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eosinophilic esophagitis: Current concepts in diagnosis and treatment

World Journal of Gastroenterology 2019年第32期25卷 4598-4613页

作者： Andrés Gómez-Aldana Mario Jaramillo-Santos Andrés Delgado Carlos Jaramillo Adán Lúquez-Mindiola Departament of Internal Medicine Section of GastroenterologySanta Fe Foundation of Bogotá(Fundación Santa Fe de Bogotá)Bogotá220246Colombia University of Los Andes Bogotá111711Colombia Department of Endoscopy Caldas UniversityManizales 275Colombia Department of Endoscopy Surgeons’Union SAS(Joint stock company)(Union de cirujanos SAS)Manizales 170001661Colombia Department of Gastroenterology Gut MédicaBogotá110221001Colombia

eosinophilic esophagitis is an immune-allergic pathology of multifactorial etiology(genetic and environmental)that affects both pediatric and adult patients.Its symptoms,which include heartburn,regurgitation,and esophageal stenosis(with dysphagia being more frequent in eosinophilic esophagitis in young adults and children),are similar to those of gastroesophageal reflux disease,causing delays in diagnosis and treatment.Although endoscopic findings such as furrows,esophageal mucosa trachealization,and whitish exudates may suggest its presence,this diagnosis should be confirmed histologically based on the presence of more than 15 eosinophils per high-power field and the exclusion of other causes of eosinophilia(parasitic infections,hypereosinophilic syndrome,inflammatory bowel disease,among others)for which treatment could be initiated.Currently,the 3“D”s(“Drugs,Diet,and Dilation”)are considered the fundamental components of treatment.The first 2 components,which involve the use of proton pump inhibitors,corticosteroids,immunosuppressants and empirical diets or guided food elimination based on allergy tests,are more useful in the initial phases,whereas endoscopic dilation is reserved for esophageal strictures.Herein,the most important aspects of eosinophilic esophagitis pathophysiology will be reviewed,in addition to evidence for the various treatments.

关键词： eosinophilic esophagitis Corticoid Esophageal stenosis Diet Dilation Proton pump inhibitor

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Richness of sputum microbiome in acute exacerbations of eosinophilic chronic obstructive pulmonary disease

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Chinese Medical Journal 2020年第5期133卷 542-551页

作者： Yu-Jing Qi Xue-Jiao Sun Zhe Wang Yan-Fei Bin Ying-Hua Li Xiao-Ning Zhong Jing Bai Jing-Min Deng Zhi-Yi He Department of Pulmonary and Critical Care Medicine The First Affiliated Hospital of Guangxi Medical UniversityNanningGuangxi 530021China Department of Pulmonary and Critical Care Medicine The People’s Hospital of LiuzhouLiuzhouGuangxi 545006China Department of Pulmonary and Critical Care Medicine The Second Affiliated Hospital of Guangxi Medical UniversityNanningGuangxi 530007China

Background:The eosinophilic chronic obstructive pulmonary disease(COPD)is known to be more sensitive to corticosteroid.The sputum microbiome has been shown to affect COPD prognosis,but its role in acute exacerbations of eosinophilic COPD is unclear.This study aimed to investigate the dynamic changes of the airway microbiome in patients with acute exacerbations of eosinophilic COPD.Methods:Fifty-seven patients with acute exacerbations of COPD from the First Affiliated Hospital of Guangxi Medical University between June 2017 and June 2018 were divided into two groups.Patients with eosinophils≥300 cells/mL in the peripheral venous blood were assigned to the eosinophilic group(Eos)and the rest to the non-eosinophilic group(Noneos).All patients received similar treatment including inhaled budesonide according to the guidelines.The induced sputum microbiome was analyzed on the 1st and 7th day of treatment using the 16S ribosomal RNA(rRNA)method.The levels of interleukin(IL)-6 and IL-8 were measured in the plasma and the sensitivity to corticosteroids was determined in isolated peripheral blood mononuclear cells.Quantitative data were compared between the two groups using the independent samples t test or Mann-Whitney U test.Categorical data were evaluated using Chi-squared test or Fisher’s exact test.Results:Twenty-six patients were classified into Eos group and 31 patients were classified into Noneos group.Prior to treatment,the alpha diversity(Shannon index)(2.65±0.63 vs.2.56±0.54,t=0.328,P=0.747)and the structure of the sputum microbiome were similar in the Eos group and the Noneos group.After 7 days of treatment,alpha diversity increased in both groups,while the microbiome richness(Ace index)was significantly lower in the Eos group(561.87±109.13 vs.767.88±148.48,t=-3.535,P=0.002).At the same time,IL-6(12.09±2.85 pg/mL vs.15.54±2.45 pg/mL,t=-4.913,P<0.001)and IL-8(63.64±21.69 pg/mL vs.78.97±17.13 pg/mL,t=-2.981,P=0.004)decreased more significantly in the Eos group,and the percentages of inhibition of IL-8 at dexamet

