Diagnosis Of Esophagitis Research Articles

Milk- or egg-allergy diagnosis increases the risk of eosinophilic esophagitis diagnosis

Milk- or egg-allergy diagnosis increases the risk of eosinophilic esophagitis diagnosis

Diagnosis and management of eosinophilic oesophagitis

Diagnosis and management of eosinophilic oesophagitis

Optimal Management of Patients with Phlegmonous Esophagitis: A Systematic Review and Meta-Analysis.

To assess the characteristics and prognosis-influencing factors of phlegmonous esophagitis, a rare condition marked by suppurative inflammation of the esophageal submucosa and muscular layers. Effective management strategies for phlegmonous esophagitis are lacking. This study aims to systematically review cases to better understand the disease's features and prognostic determinants. A systematic search was performed using PubMed/MEDLINE and Google Scholar from inception to 20 April 2023. Phlegmonous esophagitis case reports and studies with patient information were included; clinical manifestations, laboratory results, imaging findings, other diagnostic findings, and outcomes were analyzed. A pooled analysis was performed to investigate mortality-related risk factors. A total of 35 cases of phlegmonous esophagitis were selected from 31 case reports and 2 case series (median age, 57.0 years; male, 54.3%). The patients presented various clinical symptoms, with neck-to-epigastric pain and dysphagia being the most common. Comorbid diabetes mellitus was a major predisposing factor; one-third of the patients had no previous medical history. Computed tomography (CT) and endoscopic examinations were predominantly used for phlegmonous esophagitis diagnosis. Radiological findings showed that the upper and middle esophagus were most frequently involved. Treatments included administration of broad-spectrum antibiotics and drainage via endoscopy or surgery. There were three cases of mortality, and non-survivors tended to have shorter hospital stays, indicating rapid disease progression. In logistic regression, thoracic surgery was a significant mortality-related risk factor (odds ratio, 19.30; 95% confidence interval, 1.33-282.00, p = 0.03). Advancements in CT and endoscopy have led to less-invasive diagnostic and treatment methods for phlegmonous esophagitis. Endoscopic localized abscess treatment is associated with positive outcomes.

Tailoring follow-up endoscopy in patients with severe oesophagitis

ObjectiveWe aimed to investigate the clinical utility of follow-up oesophagogastroduodenoscopy (OGD2) in patients with severe oesophagitis (Los Angeles grades C or D) through evaluating the yield of Barrett’s oesophagus (BO),...

Retrospective cohort study: Effect of age as a barrier to diagnosis of eosinophilic oesophagitis.

Prior work suggests eosinophilic oesophagitis (EoE) is rare in those aged over 65 years. However, elderly patients with EoE experience a substantial diagnostic delay from symptom onset to diagnosis. To assess if age predicted whether oesophageal biopsies were obtained in patients with EoE symptoms, what clinical features predict EoE in the elderly, and if EoE phenotype differs between elderly and non-elderly patients. We conducted a retrospective cohort study utilising the University of North Carolina (UNC)electronic medical record, EoE clinicopathologic database and UNC endoscopy software from July 2008 to April 2021. A sample of 193 elderly and non-elderly patients with dysphagia, chest pain and/or heartburn were assembled. Patients with EoE were newly diagnosed per contemporaneous guidelines. Patient demographics, clinical characteristics and procedural data were extracted. Summary statistics, bivariate and multivariate analyses were performed. Of 193 patients, we included 91 elderly (47%) and 102 non-elderly (53%). Age independently predicted the odds of biopsies (adjusted odds ratio (aOR): 0.44 elderly vs. non-elderly; 95% CI: 0.21-0.92). Endoscopic features of EoE, but not symptoms, were more common in elderly than non-EoE elderly patients. Elderly patients with EoE differed from non-elderly only by time to diagnosis (aOR per year of symptoms preceding diagnosis: 1.08, 95% CI: 1.04-1.11). Elderly patients with EoE have <50% the odds of oesophageal biopsies. There were no significant differences between elderly and non-elderly EoE patients, although endoscopic features helped discriminate the two groups. Our findings suggest that older age represents a barrier to EoE diagnosis.

