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Eosinophilic esophagitis (EOE)

Alexandra Ahmet, Eric I Benchimol, Ellen B Goldbloom, Janice L Barkey
BACKGROUND: Adrenal suppression (AS), a glucocorticoid (GC) side effect associated with significant morbidity, is well described related to inhaled corticosteroid therapy for asthma. Swallowed topical glucocorticoid therapy is the main pharmacotherapy treatment for eosinophilic esophagitis (EoE) and therefore children with EoE are potentially at increased risk of AS. METHODS: In this prospective cohort study, we included children and youth <18 years diagnosed with EoE and treated with swallowed fluticasone or oral viscous budesonide for more than 1 month...
2016: Allergy, Asthma, and Clinical Immunology
Leon A Sokulsky, Adam M Collison, Scott Nightingale, Anna Le Fevre, Elizabeth Percival, Malcolm R Starkey, Philip M Hansbro, Paul S Foster, Joerg Mattes
INTRODUCTION: Food antigens are common inflammatory triggers in pediatric eosinophilic esophagitis (EoE). TNF-related apoptosis-inducing ligand (TRAIL) promotes eosinophilic inflammation through the upregulation of Midline (MID)-1 and subsequent downregulation of Protein Phosphatase 2A (PP2A) but the role of this pathway in EoE that is experimentally induced by repeated food antigen challenges has not been investigated. METHODS: Esophageal mucosal biopsies were collected from children with EoE and controls and assessed for TRAIL and MID-1 protein and mRNA transcript levels...
October 13, 2016: American Journal of Physiology. Gastrointestinal and Liver Physiology
Anca Trifan, Oana Stoica, Catalin-Alexandru Chihaia, Mihai Danciu, Carol Stanciu, Ana-Maria Singeap
INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by a marked eosinophilic infiltrate in the esophageal mucosa. What was once considered a rare disease has nowadays become one of the most frequent esophageal diseases in the Western countries, occupying a place just next to the gastroesophageal reflux disease. EoE etiology and pathogenesis remain largely unknown, although most studies consider that allergic and genetic factors play the most important role...
October 2016: Medicine (Baltimore)
Anna K Le Fevre, Marjorie M Walker, Amir Hadjiashrafy, Rani Bhatia, Joerg Mattes, Nicholas J Talley, Scott Nightingale
OBJECTIVES: This study compared the clinical and histopathological characteristics of children with EoE and elevated anti-transglutaminase (TTG Ab) with those with EoE and normal TTG Ab titres. METHODS: Single center chart and blinded histopathological review of patients diagnosed with EoE over a four-year period, who had esophageal and duodenal biopsies taken at time of endoscopy, and TTG Ab measured within 6 months of biopsy. Patients with histology-proven CD were excluded...
October 12, 2016: Journal of Pediatric Gastroenterology and Nutrition
E Gómez Torrijos, P Sánchez Miranda, P Donado Palencia, A Castro Jimenez, J Rodriguez Sánchez, Y Mendez Díaz, L Moreno Lozano, R García Rodríguez
BACKGROUND: Eosinophilic esophagitis (EoE) is a chronic inflammatory emerging disease of the oesophagus with immunoallergic aetiology. Until now, few studies about this disease in children and adolescents have been published Objectives: To study the demographic, clinical, serologic, endoscopic-histological and allergologic characteristics of the patients and their atopic and digestive comorbidities. METHODOLOGY: It is an prospective observacional study in children and adolescents (<16 years) assessed in a multidisciplinary specialized eosinpophilic esopahgitis unit in a tertiary referral centre in the central region of Spain carried out between 2011-2015...
October 10, 2016: Journal of Investigational Allergology & Clinical Immunology
Emily C McGowan, Thomas A Platts-Mills
Eosinophilic esophagitis (EoE) is a clinicopathologic condition characterized by symptoms of esophageal dysfunction and eosinophil-predominant inflammation. In adults, the three most common treatment options are swallowed steroids, elimination diets, and periodic esophageal dilations. Many different elimination diets have been studied in adults, including elemental diets, allergy testing-directed diets, and empiric elimination diets. This article will review the existing data on these dietary therapies and will propose an approach to dietary management in adult EoE...
November 2016: Current Gastroenterology Reports
R Soto-Solís, K Santana-de Anda, N González-Uribe, C Gallegos, C Romo-Aguirre, J M Remes-Troche, M A Ballesteros-Amozurrutia
INTRODUCTION: Eosinophilic esophagitis (EoE) is a chronic, immune disorder mediated largely by food antigens. It shares nonspecific symptoms with gastroesophageal reflux disease (GERD). EoE is rarely reported in Mexico, perhaps due to the racial characteristics of the population or because of insufficient diagnostic suspicion. AIMS: Our aim was to describe a Mexican cohort with EoE and evaluate the usefulness of the clinical history and endoscopy in the EoE diagnosis, in comparison with GERD patients...
