12 weeks using esophagogastroduodenoscopy with biopsy sampling. Endoscopic dilatation should be considered in patients suffering from severe dysphagia due to esophagus stricture.Conclusion.Increased incidence of EoE predominantly among children and young people, as well as its chronic character requiring long-term maintenance therapy, make EoE a significant issue to the practice of gastroenterology.

scholarly journals Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

2010 ◽  
Vol 24 (9) ◽  
pp. 547-551 ◽  
Author(s):  
Robert Enns ◽  
Pooya Kazemi ◽  
Wiley Chung ◽  
Mitchell Lee
Keyword(s):  
Family History ◽  
Eosinophilic Esophagitis ◽  
Patient Characteristics ◽  
Response To Treatment ◽  
Treatment Modalities ◽  
Telephone Interviews ◽  
Endoscopic Findings ◽  
History Of ◽  
One Year ◽  
Seasonal Allergies

Eosinophilic esophagitis (EE) is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women) with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

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