Endoscopic Findings Of Eosinophilic Esophagitis Research Articles

Lymphocytic Esophagitis: A Case Series of Esophageal Disease with Increasing Frequency.

Lymphocytic esophagitis (LE) is a poorly understood clinical finding that has been increasingly identified in the last decade. Previous studies proposed increased frequency of LE in elderly females, as well as associations with smoking and pediatric Crohn's disease. We aimed to determine the patient characteristics and clinical features of our adult LE patients. As inflammation in the esophagus has been linked to cancer, this review also describes this association. However, there are no reported cases of malignant transformation in those with underlying lymphocytic esophagitis. We retrospectively reviewed records for patients at the University of Missouri Hospital- Columbia (located in the USA) who had a histopathological diagnosis of LE. Cases of LE were identified using the pathology reporting system at the University of Missouri Hospital for esophageal biopsy specimens for the above-mentioned period. The data of a total of 20 adult cases with esophageal biopsy specimens consistent with LE were included. LE seems to be a benign but disturbing clinical problem and should be remembered in elderly females complaining of dysphagia or refractory reflux symptoms. It has similar endoscopic findings of eosinophilic esophagitis with rings and esophagitis. Smoking and hiatal hernia are common risk factors. The majority of LE patients can respond to proton pump inhibitor (PPI) therapy. Endoscopic dilations and steroid therapy should be considered for PPI nonresponder LE patients.

The "caterpillar sign": a novel endoscopic indicator of eosinophilic esophagitis.

Although several endoscopic findings of eosinophilic esophagitis (EoE), such as the EoE endoscopic reference score (EREFS), have been reported thus far, these endoscopic findings exhibit low specificity. Furthermore, most of these endoscopic findings were evaluated solely in patients from Western nations. We have recently noted a fragile, protruded mucosal lesion sandwiched between longitudinal furrows (similar to caterpillar tracks) on the esophagus in patients with EoE. We have termed this novel finding the "caterpillar sign". This study evaluated the clinical significance of the caterpillar sign and the EREFS for diagnosis of EoE in Japanese patients. We retrospectively analyzed endoscopic images from 165 consecutive patients who underwent tissue collection on suspicion of EoE. We compared the clinical significance between the EREFS and the caterpillar sign. We defined EoE as the presence of ≥ 15 eosinophils on esophageal mucosa per high-power field; control images had < 15 eosinophils per high-power field. For evaluation of endoscopic diagnosis capacity using the total EREFS, 2 points was set as the cutoff value. The presence or absence of the caterpillar sign was evaluated. The sensitivity, specificity, positive predictive value, and negative predictive value of total EREFS ≥ 2 for the diagnosis of EoE were 100%, 56.2%, 56.6%, and 100%; for the caterpillar sign, those values were 83.3%, 98.1%, 96.2%, and 91.2%, respectively. Interobserver agreement for identification of the caterpillar sign was substantial (κ = 0.80) CONCLUSIONS: The caterpillar sign could be a novel reliable indicator for endoscopic diagnosis of EoE.

Examination of clinical and endoscopic findings of eosinophilic esophagitis in our hospital and correspondence at the time of endoscopic screening of gastric cancer in population-based screening

Examination of clinical and endoscopic findings of eosinophilic esophagitis in our hospital and correspondence at the time of endoscopic screening of gastric cancer in population-based screening

Nationwide Multicenter Study of Eosinophilic Esophagitis in Korean Children.