October 3, 2016: Revista de Gastroenterología de México
Jae Hyon Park, Dong Yeon Jeong, Laurent Peyrin-Biroulet, Michael Eisenhut, Jae Il Shin
Proinflammatory cytokines are thought to modulate pathogeneses of various inflammatory bowel diseases (IBDs). Thymic stromal lymphopoietin (TSLP), which has been studied in various allergic diseases such as asthma, atopic dermatitis (AD) and eosinophilic esophagitis (EoE), has been less considered to be involved in IBDs. However, mucosal dendritic cells (DCs) induced by various cytokines including TSLP were reported to cause polarization of T cell toward Th2 response, the differentiation of regulatory T-cell (Treg), and secretion of IgA by B cells...
October 1, 2016: Autoimmunity Reviews
Nisha A Shah, Dustin M Albert, Noah M Hall, Fouad J Moawad
Eosinophilic esophagitis (EoE) is a chronic and progressive immune-mediated condition defined by symptoms of esophageal dysfunction and dense eosinophilic infiltration of the esophageal mucosa. Therapies consist of anti-eosinophilic medications and specialized diets aimed to decrease the progression of EoE and alleviate its symptoms, namely, dysphagia and food impaction. Assessing response to therapy remains challenging, as treatment end points are not well defined and currently consist of clinical, histologic, and endoscopic features...
2016: Clinical and Experimental Gastroenterology
Thomas M Runge, Swathi Eluri, Cary C Cotton, Caitlin M Burk, John T Woosley, Nicholas J Shaheen, Evan S Dellon
GOALS: To characterize patients who suffer perforation in the context of eosinophilic esophagitis (EoE) and to identify predictors of perforation. BACKGROUND: Esophageal perforation is a serious complication of EoE. MATERIALS AND METHODS: We conducted a retrospective cohort study of the University of North Carolina EoE clinicopathologic database from 2001 to 2014. Subjects were included if they had an incident diagnosis of EoE and met consensus guidelines, including nonresponse to a PPI trial...
September 27, 2016: Journal of Clinical Gastroenterology
Ekaterini Politi, Aspasia Angelakopoulou, Dimitra Grapsa, Maria Zande, Kalliopi Stefanaki, Ioanna Panagiotou, Eleftheria Roma, Ekaterini Syrigou
OBJECTIVES: Previous data have suggested that filaggrin (FLG) and periostin (POSTN) genes may be dysregulated in eosinophilic esophagitis (EoE). We aimed to further evaluate the expression patterns of FLG and POSTN proteins in esophageal tissue samples of patients with EoE, as compared to those of patients with gastroesophageal reflux disease (GERD) and normal controls. METHODS: A total of 61 prospectively collected cases, including 40 children with EoE and 21 children with gastroesophageal reflux disease (GERD), and a control group of 14 sex and age-matched healthy children were enrolled...
September 24, 2016: Journal of Pediatric Gastroenterology and Nutrition
Jeffrey A Alexander, Karthik Ravi, Felicity T Enders, Debra M Geno, Lori A Kryzer, Kristin C Mara, Thomas C Smyrk, David A Katzka
BACKGROUND & AIMS: Montelukast, a cysteinyl leukotriene type-1 receptor blocker, has been shown in small retrospective studies to reduce symptoms in patients with eosinophilic esophagitis (EoE). We performed a randomized placebo-controlled double blind trial to determine whether montelukast maintains symptomatic remission induced by topical steroid therapy in patients with EoE. METHODS: We performed a prospective study of adult patients with EoE (solid food dysphagia and a peak esophageal eosinophil count of > 20 cells/high-powered field) enrolled the Mayo Clinic in Rochester Minnesota from April 2008 through February 2015...
September 17, 2016: Clinical Gastroenterology and Hepatology
Michael A Scaffidi, Ankit Garg, Brandon Ro, Christopher Wang, Tony T C Yang, Ian S Plener, Andrea Grin, Errol Colak, Samir C Grover
Background. Esophageal intramural pseudodiverticulosis (EIPD) is an idiopathic benign chronic disease characterized by flask-like outpouchings of the esophageal wall. It is unknown whether there is a genuine association between EIPD and eosinophilic esophagitis (EoE). Aims. To investigate a possible relationship between EIPD and EoE. Methods. Patients with radiographic or endoscopic evidence of pseudodiverticulosis were identified from the database at a single academic center. Cases were analyzed in three areas: clinical information, endoscopic findings, and course...