Efficacy and safety of dupilumab up to 52 weeks in adults and adolescents with eosinophilic oesophagitis (LIBERTY EoE TREET study): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial

Efficacy and safety of dupilumab up to 52 weeks in adults and adolescents with eosinophilic oesophagitis (LIBERTY EoE TREET study): a multicentre, double-blind, randomised, placebo-controlled, phase 3 trial

Description of allergic phenotype in patients with eosinophilic oesophagitis: management protocol proposal

There is a profile of patient with eosinophilic oesophagitis and atopic background, marked by the existence of IgE-mediated sensitizations. Our aim is to report the observed sensitivities to environmental and food allergens and panallergens in patients with eosinophilic oesophagitis with atopic background as well as characterizing other markers or analytical parameters. We suspect that the prevalence of sensitization to panallergens will be high and this will probably be relevant in terms of the onset and clinical course of the disease. We collated clinical and analytical data from 160 adult patients with a reported diagnosis of eosinophilic oesophagitis. These patients were studied between 1 January 2012 and 31 December 2020. During an initial visit skin tests were performed with full batteries of routine aero-allergens and foodstuffs. Patients were subsequently referred for blood test and determination of specific IgE, blood count and total IgE (in all cases), as well as eosinophilic cation protein and IMMUNOISAC in the centres in which this was available. We were able to detect a broad spectrum of sensitizations to environmental, foodstuffs and panallergens. The most common allergic disease was rhinoconjuntivitis. The sensitizations observed to foodstuffs were atypical for the adult population and were not responsible for manifestations compatible with immediate allergy. An important percentage of patients presented seasonal worsening of choking symptoms. We should be able to identify patients with eosinophilic oesophagitis and atopic background. Identifying this phenomenon would enable giving dietary and environmental recommendations as well as more specific and effective treatments to our patients.

Development and Validation of Deep Learning Models for the Multiclassification of Reflux Esophagitis Based on the Los Angeles Classification.

This study is to evaluate the feasibility of deep learning (DL) models in the multiclassification of reflux esophagitis (RE) endoscopic images, according to the Los Angeles (LA) classification for the first time. The images were divided into three groups, namely, normal, LA classification A + B, and LA C + D. The images from the HyperKvasir dataset and Suzhou hospital were divided into the training and validation datasets as a ratio of 4 : 1, while the images from Jintan hospital were the independent test set. The CNNs- or Transformer-architectures models (MobileNet, ResNet, Xception, EfficientNet, ViT, and ConvMixer) were transfer learning via Keras. The visualization of the models was proposed using Gradient-weighted Class Activation Mapping (Grad-CAM). Both in the validation set and the test set, the EfficientNet model showed the best performance as follows: accuracy (0.962 and 0.957), recall for LA A + B (0.970 and 0.925) and LA C + D (0.922 and 0.930), Marco-recall (0.946 and 0.928), Matthew's correlation coefficient (0.936 and 0.884), and Cohen's kappa (0.910 and 0.850), which was better than the other models and the endoscopists. According to the EfficientNet model, the Grad-CAM was plotted and highlighted the target lesions on the original images. This study developed a series of DL-based computer vision models with the interpretable Grad-CAM to evaluate the feasibility in the multiclassification of RE endoscopic images. It firstly suggests that DL-based classifiers show promise in the endoscopic diagnosis of esophagitis.

S490 A Single Center Experience in the Management and Follow-Up of Patients With Esophagitis: A Retrospective Study

