Esophagitis In Patients Presenting Research Articles

Incidence of Cardiac Drugs to Cause Pinpoint Odynophagia as a Differentiating Sign of Pills Induced Esophagitis in Patients Presenting with Angina

Incidence of Cardiac Drugs to Cause Pinpoint Odynophagia as a Differentiating Sign of Pills Induced Esophagitis in Patients Presenting with Angina

Su1873 Eosinophilic Esophagitis in Patients Presenting With Dysphagia–a Prospective Analysis

Introduction Eosinophilic oesophagitis (EO) is a chronic relapsing,immune/antigen mediated disease of the oesophagus with rapidly increasing incidence and prevalence; however EO often remains under-diagnosed. Early detection and appropriate therapy improves quality of life and may prevent development of chronic oesophageal changes. A diagnosis can only be made when a dense eosinophilia is confirmed on histology in the context of typical symptoms (e.g.solid food dysphagia) 1 .We prospectively assessed the prevalence of EO in patients presenting to endoscopy at a tertiary referral centre with solid food dysphagia over 2 years. Methods Between Jan 2010 and Dec 2011,746 patients with dysphagia (including food bolus obstruction)had high definition white light endoscopy performed. Patient demographics,symptomatology,endoscopic and histological findings were recorded.EO was defined as the presence of > 15 eosinophils per high power field Results Patients with oesophageal malignancy (n = 65),barrett’s oesophagus(n = 48) and post-oesophageal surgery complications (n = 16) were excluded. Of the 628 remaining patients,388(62%) (254 male; mean age 59; range 18–88) had mid-oesophageal biopsies taken.23/388 (5.9%)were diagnosed with EO 19 male; mean age 40; range 26–56).Endoscopy showed mucosal pathology in 12/23 (52%)patients with confirmed EO; oesophagitis (n = 3),red furrows (n = 3),distal narrowing (n = 2),corrugated rings (n = 2),mucosal tear (n = 1) and white exudates (n = 1).250 of the remaining patients had grade A or B oesophagitis. Overall 17 patients had food bolus obstruction.11/17 patients had biopsies taken and 5/11(46%) showed histological evidence of EO.4/5 patients with bolus obstruction had distal oesophagitis on endoscopy but EO was confirmed following ≥4 mid-oesophageal biopsies. There was a trend towards those with EO having had a greater number of biopsies taken (mean 6.14; range 2–12) compared to those without EO (mean 5.02; range 2–8; p = 0.082).28% and 51% had ≤3 and ≤4 biopsies collected respectively. The mean (±SD) number of eosinophils/hpf in the EO group was 64.3 (51.3). Conclusion Mid-oesophageal biopsies can diagnose EO in at least 1 in 16 cases of patients with unexplained solid food dysphagia.However,1/3 of patients in whom EO should have been considered (including 6 with food bolus obstruction)did not have biopsies collected.Furthermore, 1/4 had less than the recommended minimum 4 mid-oesophageal biopsies. In summary, our experience has shown that EO detection is likely to improve further if all patients with symptoms conducive with EO (e.g.solid food dysphagia) routinely trigger an EO biopsy protocol of ≥4 from the mid-oesophagus regardless of endoscopic findings. Disclosure of Interest None Declared Reference Liacouras CA, Furuta GT et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128(1):3–20 e6.

Routine Screening for Eosinophilic Esophagitis in Patients Presenting with Dysphagia

Purpose: To identify the prevalence of pathologic eosinophilic esophagitis (EoE) in a cohort of adult patients who present for specialty care in the gastroenterology clinic with the complaint of esophageal dysphagia. Methods: A prospective, unblinded multicenter study with a total of 111 patients (60 males and 51 females) with a chief complaint of dysphagia and age >18 were enrolled. Exclusion criteria included patients <18 years of age, pregnancy, patients who demonstrated a clear obstructive etiology, or patients utilizing inhaled or systemic corticosteroids. If no obstructive etiology could be found at the time of endoscopy, patients underwent systematic biopsy of the duodenum, stomach and esophagus. A total of 20 biopsies (4 from the duodenum, 4 from the stomach, 4 from the distal esophagus, 4 from the mid esophagus and 4 from the proximal esophagus) were taken. The biopsies of the stomach and duodenum were utilized to exclude the diagnosis of eosinophilic gastroenteritis, which is a completely separate entity than EoE. A single pathologist was utilized in processing of the tissue samples, with an eosinophil count of >15 per high power field being considered positive for EoE. Results: Of 111 patients, 80 patients (72%) were found to have non-obstructive dysphagia, 20 patients (18%) were found to have obstructive dysphagia, and 11 patients (10%) withdrew their consent or did not show for their procedure. Patients who withdrew consent or did not show for their procedure were counted as having obstructive dysphagia and were excluded from primary analysis. Of those patients with non-obstructive dysphagia, 17 patients (21.25% 95%CI: 12.21%-30.21%) were found to have histologic characteristics of EoE. In the same group, 31% of males vs. 10.5% of females had histologic characteristics of EoE (p-value 0.024). 25% of Caucasians with non-obstructive dysphagia vs. 6.2% of non-Caucasians had histologic evidence of EoE (p-value 0.091). The mean age of patients with non-obstructive dysphagia presenting with histologic evidence of EoE was 34.3. Conclusion: Patients with non-obstructive dysphagia have a greater than 1 in 5 chance of having histologic evidence of EoE on esophageal biopsy. Therefore, all adult patients undergoing upper endoscopy for the complaint of dysphagia should have esophageal biopsies obtained if no mechanical cause for their dysphagia is readily apparent.