PurposeIn East Asian countries, there are only a few epidemiologic studies of eosinophilic esophagitis (EoE) and no studies in children. We investigated the incidence and compared the clinical characteristics of EoE and eosinophilic gastroenteritis involving the esophagus (EGEIE) in Korean children.MethodsA total of 910 children, who had symptoms of esophageal dysfunction, from 10 hospitals in Korea were included. EoE was diagnosed according to diagnostic guidelines and EGEIE was diagnosed when there were >15 eosinophils in the esophagus per high power field (HPF) and >20 eosinophils per HPF deposited in the stomach and duodenum with abnormal endoscopic findings.ResultsOf the 910 subjects, 14 (1.5%) were diagnosed with EoE and 12 (1.3%) were diagnosed with EGEIE. Vomiting was the most common symptom in 57.1% and 66.7% of patients with EoE and EGEIE, respectively. Only diarrhea was significantly different between EoE and EGEIE (p=0.033). In total, 61.5% of patients had allergic diseases. Exudates were the most common endoscopic findings in EoE and there were no esophageal strictures in both groups. The median age of patients with normal endoscopic findings was significantly younger at 3.2 years, compared to the median age of 11.1 years in those with abnormal endoscopic findings (p=0.004).ConclusionThe incidence of EoE in Korean children was lower than that of Western countries, while the incidence of EGEIE was similar to EoE. There were no clinical differences except for diarrhea and no differences in endoscopic findings between EoE and EGEIE.

Endoscopic findings of eosinophilic esophagitis successfully treated with a short-term 6-food-group elimination diet and reintroduction therapy

We reported a case of eosinophilic oesophagitis (EoE) treated with short-term 6-food-group elimination diet and reintroduction therapy.1 Elimination diet and reintroduction therapies for EoE are usually performed for 6 to...

Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors.

Background and study aims Endoscopic findings of esophageal eosinophilia sometimes localize to small areas of the esophagus. A previous study suggested that pathogenesis of localized-type eosinophilic esophagitis (LEoE) was associated with acid reflux. However, LEoE treatment outcomes have not been studied. We aimed to analyze the clinical and histologic significance of LEoE in comparison with diffuse-type eosinophilic esophagitis (DEoE). Patients and methods This study included 106 patients with esophageal eosinophilia. Esophageal eosinophilia was defined as a condition where the maximum number of intraepithelial eosinophils was ≥ 15 per high-power field. LEoE was defined as an endoscopic lesion confined to one-third of the esophagus: upper, middle, or lower. Esophageal eosinophilia encompassing more than two-thirds of the esophagus was defined as DEoE. We retrospectively compared LEoE and DEoE in terms of clinical characteristics, histologic findings, and proportion of proton pump inhibitor (PPI) responders. Results Of 106 patients, 12 were classified as having LEoE and 94 were classified as having DEoE. The proportion of asymptomatic patients was significantly higher in the LEoE group than the DEoE group (42 % vs 7 %, P < 0.01). In the LEoE group, 10 patients (84 %) had endoscopic lesions in the lower esophagus. The maximum number of eosinophils did not differ between the groups (54 [24 – 71] for LEoE, 40 [20 – 75] for DEoE, P = 0.65). The prevalence of PPI responders was significantly higher in the LEoE group than the DEoE group (100 % vs 63 %, P = 0.01). Conclusion LEoE can be a sign of good responsiveness to PPI therapy.

An Evaluation of the Quality of Esophageal Biopsies in Patients with Eosinophilic Esophagitis