Introduction: Gastroesophageal reflux disease (GERD) is a chronic condition in which the reflux of gastric content into the esophagus results in symptoms and complications, such as erosive esophagitis, Barrett’s esophagus (BE), and esophageal adenocarcinoma. There are four grades of esophagitis increasing in severity from A to D. In patients with esophagitis on initial endoscopic evaluation, the current American College of Gastroenterology (ACG) guidelines recommend repeat esophagogastroduodenoscopy (EGD) after a minimum 8-week of proton pump inhibitor (PPI) therapy, to ensure healing of esophagitis and to determine the presence of BE. Our objectives were to characterize patients with esophagitis who presented to Saint Louis University Hospital (SLUH), understand practice patterns, and identify variables that predict disease progression and affect clinical outcomes. Methods: We identified 256 patients who presented to SLUH for EGD for any indication between 2012 and 2018 and were found to have endoscopic diagnosis of esophagitis. Laboratory and pathologic data were reviewed for initial and follow-up endoscopy. All categorical variables were analyzed by chi-square analysis. Analysis of variance (ANOVA) and t-tests were used for continuous data, and analysis was performed using SPSS version 27.0. Results: Out of the 256 patients who were diagnosed with esophagitis, 61 were classified as Grade A, 59 Grade B, 45 Grade C and 91 Grade D. The mean age was 59 ± 15 and the mean BMI was 27.3 ± 8. PPI prescription percentage, repeat EGD and outcomes are shown in Table. There was no statistically significant association between sex, ethnicity, smoking history, or alcohol use history and development of BE. Conclusion: Our study showed under-prescription of PPI in patients with esophagitis. Repeat EGD was only recommended for 28%, 32%, 49% and 57% of the patients with Grades A, B, C and D esophagitis, respectively. Stronger efforts should be taken to help adhere to the guidelines in prescribing acid-suppressive medications and recommending repeat EGD for patients with esophagitis. Development of esophageal cancer was the highest in those with Grade D esophagitis. Larger studies are needed to evaluate the risk of BE or dysplasia in patients with Grades A and B esophagitis and to provide additional data on rates of development of BE or esophageal cancer in the respective groups. Table 1. - Results of a single-center study on PPI prescription percentage, repeat EGD and outcomes in patients with endoscopic diagnosis of esophagitis Grade of esophagitis PPI treatment recommended Repeat EGD recommended Repeat EGD performed Barrett’s esophagus present on follow up Dysplasia present on follow up Esophageal cancer present on follow up A (N=61) 51 (84%) 17 (28%) 6 (35%) 2 (3.3%) 2 (3.3%) 1 (1.6%) B (N=59) 40 (68%) 19 (32%) 4 (21%) 3 (5.1%) 1 (1.7%) 1 (1.7%) C (N=45) 38 (84%) 22 (49%) 3 (14%) 1 (2.2%) 1 (2.2%) 1 (2.2%) D (N=91) 74 (81%) 52 (57%) 19 (37%) 8 (8.8%) 3 (3.3%) 5 (5.5%)

135. A COMPARISON OF THE INOUE ASSESSMENT METHODS AND THE HILL GRADING OF THE GASTROESOPHAGEAL JUNCTION IN DIAGNOSING REFLUX SYMPTOM SEVERITY, ESOPHAGITIS, AND GERD AMONG PATIENTS WHO UNDERWENT UPPER GI ENDOSCOPY IN A TERTIARY HEALTHCARE FACILITY

Abstract Gastroesophageal reflux disease (GERD) results from failure of the anti-reflux barriers in the gastroesophageal junction. Inoue proposed cardiac opening (CO), sliding hernia (SH), and scope holding time (SHT%) to assess this junction. To compare these Inoue methods and the Hill grade in diagnosis of severe GERD symptoms, moderate–severe esophagitis and GERD. Patients scheduled for gastroscopy off proton pump inhibitors were included. Symptoms were assessed using the GERDQ score. Esophagitis was determined using the modified LA Classification. The gastroesophageal junction was described using the Inoue methods and the Hill grade. The Inoue methods individually and as a composite score were compared to Hill grade. We were unable to reach our target sample size of 91. Only 69 patients were included. In severe GERD symptom diagnosis (GERDQ ≥11), Inoue score (composed of CO and SH with 1 point each) had good performance (AUC 0.87, 95%CI 0.70–1.04). In moderate–severe esophagitis diagnosis (LA grades B-D), SH (AUC 0.73, 95%CI 0.58–0.88) and Inoue score (AUC 0.79, 95%CI 0.64–0.94) had fair performance. In GERD (either GERDQ ≥8 or esophagitis) diagnosis, Inoue score (AUC 0.88, 95%CI 0.80–0.97) and CO (AUC 0.76, 95%CI 0.63–0.89) had fair-good performance. The rest had poor or failed values. Inoue score had fair-good performance in diagnosing severe GERD symptoms, moderate–severe esophagitis and GERD. Sliding hernia had fair performance in diagnosing moderate–severe esophagitis. CO had fair performance in diagnosing GERD. SHT% and Hill grade were poor/failed for all outcomes.

Objectively confirmed gastroesophageal reflux disease and risk of atrial fibrillation: a population-based cohort study in Sweden.

