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Eosinophilic esophagitis

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
E Ten Velde, B C Gonera-de Jong
In this case report we discuss two children with dysphagia. Both presented with difficulties in swallowing and oesophageal impaction of solid food. The first case involves a 16-year-old boy who suffered from dysphagia for many years. After a long diagnostic journey, during which a psychogenic cause was suspected, he was diagnosed with oesophageal achalasia. After a balloon dilatation of the lower oesophageal sphincter his complaints persisted and the treatment procedure was repeated. The second case involves a 15-year-old girl, who presented with a food impaction in the distal oesophagus...
2016: Nederlands Tijdschrift Voor Geneeskunde
Yusuke Tonai, Ryu Ishihara, Yasushi Yamasaki, Takashi Kanesaka, Sachiko Yamamoto, Tomofumi Akasaka, Noboru Hanaoka, Yoji Takeuchi, Koji Higashino, Noriya Uedo, Yasuhiko Tomita, Hiroyasu Iishi
Background and study aims: Better endoscopic diagnosis in case of Barrett's esophagus is still needed. White globe appearance (WGA) is a novel endoscopic marker for gastric adenocarcinoma, with high sensitivity for differentiating between gastric cancer/high-grade dysplasia and other lesions. We report 2 cases of esophageal adenocarcinoma with WGA. In Case 1, esophagogastroduodenoscopy (EGD) revealed a 10-mm esophageal adenocarcinoma in a 48-year-old Japanese woman with short-segment Barrett's esophagus. A small (< 1 mm) white globular lesion, typical of WGA, was observed under the epithelium by magnifying narrow-band imaging...
October 2016: Endoscopy International Open
Frank Zerbib
Eosinophilic esophagitis is a major cause of dysphagia and esophageal food impaction in young adults, although the diagnostic can be made in older patients. The diagnosis of eosinophilic esophagitis is suspected on endoscopic abnormalities of esophageal mucosa and confirmed by esophageal biopsy samples. Approximately 50% of patients with eosinophilic esophagitis do respond to proton pump inhibitors therapy. The first line therapy for eosinophilic esophagitis is proton pump inhibitor therapy. Ingested topical steroids represent a second-line therapy...
October 10, 2016: La Presse Médicale
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
N Nakajima, H Sato, K Takahashi, G Hasegawa, K Mizuno, S Hashimoto, Y Sato, S Terai
BACKGROUND: Histopathology of muscularis externa in primary esophageal motility disorders has been characterized previously. We aimed to correlate the results of high-resolution manometry with those of histopathology. METHODS: During peroral endoscopic myotomy, peroral esophageal muscle biopsy was performed in patients with primary esophageal motility disorders. Immunohistochemical staining for c-kit was performed to assess the interstitial cells of Cajal (ICCs)...
October 3, 2016: Neurogastroenterology and Motility: the Official Journal of the European Gastrointestinal Motility Society
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
F M Carlier, Y Sibille, C Pilette
Airway and intestinal epithelial layers represent first-line physical barriers, playing a key role in mucosal immunity. Barrier dysfunction, characterized by alterations such as disruption of cell-cell apical junctions and aberrant epithelial responses, probably constitutes early and key events for chronic immune responses to environmental antigens in the skin and in the gut. For instance, barrier dysfunction drives Th2 responses in atopic disorders or eosinophilic esophagitis. Such epithelial impairment is also a salient feature of allergic asthma and growing evidence indicates that barrier alterations probably play a driving role in this disease...
September 29, 2016: Clinical and Experimental Allergy: Journal of the British Society for Allergy and Clinical Immunology
S Goetze, A K Dumke, D Zillikens, U C Hipler, P Elsner
Anti-laminin γ1-pemphigoid (formerly known as anti-p200 pemphigoid) is a rare subepidermal autoimmunobullous disorder first described by Zillikens et al. in 1996 (1,2). Clinically, it mimics bullous pemphigoid, linear IgA dermatosis, dermatitis herpetiformis, pompholyx or the inflammatory variant of epidermolysis bullosa acquisita, respectively (1,3). The laminin γ1-chain has been identified as the major targeting antigen (1,4,5). Histologically, a subepidermal split is seen accompanied by neutrophils and eosinophils as well as linear deposits of IgG and/or C3 along the dermoepidermal junction in direct immunofluorescence microscopy (1)...
September 29, 2016: Journal of the European Academy of Dermatology and Venereology: JEADV
Laura K Johnston, Chia-Lin Hsu, Rebecca A Krier-Burris, Krishan D Chhiba, Karen B Chien, Andrew McKenzie, Sergejs Berdnikovs, Paul J Bryce
Eosinophils are important in the pathogenesis of many diseases, including asthma, eosinophilic esophagitis, and eczema. Whereas IL-5 is crucial for supporting mature eosinophils (EoMs), the signals that support earlier eosinophil lineage events are less defined. The IL-33R, ST2, is expressed on several inflammatory cells, including eosinophils, and is best characterized for its role during the initiation of allergic responses in peripheral tissues. Recently, ST2 expression was described on hematopoietic progenitor subsets, where its function remains controversial...
September 28, 2016: Journal of Immunology: Official Journal of the American Association of Immunologists
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
Samuel Costa, Margarida Ferreira, Bruno Gonçalves, Raquel Gonçalves
No abstract text is available yet for this article.
May 2016: Acta Médica Portuguesa
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