Abstract
Background and AimAs the number of patients with eosinophilic esophagitis (EoE) has increased worldwide, the likelihood of diagnosing esophageal eosinophilia (EE) in screening endoscopy has also increased. Many of these EE patients do not display any symptoms (i.e. they display asymptomatic EE: aEE), and the risk of aEE patients developing EoE has yet to be demonstrated.MethodsA total of 62 250 cases were found in the endoscopic registries of two digestive disease centers in the context of gastric cancer screening from April 2016 to August 2018, and these were reviewed.ResultsThirty‐seven aEE patients (0.059%) were found in the registries, and the histories of endoscopic findings and symptoms were successfully traced for 29 of them. While 11 aEE (37.9%) patients did not show any change in endoscopic findings, 18 (62.1%) exhibited exacerbation. A comparison of the two groups showed both relative youth and diffuse disease distribution to be independent risk factors for progression (P = 0.0034 and 0.0078, respectively). Of the 18 aEE patients whose findings showed progression, 6 developed EoE (5 (17.2%) developed proton‐pump inhibitor (PPI)‐responsive EoE, and only 1 (3.4%) developed PPI‐resistant EoE). A comparison of the non‐EoE and EoE groups showed relative youth to be an independent risk factor for progression to EoE (P = 0.0146).ConclusionsWhile some aEE patients developed symptomatic EE, the existence among them of PPI‐resistant EoE was extremely rare. Younger age and diffuse disease distribution at first detection in endoscopic findings are risk factors for progression to symptomatic EE in aEE patients.
Highlights
Eosinophilic esophagitis (EoE) was first reported in 1993 and is defined as an inflammatory disease of the esophagus that is characterized by significant infiltration of eosinophils into the esophageal mucosa.[1,2] The existence of more than 15 eosinophils per high power field (HPF) in esophagus mucosa satisfies the criteria for diagnosing eosinophilic esophagitis (EoE).[3–5] These eosinophils contribute to the development of local inflammation and tissue damage through a Th2 type-dominant allergic reaction,[6] and EoE patients exhibit symptoms such as dysphagia, food impaction, chest pain, nausea, and vomiting
Three cases of gastroesophageal reflux disease (GERD) and one case of infectious disease were excluded
A recent review article mentioned that the prevalence of EoE in Japan has been increasing by up to 0.4%; the studies mentioned in the article mainly focused on symptomatic patients, and the precise prevalence of aEE has been unclear.[21]
Summary
Eosinophilic esophagitis (EoE) was first reported in 1993 and is defined as an inflammatory disease of the esophagus that is characterized by significant infiltration of eosinophils into the esophageal mucosa.[1,2] The existence of more than 15 eosinophils per high power field (HPF) in esophagus mucosa satisfies the criteria for diagnosing EoE.[3–5] These eosinophils contribute to the development of local inflammation and tissue damage through a Th2 type-dominant allergic reaction,[6] and EoE patients exhibit symptoms such as dysphagia, food impaction, chest pain, nausea, and vomiting. Screened aEE shares common features with EoE: linear furrowing, concentric rings, and white speckled exudates The existence of such features indicates the advisability of performing pathological diagnoses on aEE patients.[9–11]. As the number of patients with eosinophilic esophagitis (EoE) has increased worldwide, the likelihood of diagnosing esophageal eosinophilia (EE) in screening endoscopy has increased Many of these EE patients do not display any symptoms (i.e. they display asymptomatic EE: aEE), and the risk of aEE patients developing EoE has yet to be demonstrated. Younger age and diffuse disease distribution at first detection in endoscopic findings are risk factors for progression to symptomatic EE in aEE patients
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