This study aimed to determine the risk of atrial fibrillation in patients with objectively confirmed GERD. This was a nationwide population-based cohort study between 2005 and 2018, including the majority ( n = 8 421 115) of all Swedish adult residents (≥18 years). Within this cohort, the exposed group were all individuals with a diagnosis of esophagitis or Barrett's esophagus, and the unexposed group was made up of five times as many individuals without any GERD, matched by age, sex, and calendar year. The outcome was the first diagnosis of atrial fibrillation. Cox regression provided hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for confounders. Among 118 013 individuals with esophagitis or Barrett's esophagus and 590 065 without GERD, 7042 (6.0%) and 40 962 (6.9%) developed atrial fibrillation, respectively. The risk of atrial fibrillation among patients with GERD was 13% increased within the first year of diagnosis (HR, 1.13; 95% CI, 1.06-1.20), but was not increased after that. Among individuals aged less than 60 years, the HR of atrial fibrillation was 55% increased within the first year of diagnosis (HR, 1.55; 95% CI, 1.27-1.88), and this association remained increased after the first year (HR, 1.14; 95% CI, 1.06-1.22). No association was found in older participants (≥60 years). Results were similar in men and women. This large population-based cohort study indicates that objectively determined GERD increases the risk of atrial fibrillation shortly after diagnosis in men and women younger than 60 years.

Recognition of esophagitis in endoscopic images using transfer learning.

BACKGROUNDEsophagitis is an inflammatory and damaging process of the esophageal mucosa, which is confirmed by endoscopic visualization and may, in extreme cases, result in stenosis, fistulization and esophageal perforation. The use of deep learning (a field of artificial intelligence) techniques can be considered to determine the presence of esophageal lesions compatible with esophagitis.AIMTo develop, using transfer learning, a deep neural network model to recognize the presence of esophagitis in endoscopic images.METHODSEndoscopic images of 1932 patients with a diagnosis of esophagitis and 1663 patients without any pathological diagnosis provenient from the KSAVIR and HyperKSAVIR datasets were splitted in training (80%) and test (20%) and used to develop and evaluate a binary deep learning classifier built using the DenseNet-201 architecture, a densely connected convolutional network, with weights pretrained on the ImageNet image set and fine-tuned during training. The classifier model performance was evaluated in the test set according to accuracy, sensitivity, specificity and area under the receiver operating characteristic curve (AUC).RESULTSThe model was trained using Adam optimizer with a learning rate of 0.0001 and applying binary cross entropy loss function. In the test set (n = 719), the classifier achieved 93.32% accuracy, 93.18% sensitivity, 93.46% specificity and a 0.96 AUC. Heatmaps for spatial predictive relevance in esophagitis endoscopic images from the test set were also plotted. In face of the obtained results, the use of dense convolutional neural networks with pretrained and fine-tuned weights proves to be a good strategy for predictive modeling for esophagitis recognition in endoscopic images. In addition, adopting the classification approach combined with the subsequent plotting of heat maps associated with the classificatory decision gives greater explainability to the model.CONCLUSIONIt is opportune to raise new studies involving transfer learning for the analysis of endoscopic images, aiming to improve, validate and disseminate its use for clinical practice.

Efficacy of rabeprazole (Razo®) in the treatment of various clinical variants of GERD: results from the GERBERA study

Introduction. Gastroesophageal reflux disease (GERD) is extremely common in the structure of gastroenterological diseases. Aim. To conduct a prospective observational post-marketing study of rabeprazole (Razo®) 20 mg taking once daily in patients with non-erosive reflux disease (NERD) after 2 and 4 weeks of therapy and esophagitis stage A and B after 4 weeks of therapy (GERBERA).Materials and methods. 75 patients with GERD were included in the study (36 men and 39 women, mean age 41.7 ± 1.5 years). Clinical examination with the completion of standard questionnaires, assessment of the quality of life of patients were performed at three visits: before the start of the treatment, after 2 and 4 weeks of therapy. Fibroesophagogastroduodenoscopy was performed in all patients before treatment and in patients with esophagitis after 4 weeks of therapy. All patients received rabeprazole (Razo®) at a dose of 20 mg once a day for the treatment of GERD. The diagnosis of heartburn and sour eructation was carried out according to the recommendations of the Montreal Consensus, the diagnosis of esophagitis was performed based on the Los Angeles classification.Results and discussion. Among patients with NERD, 74.1% of patients responded to Razo® therapy after 2 weeks of treatment, after 4 weeks the proportion of responders increased to 94.4% (p = 0.008). Healing of erosions after 4 weeks was observed in 90.5% of patients with esophagitis. Razo® therapy was accompanied by a pronounced improvement in GERD patients in all parameters of quality of life and patient satisfaction with the results of Razo® treatment.Conclusion. Based on the results of our study, we obtained high efficacy of Razo® at a dose of 20 mg once a day for the treatment of patients with NERD and erosive esophagitis.