Introduction: Eosinophilic esophagitis (EoE) is a clinicopathologic diagnosis based on the presence of ≥15 eosinophils per high power field (hpf) in the epithelium. Additional changes include microabscesses, lamina propria (LP) papillae elongation, basal zone hyperplasia, intercellular edema, and LP fibrosis. Recent studies have shown the importance of subepithelial fibrosis as this correlates with clinical and endoscopic findings of EoE, disease duration and response to therapy. We sought to determine the adequacy of esophageal biopsies, defined as the presence of LP, among patients with EoE. Methods: This was a single-center, retrospective, observational study at a tertiary referral center. The pathology database was interrogated to identify pathology records from 2014-2015 that contained ≥15 eosinophils/hpf. All records were reviewed by one expert GI pathologist for the presence of lamina propria. We investigated factors that could influence acquisition of deeper esophageal biopsies including type of sedation, trainee involvement, procedure duration and seniority of attending endoscopist. Results: We reviewed 119 pathology records that were contributed by 109 patients. Within the pathology records, 244 esophageal biopsies were reviewed and classified by location (proximal, distal, and other; note that a pathology record could contribute multiple location biopsies). Only 98 biopsies had the presence of LP (40%). Breakdown according to location: proximal biopsies 25/66 (38%); distal biopsies 34/90 (38%); and other biopsies 39/88 (44%) had the presence of LP. Univariable generalized linear mixed models were used to estimate the odds of a higher number of LP biopsies. Patient demographics, trainee involvement, seniority of attending endoscopist, sedation used, and procedure time were not associated with odds of a higher number of LP biopsies. When analyzed by location of biopsies, senior attending physicians (defined as > 3 years in practice) were 3.74 (95% CI: 1.45 - 9.65) times as likely to obtain a positive distal biopsy with LP when compared to junior attendings (p = 0.01). Conclusion: The majority of biopsies did not contain LP. Senior attendings were more likely to obtain quality distal biopsies. Duration of procedure, sedation type, and trainee involvement did not affect depth of biopsy. As esophageal biopsy remains the gold standard for monitoring disease activity, quality of mucosal sampling is essential to providing accurate information to guide clinical management.395_A Figure 1. Odds of a higher count of lamina propria biopsies395_B Figure 2. Odds of a positive LP on distal biopsy

PS01.016: ESOPHAGEAL DYSMOTILITY CAUSED BY ESOPHAGEAL EOSINOPHILIA REGULATES PATIENTS’ SYMPTOMS AND TREATMENT REQUIREMENTS

Abstract Background Only a few studies –none from Asia– have been reported on high-resolution manometry (HRM) assessment of esophageal motor function in eosinophilic esophagitis (EoE). This study aimed to evaluate esophageal motility in Japanese patients with esophageal eosinophil infiltration and to clarify the association between esophageal dysmotility and symptoms, endoscopic findings, severity of eosinophilic infiltration, blood eosinophil count, and response to treatment. Methods Ninety-two patients underwent both esophageal manometry and endoscopic biopsy to determine eosinophil infiltration in esophageal mucosa, looking for esophageal motility disorders, between 2009 and 2016. Of these 92 patients, 18 patients (9 males, mean age, 52.5 years) who had esophageal eosinophilia (≥ 15 eosinophils per high power field)w ere enrolled in this study. Characteristic endoscopic findings included circular rings, linear furrowing, and white exudates. HRM [ManoScan; Given Imaging] was performed and evaluated by Chicago classification ver. 3. Results HRM revealed that 15 patients (83%) had esophageal motility disorders (7 achalasia, 2 esophagogastric junction outflow obstruction (EGJOO), 2 jackhammer esophagus, 1 diffuse esophageal spasm (DES), 3 Ineffective esophageal motility (IEM). Dysphagia was observed in all the patients with achalasia or EGJOO. GERD symptoms like regurgitation or heartburn occurred in most of the patients with EGJOO or IEM. Endoscopic findings of EoE did not differ among types of dysmotility. Severity of esophageal eosinophilia did not correlate with hypercontractile motility disorders. Four patients had blood eosinophilia; none of the achalasia patients or those with normal motility had blood eosinophilia. All the patients, except those with achalasia, were treated with a proton pump inhibitor (PPI). None of the patients with jackhammer esophagus or DES responded to PPI, but one (1/2, 50%) with EGJOO, one (1/3, 33%) with IEM, and two patients (2/3, 66%) with normal motility had their symptom relieved after PPI therapy. Seven patients, including 2 with achalasia, needed steroid therapy either by prednisolone or topical steroid orally. The patients with achalasia showed good temporary response to steroid, though they underwent ordinal myotomy afterwards. One with jackhammer esophagus did not respond to steroid therapy and needed repeated myotomy. Conclusion Symptom was a possible factor to predict a type of esophageal dysmotility. Presence of esophageal dysmotility may affect treatment strategy. Disclosure All authors have declared no conflicts of interest.