关键词： Acute exacerbations of chronic obstructive pulmonary disease Sputum Microbiome eosinophilic Corticosteroid Interleukin-8 inhibition

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Metabolomic Analysis of Serum Glycerophospholipid Levels in eosinophilic and Neutrophilic Asthma

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Biomedical and Environmental Sciences 2019年第2期32卷 96-106页

作者： GAI Xiao Yan ZHANG Li Jiao CHANG Chun GUO Cheng Lin ABULIKEMU Mairipaiti LI Wen Xiong WANG Juan YAO Wan Zhen ZHANG Xu Department of Pulmonary and Critical Care Medicine Peking University Third Hospital Tianjin Key Laboratory of Metabolic Diseases and Department of Physiology Tianjin Medical University

Objective To compare the serum glycerophospholipid levels in the inflammatory subtypes of asthma by using targeted metabolomic analysis. Methods Demographic and clinical data were collected from 51 patients with asthma between January 2015 and December 2015. Routine blood and sputum induction tests were performed. eosinophilic asthma was defined as induced sputum containing ≥ 3% eosinophils, and neutrophilic asthma, as induced sputum containing ≥ 71% neutrophils. Serum metabolic glycerophospholipid profile was determined by liquid chromatography-mass spectrometry. Differences in glycerophospholipid levels between eosinophilic and non-eosinophilic asthma and between neutrophilic and non-neutrophilic asthma were analyzed using partial least squares discriminant analysis. Results The serum lysophosphatidylglycerol level was significantly higher in the group with ≥ 3% eosinophils in sputum than in the group with eosinophilic asthma and may be a biomarker of eosinophilic asthma. This information is helpful for identifying and tailoring treatment for the common asthma subtypes.

关键词： eosinophilic asthma Neutrophilic asthma Glycerophospholipids Sputum induction Metabolomics

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Massive hemorrhagic ascites: A rare presentation of eosinophilic gastroenteritis

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World Journal of Clinical Cases 2018年第7期6卷 156-160页

作者： Lei Shi Qiu-Hong Jia Fu-Jian Liu Hang Guan Zhi-Yong Jiang Department of Gastroenterology the Eighth Affiliated Hospital of Guangxi Medical University

According to Klein's classification system, the symp-tomatology of eosinophilic gastroenteritis(EG), a rare disease, differs based on the affected tissue layer. Pati-ents with subserosal EG often have peritoneal effusion. Hemorrhagic ascites due to EG is extremely rare and has not been reported in the literature. Here, we report a 57-year-old woman with EG and massive hemorrhagic ascites. Laboratory investigations showed elevated per-ipheral eosinophils with significant eosinophilia(65.6%). Ultrasonography showed massive abdominal ascites. Ab-dominal paracentesis revealed hemorrhagic peritoneal fluid and microscopy showed predominant eosinophils. Upper gastrointestinal endoscopy revealed erosions, ex-udates, and mucosal rings in the duodenal mucosa; hist-ological examination indicated eosinophilic infiltration. EG presenting with hemorrhagic ascites was diagnosed by histologic examination of eosinophilic infiltration. She was empirically treated with ketotifen 1 mg bid po with rapid resolution of ascites and a remarkable decline in peripheral eosinophil counts. Clinicians should consider the different-ial diagnosis of unexplained hemorrhagic ascites.

关键词： Hemorrhagic ascites eosinophilic infiltration eosinophilic gastroenteritis

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Central retinal artery occlusion in eosinophilic granulomatosis with polyangiitis(Churg-Strauss Syndrome):the first case report in South Korea

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International Journal of Ophthalmology(English edition) 2021年第6期14卷 948-951页

作者： Jungyul Park Up Huh Hee-young Choi Seunggeun Lee Miyeun Han Sungwoon Chung Hyerim Kim Department of Ophthalmology Pusan National University School of MedicineBiomedical Research InstitutePusan National University HospitalBusan 49241Republic of Korea Department of Thoracic and Cardiovascular Surgery Pusan National University School of MedicineBiomedical Research InstitutePusan National University HospitalBusan 49241Republic of Korea Department of Rheumatology Pusan National University School of MedicineBiomedical Research InstitutePusan National University HospitalBusan 49241Republic of Korea Department of Nephrology Pusan National University School of MedicineBiomedical Research InstitutePusan National University HospitalBusan 49241Republic of Korea Department of Laboratory Medicine Pusan National University School of MedicineBiomedical Research InstitutePusan National University HospitalBusan 49241Republic of Korea