Empiric proton pump inhibitor therapy after esophageal food impaction may mask eosinophilic esophagitis diagnosis at follow-up.

Esophageal food impaction (EFI) is often the first presentation for patients with eosinophilic esophagitis (EoE); however, there is significant heterogeneity in the management of EFI. We aimed to study the impact of EFI management, particularly post-EFI medication prescriptions on EoE diagnosis, follow-up, and recurrence in patients with endoscopic features of EoE. In our retrospective study, adults presenting between 2007 and 2017 with EFI requiring endoscopic dis-impaction with endoscopic features of EoE (furrows, rings, and/or exudates) were included. We examined the impact of demographics and EFI management on EoE diagnosis, follow-up (esophagogastroduodenoscopy [EGD] or clinic visit within 6months), and recurrence. We identified 164 cases of EFI due to suspected EoE. Biopsy was performed in 68 patients (41.5%), and 144 patients (87.8%) were placed on proton pump inhibitor (PPI) and/or swallow corticosteroids after EFI, including 88.5% of those not biopsied. PPI use at time of biopsy was negatively associated with EoE diagnosis (odds ratio: 0.39, confidence interval: 0.17-0.85). Sixty-one (37.4%) patients were lost to follow-up at 6months. Recurrent EFI at 1year occurred in 3.7% of patients. Medications, most commonly PPI, are frequently prescribed after EFI when the endoscopic features of EoE are present, which may mask the diagnosis of EoE on follow-up EGD. We estimated that for every five patients biopsied on PPI, one case of EoE is masked. As recurrent EFI within 1year is uncommon, empiric therapy should be avoided until diagnostic biopsies are obtained. Further efforts to reduce loss to follow-up after EFI are also needed.

Advancing Eosinophilic Esophagitis Diagnosis and Phenotype Assessment with Deep Learning Computer Vision.

Eosinophilic Esophagitis (EoE) is an inflammatory esophageal disease which is increasing in prevalence. The diagnostic gold-standard involves manual review of a patient's biopsy tissue sample by a clinical pathologist for the presence of 15 or greater eosinophils within a single high-power field (400× magnification). Diagnosing EoE can be a cumbersome process with added difficulty for assessing the severity and progression of disease. We propose an automated approach for quantifying eosinophils using deep image segmentation. A U-Net model and post-processing system are applied to generate eosinophil-based statistics that can diagnose EoE as well as describe disease severity and progression. These statistics are captured in biopsies at the initial EoE diagnosis and are then compared with patient metadata: clinical and treatment phenotypes. The goal is to find linkages that could potentially guide treatment plans for new patients at their initial disease diagnosis. A deep image classification model is further applied to discover features other than eosinophils that can be used to diagnose EoE. This is the first study to utilize a deep learning computer vision approach for EoE diagnosis and to provide an automated process for tracking disease severity and progression.

S0451 Clinicopathologic Features, Treatment Response, and Outcomes of Immune Checkpoint Inhibitor-Related Esophagitis