Eosinophilic Esophagitis in Children: Endoscopic Findings at Diagnosis and Post-intervention

The goal of this review is to present and summarize studies on endoscopic findings in eosinophilic esophagitis (EoE), at diagnosis and in response to treatment, utilizing rigorous peer-reviewed literature in children wherever possible and to introduce a recently proposed standardized endoscopic evaluation system. Gold standard of diagnosis and assessment of response to therapy in EoE requires multiple endoscopies with biopsies for histology, which allows for observation of the esophageal mucosa. Typical endoscopic findings in patients with EoE include edema, exudate, furrowing, concentric rings, and strictures. Endoscopic findings have been broadly characterized into inflammatory features (edema, exudate, furrowing) and fibro-stenotic features (rings, stricture), in order to better reflect their underlying pathophysiology. Recent studies suggest strong correlations between endoscopic findings, through composite scoring systems, and histology, and therefore may be helpful as part of disease surveillance. The EoE Endoscopic Reference Score (EREFS) classification system was proposed in 2013 as an outcome metric for standardization in reporting endoscopic signs of EoE. Subsequent studies support utility of composite scoring, which utility has similarly been seen in pediatric treatment trials. Endoscopy in children provides insight into the natural history of EoE, with progressively more fibro-stenotic features occurring over time, giving an additional perspective into esophageal remodeling and response to treatment. Recognition of typical endoscopic findings at diagnosis and upon repeat endoscopy has allowed a clinician to monitor visual changes in esophageal mucosal health. Further studies to assess the role of composite scoring in disease management are needed.

Endoscopic Findings in Eosinophilic Esophagitis and Esophageal Distensibility: A Proxy for Transmural Modeling?

Endoscopic Findings in Eosinophilic Esophagitis and Esophageal Distensibility: A Proxy for Transmural Modeling?

Montelukast Does not Maintain Symptom Remission After Topical Steroid Therapy for Eosinophilic Esophagitis.

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. 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 at the Mayo Clinic in Rochester, Minnesota, from April 2008 through February 2015. All patients had been treated previously for at least 6 weeks with a topical steroid until their symptoms were in remission. Steroids were discontinued and patients then were assigned randomly to groups given montelukast (20 mg/day, n= 20) or placebo (n= 21) for 26 weeks (groups were matched for age, sex, history of allergic disease, reflux symptoms, and endoscopic findings of EoE). Study participants were assessed via a structured telephone interview at weeks 2, 4, 8, 12, 16, 20, and 24. Remission was defined as the absence of solid-food dysphagia. Based on an intention-to-treat analysis, after 26 weeks, 40.0% of subjects in the montelukast group and 23.8% in the placebo group were in remission. The odds ratio for remission in the montelukast group was 0.48 (95% confidence interval, 0.10-2.16) (P= .33). No side effects were reported from either group. In a randomized controlled trial of the ability of montelukast to maintain remission in patients in remission from EoE after steroid therapy, we found montelukast to be well tolerated; 40% of patients remained in remission, but this proportion did not differ significantly from that of the placebo group. ClinicalTrials.gov no: NCT00511316.