Dear Editor,I am Dr.Jungyul Park from the Department of Ophthalmology,Pusan National University Hospital,Busan,Korea.I am writing to present a case of eosinophilic granulomatosis with polyangiitis(EGPA)with central retinal artery occlusion(CRAO).It provides important information about the relationship between ANCA and CRAO in a patient who was diagnosed with EGPA who had ophthalmic symptoms.We believe that our study makes a significant contribution to the literature because to our knowledge,the literature of EGPA with CRAO are rare worldwide and this is even the first case of EGPA with CRAO in Republic of Korea.

关键词： granuloma occlusion eosinophilic

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eosinophilic cholangitis: A case report of diagnostically challenging eosinophilic infiltrative biliary obstruction

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World Journal of Gastrointestinal Endoscopy 2019年第12期11卷 589-595页

作者： Amar Dodda Karen Matsukuma Shiro Urayama Department of Internal Medicine/Division of Gastroenterology and Hepatology University of California-DavisSacramentoCA 95817United States Department of Pathology and Laboratory Medicine University of California–DavisSacramentoCA 95817United States

BACKGROUND Evaluation of biliary strictures primarily focuses on ruling out malignancy in older age groups.With endoscopic tools such as endoscopic ultrasound(EUS)and cholangioscopy,improved biliary visualization has enhanced the investigation of intraluminal biliary lesions and provided modalities for targeted biopsies.Benign biliary strictures,however,may pose a diagnostic dilemma.CASE SUMMARY A 71-year-old female with past medial history of hypothyroidism presenting for abnormal biliary imaging.Patient’s previous evaluation was concerning for common bile duct dilation with cholelithiasis,for which she underwent a cholecystectomy.Due to persistent symptoms and worsening liver function tests,she presented to our institution for further workup.Subsequently,the patient underwent an EUS and multiple ERCP’s with cholangioscopy;biliary biopsies revealed no evidence of malignancy but concerning for prominent eosinophilic infiltration.After further review of multiple pathology specimens and the benign clinical course,we diagnosed the patient with eosinophilic cholangitis.CONCLUSION eosinophilic cholangitis is a rare disease and can present as a challenging case diagnostically.This case raises the potential utility of quantitative eosinophilic infiltration reporting in creating an objective diagnostic metric for eosinophilic cholangitis.

关键词： eosinophilic cholangitis Diagnostic criteria Endoscopic ultrasound Endoscopic retrograde cholangiopancreatography Case report

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eosinophilic granuloma of the cervical spine

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Chinese Medical Journal 1997年第10期 79-81页

ＥｏｓｉｎｏｐｈｉｌｉｃｇｒａｎｕｌｏｍａｏｆｔｈｅｃｅｒｖｉｃａｌｓｐｉｎｅＫｅｎｎｅｔｈＭａｎＣｈｅｅＣｈｅｕｎｇ，ＹａｔＷａＷｏｎｇ，ＫｅｉｔｈＤｉｐＫｅｉＬｕｋａｎｄＪｏｈｎＣｈｉＹａｎＬｅｏｎｇＥｏｓｉｎｏ... 详细信息

ＥｏｓｉｎｏｐｈｉｌｉｃｇｒａｎｕｌｏｍａｏｆｔｈｅｃｅｒｖｉｃａｌｓｐｉｎｅＫｅｎｎｅｔｈＭａｎＣｈｅｅＣｈｅｕｎｇ，ＹａｔＷａＷｏｎｇ，ＫｅｉｔｈＤｉｐＫｅｉＬｕｋａｎｄＪｏｈｎＣｈｉＹａｎＬｅｏｎｇＥｏｓｉｎｏｐｈｉｌｉｃｇｒａｎｕｌｏｍａｏｆ...