INTRODUCTION: Immune checkpoint inhibitors (ICIs) have shown practice-changing results in the treatment of many cancers, however, ICI-related gastrointestinal (GI) toxicity can limit their use. Upper GI toxicity is not as common nor as well described as lower GI toxicity. We aim to characterize esophagitis associated with ICIs by describing its clinical presentation, endoscopic features, histological findings, treatment response and outcomes. METHODS: This is a retrospective study of patients at a tertiary cancer center who developed esophagitis after receiving ICI between June 2011 and January 2020. The diagnosis of esophagitis was made based on esophagogastroduodenoscopy (EGD) findings. Patients with pre-existing gastro-esophageal disease, and recent head/neck/chest radiation were excluded. A χ2 test was used to determine associations between categorical variables. A Mann-Whitney U test was used to compare differences between continuous variables. RESULTS: Of the 657 consecutive patients who underwent EGD during or within 6 months of completing ICI therapy, 21 (3%) developed esophagitis of unclear etiology, which was deemed to be related to ICI. Of these patients, one (5%) received an inhibitor of cytotoxic T-lymphocyte associated antigen 4 alone, 15 (71%) received an inhibitor of programmed cell death protein 1 or its ligand alone, and 5 (24%) received a combination of the two classes (Table 1). The median time between the initiation of ICI and onset of esophagitis was 4 months. On EGD, isolated esophageal involvement was only seen in 3 patients (24%); distribution of esophagitis varied widely within the esophagus. Eighteen patients (86%) had concurrent involvement of the stomach, duodenum, or both. Histology showed signs of both acute and chronic inflammation (Figure 1). Proton pump inhibitors (PPIs) were used in 14 patients (67%). Steroids (prednisone or budesonide) were used in 4 patients (19%). Repeat endoscopy was only performed in 5 patients, 4 (75%) of which had complete resolution. There was a 38% mortality in our cohort during the study period (median follow up was 15 months) attributed to their underlying malignancy (Table 2). CONCLUSION: Esophagitis associated with ICI is rare. The diagnosis is one of exclusion since its clinical presentation appears similar to inflammation due to other causes. Symptoms are mild and respond well to non-immunosuppressive treatment with very few severe complications.Figure 1.: Endoscopic and histological features of ICI-related esophagitis. (A) Multiple large circumferential ulcers found in the middle third of the esophagus. (B) Inflammation noted in the gastro-esophageal junction (C) Non-bleeding erosions in the lower third of the esophagus. (D) Chronic active esophagitis, with increased neutrophils in squamous epithelium and lamina propria. Granulation tissue, clusters of lymphocytes and plasma cells in lamina propria (H&E, 20x). (E) Esophageal ulceration with underlying chronic active inflammation (H&E, 20x).Table 1.: Clinical information related to ICI and esophagitis (n = 21)Table 2.: Endoscopic findings, pathologic findings, treatment and outcomes (n = 21)

Incidence of GERD, esophagitis, Barrett's esophagus, and esophageal adenocarcinoma after bariatric surgery.

Some bariatric procedures have been associated with increased gastroesophageal reflux disease (GERD) symptoms; however, there are limited data on the long-term changes to the esophagus across bariatric procedures, and how preoperative esophageal disease is impacted by bariatric surgery. To estimate incidence of GERD, esophagitis, Barrett's esophagus, and esophageal adenocarcinoma before and after bariatric surgery and to identify potential risk factors for these conditions. Retrospective analysis of New York State Database (SPARCS). Adult patients undergoing bariatric surgery (Roux-en-Y gastric bypass, adjustable gastric banding, laparoscopic sleeve gastrectomy, and biliopancreatic diversion) from 1995 to 2010. Multivariable Cox proportional hazard models were used to examine the association between preoperative diagnosis, surgery type, and postoperative diagnosis. A total of 48,967 records were analyzed; 30.3% had a diagnosis of GERD at the time of surgery and .4% had a diagnosis of esophagitis and Barrett's. Preoperative GERD/esophagitis/Barrett's was associated with higher risk of GERD, esophagitis, and Barrett's, but not esophageal adenocarcinoma, postoperatively. Roux-en-Y gastric bypass patients had lowest risk of being diagnosed with GERD postoperatively. Overall, esophageal adenocarcinoma incidence in the sample was .04%; the rate among patients with preoperative GERD and Barrett's was .1% and .9%, respectively. Incidence of esophageal adenocarcinoma did not differ by bariatric surgery type. Preoperative diagnosis is a risk factor for postoperative esophageal disease after bariatric surgery. Adjustable gastric banding and laparoscopic sleeve gastrectomy are associated with higher risk of postoperative GERD and esophagitis compared with Roux-en-Y gastric bypass. Incidence of esophageal adenocarcinoma did not differ by surgery type.