The Impact of Eosinophilic Esophagitis on Body Mass Index

Introduction: Eosinophilic esophagitis (EoE) is a chronic inflammatory condition which causes esophageal remodeling and stricture formation over time. EoE presents with feeding intolerance and failure to thrive in children and is the most common cause of food impaction in adults. These symptoms and potential alterations in diet may affect weight gain. Our aim was to determine the influence of clinical symptoms and endoscopic findings of EoE on weight at diagnosis. Methods: EoE adult patients (age > 18 years) were prospectively enrolled into our database. All patients were diagnosed per recent consensus guidelines. Endoscopic features and histology were recorded. Disease behavior was classified as inflammatory if endoscopic findings demonstrated furrows or white plaques and as fibrostenotic if endoscopic findings included fixed rings or strictures. Records were examined to record body mass index (BMI) at diagnosis and follow-up, and compared against disease behavior. Patients with BMI <20 were classified as underweight, 20-25 normal weight, 25-30 overweight, and >30 obese. Results: We enrolled 329 consecutive patients with EoE with mean age of 41.2 ± 10.9 years; 80.9% were male, and 83.3% were Caucasian. In this cohort, 63.6% presented with fibrostenotic disease (31.9% presented with stricture). At diagnosis, 1.5% were underweight, 26.1% had normal weight, 48.3% were overweight, and 21.0% were obese (data was unavailable for 3%). Patients with fibrostenotic disease tended to have lower BMI at diagnosis (p=0.06). All 5 underweight patients had fibrostenotic disease. There was no difference in number of eosinophils per high-powered field, age, race, sex, or endoscopic findings of rings, furrows, plaques, or strictures between the four BMI categories. There was no correlation between BMI and duration of symptoms before diagnosis (p=0.98). After a mean follow-up of 40.1 ± 26.8 months, the change in BMI was similar between the two phenotypes (+0.738 fibrostenotic vs +0.517 inflammatory, p=0.39). The majority of patients remained in the same BMI category regardless of phenotype (fibrostenotic 75.6% vs inflammatory 71.3%, p=0.41); 6.2% of fibrostenotic patients lost weight vs 11.1% of inflammatory patients (p=0.02) and 18.1% of fibrostenotic patients gained weight vs 17.6% of inflammatory patients (p=1.00). Conclusion: More than two-thirds of EoE patients in our study were overweight or obese, which is consistent with national trends in the general population. Even though EoE may alter patients’ diet due to structural changes in the esophagus, it does not significantly alter their weight. Our data also suggest that low BMI at diagnosis may be associated with fibrostenotic disease independent of presenting symptoms.

Su1848 Differences in Presentation of Eosinophilic Esophagitis by Atopic Status, Eosinophilia, and Age of Symptom Onset: An Analysis of Non-Endoscopic Phenotypes

Background: Separate phenotypes of eosinophilic esophagitis (EoE) based on an inflammatory, fibrotic, or mixed appearance have recently been described, but the trends in these phenotypes over time is unknown. Aim: To describe the number of EoE patients with inflammatory, fibrostenotic, and mixed phenotypes over the past decade, determine time trends, and explore reasons for any change. Methods: This was a retrospective study of the University of North Carolina EoE Clinicopathologic database over the past decade, from 2001-2011. Subjects with an incident diagnosis of EoE who met consensus guidelines were included. All had symptoms of esophageal dysfunction, ≥15 eos/hpf (hpf area=0.24 mm2), and did not respond to a PPI trial. The phenotypes were defined as fibrostenotic if there were esophageal rings, narrowing, or strictures and no evidence of linear furrows or white plaques; as inflammatory if there were furrows, plaques, or a normal esophagus and no evidence of fibrostenotic changes; and as mixed if there were a combination of findings. The proportions of phenotypes per year were calculated. Results: Of 374 EoE cases (mean age 25, range 6 mos-82 yrs; 73% male; 81% white; mean eosinophil count 86, range 15609), 134 (36%) had an inflammatory phenotype, 163 (43%) were mixed, and 77 (21%) were fibrostenotic. There was a significant change in the proportion of phenotypes over time (Figure). In 2001, 50% of patients were fibrostenotic, 50% were inflammatory, and none were mixed. In 2011, just 12% were fibrostenotic with 29% inflammatory and 59% mixed (p=0.002). There was no significant change in duration of symptoms prior to the diagnosis of EoE over this time frame (mean 8 yrs in 2001, 6 years in 2006, and 10 years in 2011; p=0.15). The proportion of patients with a endoscopically normal appearing esophagus decreased over this time frame (50% normal in 2001-2002, 16% normal in 2006, and 10% normal in 2001; p=0.05). The age at diagnosis of EoE did not change substantially between 2006 and 2011 (mean 27.7 vs 27.6 yrs; p=0.36). Conclusions: Over the past decade, the proportion of patients with a purely fibrostenotic phenotype of EoE has significantly decreased. This trend does not appear to be explained by a decrease in the length of symptoms prior to diagnosis of EoE or with EoE diagnosed in younger patients. It may be due to increased awareness of the endoscopic findings of EoE and recognition of subtle furrows and plaques with higher resolution endoscopes.