关键词： the spine granuloma eosinophilic cervical

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eosinophilic ascites: A diagnostic and therapeutic challenge

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World Journal of Gastrointestinal Surgery 2016年第9期8卷 656-659页

作者： Shefali Agrawal Sandeep Vohra Sangeeta Rawat Vikas Kashyap Hepatobiliary and Pancreatic Surgery Department of Surgical Oncology Indraprastha Apollo Hospitals Sarita Vihar New Delhi 110076 India Department of Radiology Indraprastha Apollo Hospitals Sarita Vihar New Delhi 110076 India Department of Pathology Indraprastha Apollo Hospitals Sarita Vihar New Delhi 110076 India

eosinophilic gastroenteritis(EGE) is a rare condition characterized by eosinophilic infiltration of the gastrointestinal tract. Depending on the dominant layer of infiltration it is classified into three types namely, mucosal, muscularis and subserosal. The most uncommon variant is the subserosal type characterized by primarily subserosal disease, eosinophilic ascites and peripheral hypereosinophilia. The clinical features are non-specific with history of atopic predisposition and allergy. Endoscopic biopsy is frequently non-diagnostic due to an uninvolved gastrointestinal mucosa rendering its diagnosis a challenge. The mainstay of diagnosis is peripheral hypereosinophilia and eosinophil-rich ascitic fluid on diagnostic paracentesis. Oral steroid therapy is usually the first line of treatment with dramatic response. Due to a propensity for relapse, steroid-sparing therapy should be considered for relapses of EGE. We report a case of subserosal EGE with diagnostic clinical features and treatment response and review the current strategy in the management of eosinophilic ascites.

关键词： Gastrointestinal Atopy eosinophilic ascites Endoscopic biopsy Eosinophilia

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eosinophilic esophagitis in patients with esophageal atresia and chronic dysphagia

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World Journal of Gastroenterology 2014年第47期20卷 18038-18043页

作者： Sirvart Kassabian Virginia Baez-Socorro Thomas Sferra Reinaldo Garcia Department of Pediatric Gastroenterology Nutrition and HepatologyAkron Children’s HospitalAkronOH 44308United States Division of Pediatric Gastroenterology Nutrition and HepatologyRainbow Babies and Children’s HospitalClevelandOH 44106United States

Esophageal atresia(EA)is defined as a discontinuity of the lumen of the esophagus repaired soon after birth.Dysphagia is a common symptom in these patients,usually related to stricture,dysmotility or peptic esophagitis.We present 4 cases of patients with EA who complained of dysphagia and the diagnosis of eosinophilic esophagitis(Eo E)was made,ages ranging from9 to 16 years.Although our patients were on acid suppression years after their EA repair,they presented with acute worsening of dysphagia.Esophogastroduodenoscopy and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with Eo E.Two of 4 patients improved symptomatically with the topical steroids.It is important to note that all our patients have asthma and 3 out of 4 have tested positive for food allergies.One of our patients developed recurrent anastomotic strictures that improved with the treatment of the Eo E.A previous case report linked the recurrence of esophageal strictures in patients with EA repair with Eo E.Once the Eo E was treated the strictures resolved.On the other hand,based on our observation,Eo E could be present in patients without recurrent anastomotic strictures.There appears to be a spectrum in the disease process.We are suggesting that Eo E is a frequent concomitant problem in patients with history of congenital esophageal deformities,and for this reason any of these patients with refractory reflux symptoms or dysphagia(with or without anastomotic stricture)may benefit from an endoscopic evaluation with biopsies to rule out Eo E.

关键词： eosinophilic esophagitis Esophageal atresia Trache

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eosinophilic gastroenteritis:An unusual type of gastroenteritis

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World Journal of Gastroenterology 2013年第31期19卷 5061-5066页

作者： Sachin B Ingle Chitra R Hinge(Ingle) Department of Pathology MIMSR Medical College Maharashtra 4132512 India Department of Physiology MIMSR Medical College Maharashtra 4132512 India

eosinophilic gastroenteritis(EGE) is a rare disorder characterized by eosinophilic infiltration of the bowel wall with various gastrointestinal manifestations.Till date only 280 cases have been described in the literature.A high index of suspicion,by excluding other causes of peripheral eosinophilia,is a pre requisite for accurate diagnosis.EGE is an uncommon gastrointestinal disease affecting both children and adults.It was first described by Kaijser in 1937.Presentation may vary depending on location as well as depth and extent of bowel wall involvement and usually runs a chronic relapsing course.This condition can respond to low dose steroid therapy,thereby preventing grave complications like ascites and intestinal obstruction that might need surgical intervention.The natural history of EGE has not been well documented.eosinophilic gastroenteritis is a chronic,waxing and waning condition.Mild and sporadic symptoms can be managed with reassurance and observation,whereas disabling gastrointestinal(GI) symptom flare-ups can often be controlled with oral corticosteroids.When the disease manifests in infancy and specific food sensitization can be identified,the likelihood of disease remission by late childhood is high.GI obstruction is the most common complication.Fatal outcomes are rare.

关键词： eosinophilic gastroenteritis Unusual type Review of literature

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