Recommendations for the diagnosis and practical management of paediatric eosinophilic oesophagitis

Eosinophilic oesophagitis is an emerging and chronic disorder mediated by the immune system, and is characterised by symptoms of oesophageal dysfunction and inflammation with isolated eosinophil infiltration in the oesophagus. It is more common in males and in atopic subjects, and the symptoms vary with age. In younger children, there is vomiting, abdominal pain and dietary problems, with dysphagia and food impaction in older children and adolescents. The diagnosis is based on the presence of symptoms and oesophageal inflammation with ≥15 eosinophils/high power field, and after ruling out other causes of oesophageal eosinophilia. Without treatment, the disease usually persists and can progress to fibrostenotic forms more common in adults. The treatment options included proton pump inhibitors, empirical elimination diets, and swallowed topical corticosteroids. Maintenance therapy is advisable after the induction treatment. Diet is the only treatment that is directed at the cause of the disease, on identifying the triggering food or foods. The response to the treatments requires a histological assessment due to the poor agreement between the symptoms and the oesophageal inflammation.The practical management of Eosinophilic oesophagitis presents with challenges, due to, among other causes, the current lack of availability of specific drugs, and its approach with, occasionally complex, diet treatments. The present document, prepared by the Working Group on Eosinophilic Gastrointestinal Disorders of the Spanish Society of Paediatric Gastroenterology, Hepatology and Nutrition, has as its objective to help in the diagnostic and therapeutic approach to paediatric eosinophilic oesophagitis, based on the recent evidence-based consensus guidelines.

Длительное наблюдение пациента с эозинофильным эзофагитом

A young man with complaints of dysphagia and heartburn had the diagnosis of eosinophilic oesophagitis verified at the age of 21 based on a typical endoscopic picture (transverse rings, oesophageal stricture) and histological examination (significant eosinophilic infiltration of the oesophageal mucosa). According to his medical history, at the age of 7 the patient was diagnosed with bronchial asthma, atopic dermatitis, food allergy, the manifestation of eosinophilic oesophagitis also occurred in childhood, and at the age of 14 an oesophageal stricture was found. Initial treatment with fluticasone and proton pump inhibitors resulted in achievement of clinical, endoscopic and histological remission. The article presents the dynamic course of eosinophilic oesophagitis over a 4-year period; the patient’s refusal of medication or withdrawal of fluticasone, quitting of the elimination diet was followed by clinical or histological worsening. Marked histological changes in the oesophageal mucosa might have not been accompanied by complaints of dysphagia neither a typical endoscopic picture could be observed. Maintenance therapy with topical steroids should be administered for a long period, and histological remission is an important criterion of its effectiveness. Key words: eosinophilic oesophagitis, fluticasone, topical steroids, proton pump inhibitor, remission

A description of eosinophilic esophagitis in the Southwestern state of Nevada

ABSTRACT Objectives Eosinophilic esophagitis (EoE) is a rare immune-mediated esophageal disorder that has been documented worldwide. Prior to this study, eosinophilic esophagitis had not been described in the Southwestern state of Nevada. Records containing positive eosinophilic esophagitis diagnosis codes were extracted from a large hospital utilization database and yielded over 2,000 records over 5 years (2013–2017). Methods Descriptive statistics were used to identify the overall population demography. Logistic regression was used to determine the factors associated with an eosinophilic esophagitis event in Nevada. Results Males were 2.93 times more likely (95% CI: 2.53, 3.41; p < 0.001) to have had an eosinophilic esophagitis event when compared to females. Older age was also significant; for each additional year in age the odds of having an eosinophilic esophagitis visit increased by 30% (95% CI: 1.28, 1.31; p < 0.001). Finally, individuals living in the Northern region had 1.95 higher odds of an eosinophilic esophagitis event than their Southern counterparts (OR = 1.95, 95% CI: 1.68, 2.26; p < 0.001). Conclusions The climate in Nevada makes this study novel, as the climate is unlike other studies reporting EoE disease prevalence. Previous atopic studies in Nevada report that warmer, drier weather leads to increased atopic illness and perennial pollen, which ultimately may be contributing to the higher than expected number of EoE records identified. Given the well-documented relationship between EoE and atopy, Nevada may be a susceptible region for this condition and an ideal location for future studies.