Su1849 Is Low Body Mass Index a Risk Factor for Eosinophilic Esophagitis?

Background: Separate phenotypes of eosinophilic esophagitis (EoE) based on an inflammatory, fibrotic, or mixed appearance have recently been described, but the trends in these phenotypes over time is unknown. Aim: To describe the number of EoE patients with inflammatory, fibrostenotic, and mixed phenotypes over the past decade, determine time trends, and explore reasons for any change. Methods: This was a retrospective study of the University of North Carolina EoE Clinicopathologic database over the past decade, from 2001-2011. Subjects with an incident diagnosis of EoE who met consensus guidelines were included. All had symptoms of esophageal dysfunction, ≥15 eos/hpf (hpf area=0.24 mm2), and did not respond to a PPI trial. The phenotypes were defined as fibrostenotic if there were esophageal rings, narrowing, or strictures and no evidence of linear furrows or white plaques; as inflammatory if there were furrows, plaques, or a normal esophagus and no evidence of fibrostenotic changes; and as mixed if there were a combination of findings. The proportions of phenotypes per year were calculated. Results: Of 374 EoE cases (mean age 25, range 6 mos-82 yrs; 73% male; 81% white; mean eosinophil count 86, range 15609), 134 (36%) had an inflammatory phenotype, 163 (43%) were mixed, and 77 (21%) were fibrostenotic. There was a significant change in the proportion of phenotypes over time (Figure). In 2001, 50% of patients were fibrostenotic, 50% were inflammatory, and none were mixed. In 2011, just 12% were fibrostenotic with 29% inflammatory and 59% mixed (p=0.002). There was no significant change in duration of symptoms prior to the diagnosis of EoE over this time frame (mean 8 yrs in 2001, 6 years in 2006, and 10 years in 2011; p=0.15). The proportion of patients with a endoscopically normal appearing esophagus decreased over this time frame (50% normal in 2001-2002, 16% normal in 2006, and 10% normal in 2001; p=0.05). The age at diagnosis of EoE did not change substantially between 2006 and 2011 (mean 27.7 vs 27.6 yrs; p=0.36). Conclusions: Over the past decade, the proportion of patients with a purely fibrostenotic phenotype of EoE has significantly decreased. This trend does not appear to be explained by a decrease in the length of symptoms prior to diagnosis of EoE or with EoE diagnosed in younger patients. It may be due to increased awareness of the endoscopic findings of EoE and recognition of subtle furrows and plaques with higher resolution endoscopes.

Su1847 Decreasing Frequency of the Fibrostenotic Phenotype of Eosinophilic Esophagitis: Time Trends Over the Past Decade