2016: Canadian Journal of Gastroenterology & Hepatology
Thirumazhisai Gunasekaran, Gautham Prabhakar, Alan Schwartz, Kiranmai Gorla, Sandeep Gupta, James Berman
Aim. Compare EoE-AP with EoE-D for clinical, endoscopy (EGD), histology and outcomes and also with FAP-N. Method. Symptoms, physical findings, EGD, histology, symptom scores, and treatments were recorded for the three groups. Cluster analysis was done. Results. Dysphagia and abdominal pain were different in numbers but not statistically significant between EoE-AP and EoE-D. EGD, linear furrows, white exudates were more in the EoE-D and both combined were significant (p < 0.05). EoE-D, peak and mean eosinophils (p  0...
2016: Canadian Journal of Gastroenterology & Hepatology
Ashleigh A Olson, Michael D Evans, Mats W Johansson, Chloe H Kim, David M Manthei, Eric A Gaumnitz, Sameer K Mathur
BACKGROUND: Evaluation of IgE-mediated food sensitivity is frequently performed for patients with eosinophilic esophagitis (EoE). However, the clinical relevance of identifying IgE-mediated sensitivity to foods in adults is unclear. OBJECTIVE: To determine whether EoE associated with food or aeroallergen sensitivity represents a phenotype of EoE with distinct clinical or biological features. METHODS: A medical record review identified 257 patients with a diagnosis of EoE evaluated in the adult allergy clinic at the University of Wisconsin Hospital and Clinics from 2008 to 2013...
October 2016: Annals of Allergy, Asthma & Immunology
Tamar Rubin, Jacqueline Clayton, Denise Adams, Rabin Persad, Sunita Vohra
BACKGROUND: Heterogeneity has been noted in the selection and reporting of disease-specific, pediatric outcomes in randomized controlled trials (RCTs). The consequence is invalid results or difficulty comparing results across trials. The primary objective of this systematic review was to assess primary outcome and outcome measure selection and reporting, in pediatric eosinophilic esophagitis (EoE) treatment trials. As secondary objectives, we compared trial disease definition to established concensus guidelines, and the efficacy of current EoE treatments...
2016: Allergy, Asthma, and Clinical Immunology
Yiang Hui, Sonja Chen, Kara A Lombardo, Murray B Resnick, Shamlal Mangray, Andres Matoso
Histologically, esophageal biopsies should have {greater than or equal to}15 intraepithelial eosinophils (IEEs) per high power field (HPF) to support a clinicopathologic diagnosis of eosinophilic esophagitis (EoE). Children with clinically apparent EoE may show pauci-eosinophilic biopsies due to patchy involvement. Immunostaining (IHC) for arachidonate-15 lipooxygenase (ALOX15) has been demonstrated to be a sensitive marker for EoE. We retrospectively assessed the expression of ALOX15 in 48 biopsies from 21 patients with established diagnosis of EoE and with tissue fragments below the threshold of 15 IEEs/HPF...
August 30, 2016: Pediatric and Developmental Pathology
Purna Krishnamurthy, Mark H Kaplan
Allergic inflammation requires the orchestration of altered gene expression in the target tissue and in the infiltrating immune cells. The transcription factor STAT6 is critical in activating cytokine gene expression and cytokine signaling both in the immune cells and in target tissue cells including airway epithelia, keratinocytes and esophageal epithelial cells. STAT6 is activated by the cytokines IL-4 and IL-13 to mediate the pathogenesis of allergic disorders such as asthma, atopic dermatitis, food allergy and eosinophilic esophagitis (EoE)...
August 2016: Immune Network
Diego Garcia-Compean, Emmanuel Irineo Gonzalez-Moreno, José Alberto Gonzalez-Gonzalez, Omar David Borjas-Almaguer, Héctor J Maldonado-Garza
BACKGROUND: According to consensus recommendations, for diagnosis of eosinophilic esophagitis (EoE) is required the presence of esophageal symptoms, ˃ 15 eosinophils/high power field and unresponsiveness to proton pump inhibitors . Nevertheless, lack of consistency with these guidelines has been reported in recent publications. AIMS: To assess consistency with EoE diagnostic guidelines in the published studies on prevalence and also evaluate other clinical and methodological parameters...
August 25, 2016: Journal of Digestive Diseases
Kotryna Truskaite, Aldona Dlugosz
Background. The relation of esophageal food bolus impaction (FBI) to eosinophilic esophagitis (EoE) and lymphocytic esophagitis (LyE) is unclear. The aim of this study was to determine the prevalence of EoE and LyE among adults with FBI. Methods. In this retrospective study we analyzed data from all patients referred for gastroscopy during the past 5 years, because of a present or recent episode of FBI. Results. We found 238 patients with FBI (median age 51 (17-96), 71% males). Endoscopic therapy was required in 143 patients...
2016: Gastroenterology Research and Practice
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