Prevalence and Predictive Factors of Eosinophilic Esophagitis in Patients Presenting With Dysphagia: A Prospective Study

Prevalence and Predictive Factors of Eosinophilic Esophagitis in Patients Presenting With Dysphagia: A Prospective Study

Prevalence and Predictive Factors of Eosinophilic Esophagitis in Patients Presenting With Dysphagia: A Prospective Study

Prevalence and Predictive Factors of Eosinophilic Esophagitis in Patients Presenting With Dysphagia: A Prospective Study

Prevalence and Predictive Factors of Eosinophilic Esophagitis in Patients Presenting With Dysphagia: A Prospective Study

Eosinophilic esophagitis (EE) is an increasingly recognized cause of dysphagia. We prospectively assessed the prevalence of EE using midesophageal biopsies in patients presenting with no endoscopically evident cause of dysphagia. We also aimed to determine the clinical and endoscopic factors predictive of EE in outpatients undergoing endoscopy for dysphagia. Outpatients (18-60 yr of age) undergoing endoscopy for dysphagia at Mayo Clinic, Rochester between June 2005 and June 2006 were enrolled. Patients completed the validated Mayo Dysphagia Questionnaire (MDQ). Biopsies were obtained from the midesophagus if there was no endoscopically evident cause of dysphagia or there were endoscopic findings suggestive of EE. EE was defined as the presence of >20 eosinophils/high-power field. Logistic regression was performed to identify predictors of EE. Of 376 patients enrolled, 238 (63%) completed the MDQ and 222 (59%) had midesophageal biopsies; 33 (15%, 95% CI 6%-12%) had EE by biopsy. Ten of 102 (9.8%) patients who appeared endoscopically normal had EE by biopsy, while 8 of 21 (38%) patients with endoscopic changes suggestive of EE had EE on biopsy. Predictors of EE were younger age, endoscopic features suggestive of EE, absence of use of proton pump inhibitors, and a history of any food impaction for greater than 5 min. Midesophageal biopsies from normal-appearing mucosa should be obtained in all patients with unexplained solid food dysphagia; this may diagnose EE in about one in 10 cases.

Prospective Analysis of Eosinophilic Esophagitis in Patients Presenting with Dysphagia

Purpose: Eosinophilic Esophagitis (EoE) is thought to be a rare inflammatory condition in adults, but the incidence may be rising. Recently it has become more prevalent in adults presenting with dysphagia. To date, there are no prospective studies looking at the prevalence of EoE in patients presenting with dysphagia. Methods: Patients presenting for EGD with a complaint of dysphagia at University Hospital (UH) and the VAMC were asked to participate. All patients completed a detailed questionnaire followed by EGD with four quadrant biopsies in the distal and proximal esophagus. EoE was defined as >20 eosinophils/hpf averaged over 5 random specimens in either the distal or proximal esophagus. Primary endpoint was the prevalence of EoE; secondary endpoints included age, gender, asthma, food allergies, and endoscopic findings. Fisher's exact and paired T-analysis were used for analysis. Results: (See Table) Ninety-six patients enrolled between December 2005 and May 2006 (56 VAMC, 40 UH). Two patients did not undergo esophageal biopsies and were excluded from the analysis (94 total patients). Median age was 59 years, and 68/94 (72%) were male. Eleven patients (11.7%) met pathologic criteria for EoE. No significant difference in EoE cases between male and female (p= 0.42). Mean age of EoE patients 38 ± 12 vs. 61 ± 15 for non-EoE patients (p < 0.0001). EoE was diagnosed in 19% of patients less than 50 years (RR 4.5 for age <50 vs. >50). Asthma was present in 5/11 (45%) of EoE cases vs. 19/83 of controls (23%) (p=.31). Food allergies present in 5/11 (45%) of EoE cases vs. 10/83 (12%) of controls (p < 0.05). Two EoE patients did not have the classic EGD findings (one esophagitis, one distal stricture). There was a ringed esophagus ± furrows in 6 patients whose biopsies did not meet histologic criteria.Table 1Conclusions: EoE was diagnosed in 11.7% of patients presenting with dysphagia with relative risk of 4.5 if age <50. Food allergies is a significant risk factor for EoE. Esophageal biopsies may be warranted in patients presenting with dysphagia especially in the younger population. Patients may not present with classic endoscopic findings.

The Prevalence of Eosinophilic Esophagitis in Patients Presenting with Food Impactions

The Prevalence of Eosinophilic Esophagitis in Patients Presenting with Food Impactions

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?

Does Endoscopic Appearance of Esophagus Always Suffice the Diagnosis of Esophagitis in Patients Presenting with Otolaryngologic Symptoms?