Background: Separate phenotypes of eosinophilic esophagitis (EoE) based on an inflammatory, fibrotic, or mixed appearance have recently been described, but the trends in these phenotypes over time is unknown. Aim: To describe the number of EoE patients with inflammatory, fibrostenotic, and mixed phenotypes over the past decade, determine time trends, and explore reasons for any change. Methods: This was a retrospective study of the University of North Carolina EoE Clinicopathologic database over the past decade, from 2001-2011. Subjects with an incident diagnosis of EoE who met consensus guidelines were included. All had symptoms of esophageal dysfunction, ≥15 eos/hpf (hpf area=0.24 mm2), and did not respond to a PPI trial. The phenotypes were defined as fibrostenotic if there were esophageal rings, narrowing, or strictures and no evidence of linear furrows or white plaques; as inflammatory if there were furrows, plaques, or a normal esophagus and no evidence of fibrostenotic changes; and as mixed if there were a combination of findings. The proportions of phenotypes per year were calculated. Results: Of 374 EoE cases (mean age 25, range 6 mos-82 yrs; 73% male; 81% white; mean eosinophil count 86, range 15609), 134 (36%) had an inflammatory phenotype, 163 (43%) were mixed, and 77 (21%) were fibrostenotic. There was a significant change in the proportion of phenotypes over time (Figure). In 2001, 50% of patients were fibrostenotic, 50% were inflammatory, and none were mixed. In 2011, just 12% were fibrostenotic with 29% inflammatory and 59% mixed (p=0.002). There was no significant change in duration of symptoms prior to the diagnosis of EoE over this time frame (mean 8 yrs in 2001, 6 years in 2006, and 10 years in 2011; p=0.15). The proportion of patients with a endoscopically normal appearing esophagus decreased over this time frame (50% normal in 2001-2002, 16% normal in 2006, and 10% normal in 2001; p=0.05). The age at diagnosis of EoE did not change substantially between 2006 and 2011 (mean 27.7 vs 27.6 yrs; p=0.36). Conclusions: Over the past decade, the proportion of patients with a purely fibrostenotic phenotype of EoE has significantly decreased. This trend does not appear to be explained by a decrease in the length of symptoms prior to diagnosis of EoE or with EoE diagnosed in younger patients. It may be due to increased awareness of the endoscopic findings of EoE and recognition of subtle furrows and plaques with higher resolution endoscopes.

Endoscopic ablative therapy for Barrett's esophagus: a potential cause of eosinophilic esophagitis

Markedly increased esophageal eosinophils are associated with allergy- or reflux-based eosinophilic esophagitis. Other known disorders that cause this entity are unusual. To characterize the clinical, endoscopic, and histological findings of patients who develop marked esophageal eosinophilic infiltration after ablative therapy for Barrett's dysplasia. All patients who underwent endoscopic ablation of Barrett's esophagus between 1991 and 2009 with photodynamic therapy or radio frequency were screened for a pathologic descriptor of 'eosinophils' on biopsy. Patients whose biopsies demonstrated >15 eosinophils per high power (HPF) field in squamous epithelium after ablation were reviewed and included in the study group. Thirteen of 385 (3.4%) patients underwent ablation for Barrett's esophagus and subsequently had large numbers of intraepithelial eosinophils. All patients had long segment Barrett's (mean 8.0 cm) with low- or high-grade dysplasia or adenocarcinoma. All had undergone photodynamic therapy as their form of ablation. No patients had typical symptoms or endoscopic findings of eosinophilic esophagitis. Eleven patients were on proton pump inhibitors. The time between ablation and onset of esophageal eosinophilia ranged from 83 to 692 days. Intraepithelial eosinophil counts ranged from 30 to 150/HPF (mean 90). The majority of cases showed eosinophilic degranulation, spongiosis, increased papillary height, and basal zone thickening. The natural history of esophageal eosinophilia was variable after ablation, persisting consistently or sporadically on biopsy for up to 6 years. Ablation for Barrett's dysplasia can be followed rarely by eosinophil infiltrates with a histological resemblance to allergy-based eosinophilic esophagitis, but lacking dysphagia. The pathophysiology is unknown.

Reliability of Endoscopic Findings in Eosinophilic Esophagitis With White Light and Narrow Band Imaging

Reliability of Endoscopic Findings in Eosinophilic Esophagitis With White Light and Narrow Band Imaging

Utility of the Mayo Dysphagia Questionnaire-30 Day for Prediction of Histologic and Endoscopic Findings in Eosinophilic Esophagitis (EoE)

Utility of the Mayo Dysphagia Questionnaire-30 Day for Prediction of Histologic and Endoscopic Findings in Eosinophilic Esophagitis (EoE)

S1086 The Rising Incidence of Eosinophilic Esophagitis Correlates With Increased Awareness of the Disease

Background: Prevalence of eosinophilic esophagitis (EoE) has been reported variably according to the subject and definition . We evaluated prevalence of EoE among patients who had esophageal or upper gastrointestinal (UGI) symptoms. Methods: Patients who had seven esophageal or UGI symptoms (dysphagia, food impaction, acid regurgitation, heartburn, chest pain, epigastric pain and neasea and/or vomiting) for more than once a week were prospectively collected from Jan. to Oct. 2009. All responded to symptomatic questionnaire, underwent gastroduodenoendoscopy and esophageal biopsies (3 pieces from distal esophagus, 2 from middle). Typical endoscopic findings of EoE (ring-like appearance, liner furrow, whitish papule, shearing or friability) were recorded. EoE was diagnosed if esophageal biopsy showed ≥20 eosinophils/high power field. Results: 122 patients (male:female 63:59, mean age 47.2 years) were enrolled and typical endoscopic findings were found in 31 (25.4%) patients (whitish papule: 19 (15.4%), ring-like appearance: 8 (6.5%), linear furrow: 5 (4.1%)). EoE was diagnosed in 8 (6.6%) patients, and typical endoscopic findings and past history of gastroesophageal reflux disorder, allergic rhinitis, atopy were significantly more common in EoE (+) patients than EoE (-). Diagnostic yield of typical endoscopic findings were 40.0% (2/5 patients) in linear furrow, 25.0% (2/8) in ring-like appearance and 15.8% (3/19) in whitish papule. Most bothersome symptoms among EoE patients were acid regurgitation (3/7, 42.9%), food impaction (2/7, 28.6%), dysphagia and epigastric pain (1/7, 14.3% respectively). Conclusion: Prevalence of EoE among patients with esophageal or UGI symptoms were 6.6% in Korea. Linear furrow and ring-like appearance showed relatively higher diagnostic value.

Clinical Implications of Endoscopically Suspected Eosinophilic Esophagitis

We aimed to determine the concordance rate and clinical predictors of eosinophilic esophagitis (EoE) in patients with endoscopically suspected eosinophilic esophagitis (ESEoE) findings. From June 2006 to December 2009 in Gangnam Severance Hospital, we prospectively enrolled the patients of "endoscopically suspected eosinophilic esophagitis (ESEoE)", and then we retrospectively reviewed and analyzed clinical features and endoscopic findings. We found 17 patients of ESEoE, and 5 of them were finally confirmed as an EoE by histology (diagnostic concordance rate 29.4%). We added two more patients previously diagnosed as EoE and compared patients of EoE＋ (n=7) with EoE- (n=12). Mean age was 56.0 (range 36-70) and 51.0 (range 36-68) years old, respectively. In EoE＋ group, there were 5 males and 2 females and 6 males and 6 females in EoE- group. The symptoms of EoE＋ patients were dysphagia (n=5), food impaction (n=3), foreign body sensation in esophagus (n=2), chest pain (n=1), and heartburn (n=1). EoE- patients complained food impaction (n=5), heartburn (n=4), chest pain (n=2), foreign body sensation in esophagus (n=2), and dysphagia (n=1). The endoscopic findings of EoE＋ patients were furrows (n=6), rings (n=5), exudates or nodules (n=3), and friability (n=1). EoE- patients showed rings (n=10) and furrows(n=7). Univariative analysis showed that 'a symptom of dysphagia', 'presence of exudates or nodules', 'more than 2 suggestive endoscopic findings' were significantly different between two groups. In ESEoE, diagnostic concordance rate was 29.4%. In addition, 'symptom of dysphagia', 'exudates or nodules', '≥ endoscopic findings' are more suggestive of EoE in ESEoE patients.