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eosinophilic esophagitis: A newly established cause of dysphagia

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World Journal of Gastroenterology 2006年第15期12卷 2328-2334页

作者： Brian M Yan Eldon A Shaffer Division of Gastroenterology Department of Medicine University of CalgaryCalgaryAlbertaCanada

eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline （1966-December 2005） for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/10s in children and 2.5/10s in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a ＂feline＂ or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable （crepe paper） mucosa, prone to tearing with minimal contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate （〉20/high power field） within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors, or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign, albeit inconvenient, course. With increasing recognition, this entity is taking its place as an established cause of solid food dysphagia.

关键词： eosinophilic esophagitis Allergy Dysphagia

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 *** is a common symptom in these patients,usually related to stricture,dysmotility or peptic *** 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 *** our patients were on acid suppression years after their EA repair,they presented with acute worsening of *** and/or barium swallow did not show stricture and biopsies revealed elevated eosinophil counts consistent with Eo *** of 4 patients improved symptomatically with the topical *** is important to note that all our patients have asthma and 3 out of 4 have tested positive for food *** 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 *** the Eo E was treated the strictures *** the other hand,based on our observation,Eo E could be present in patients without recurrent anastomotic *** appears to be a spectrum in the disease *** 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 Tracheoesophageal fistula Dysphagia

Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

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World Journal of Gastroenterology 2008年第5期14卷 803-804页

作者： Gennaro Liguori Maurizio Cortale Fabrizio Cimino Michele Sozzi Department of General and Thoracic Surgery Cattinara Hospital Trieste 34149 Italy Service of Gastroenterology Cattinara Hospital Trieste 34149 Italy

A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia. The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-de-sac in the lower part of the esophagus. Soon after the procedure, the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus, and a mediastinal emphysema. An emergency right thoracotomy was performed, followed by a total esophagectomy with esophagogastroplasty and jejunostomy. The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal, submucosal and muscular layers. The diagnosis was esophageal perforation in eosinophilic esophagitis.

关键词： Thoracic surgery emergency Esophagea perforation eosinophilic esophagitis Esophagea mucosal dissection Esophagus surgery

Endoscopic findings in patients with Schatzki rings:Evidence for an association with eosinophilic esophagitis

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World Journal of Gastroenterology 2012年第47期18卷 6960-6966页

作者： Michaela Müller Alexander J Eckardt Annette Fisseler-Eckhoff Susanne Haas Ines Gockel Till Wehrmann Department of Gastroenterology German Diagnostic ClinicD-65191 WiesbadenGermany Department of Pathology Dr.Horst-Schmidt-Kliniken65199 WiesbadenGermany Department of General and Abdominal Surgery University Medical CenterThe Johannes Gutenberg University55131 MainzGermany

AIM:To investigate endoscopic findings in patients with Schatzki rings(SRs) with a focus on evidence for eosinophilic esophagitis(EoE).METHODS:We consecutively approached all adult patients scheduled for elective outpatient upper endoscopy for a variety of indications at the German Diagnostic Clinic,Wiesbaden,Germany between July 2007 and July *** patients with endoscopically diagnosed SRs,defined as thin,symmetrical,mucosal structures located at the esophagogastric junction,were prospectively *** endoscopic findings,clinical information and histopathological findings with a focus on esophageal eosinophilia(≥ 20 eosinophils/high power field) were *** criteria for active EoE were defined as:(1) eosinophilic tissue infiltration ≥ 20 eosinophils/hpf;(2) symptoms of esophageal dysfunction;and(3) exclusion of other causes of esophageal *** reflux disease was excluded by proton pump inhibitor treatment prior to *** presence of ≥ 20 eosinophils/hpf in esophageal biopsies in patients that did not fulfil the criteria of EoE was defined as esophageal ***:A SR was diagnosed in 171(3.3%;128 males,43 females,mean age 66 ± 12.9 years) of the 5163 patients that underwent upper *** of the 116 patients(17%) from whom esophageal biopsies were obtained showed histological hypereosinophilia(≥ 20 eosinophils/hpf).Nine of these patients(8 males,1 female,mean age 49 ± 10 years) did not fulfill all diagnostic criteria of EoE,whereas in 11(9%) patients with ≥ 20 eosinophils/hpf,a definite diagnosis of EoE was *** of the 11 patients(27%) with definite EoE had no suspicious endoscopic features of *** contrast,in the 25 patients in whom EoE was suspected by endoscopic features,EoE was only confirmed in 7(28%) *** with EoE were younger(mean age 41.5 ± 6.5 vs 50.5 ± 11.5 years,P = 0.012),were more likely to have a history of allergies(73% vs 29%,P = 0.007

关键词： Schatzki ring Dysphagia Esophageal eo-sinophilia eosinophilic esophagitis Food impaction

Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies:A review of the literature

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World Journal of Gastroenterology 2008年第9期14卷 1463-1466页

作者： Javier Molina-Infante Lucía Ferrando-Lamana Jose María Mateos-Rodríguez Belén Pérez-Gallardo Ana Beatriz Prieto-Bermejo Unit of Gastroenterology Hospital San Pedro de Alcantara Avda. Pablo Naranjo s/n 10003 Caceres Spain Department of Pathology. Hospital San Pedro de Alcantara Avda. Pablo Naranjo s/n 10003 Caceres Spain

eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have overlapping clinical, manometric, endoscopic and histopathologic features. The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field (eo/HPF) in esophageal biopsies. We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptomatic on proton pump inhibitor (PPI) therapy. The first patient also achieved a histologic response, while EE remained in the other patient after effective PPI treatment, as shown by 24-h esophageal pH monitoring. Topical steroid therapy combined with PPI led to complete remission in this latter patient. GERD and EE may be undistinguishable, even by histology, so diagnosis of EE should only be established after a careful correlation of clinical, endoscopic and pathologic data obtained under vigorous acid suppression. These diagnostic difficulties are maximal when both diseases overlap. Limited data are available about this topic, and the interaction between EE and GERD is a matter of debate. In this setting, upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease. A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment, EE should be suggested. However, a clinical response to PPI may not rule out quiescent EE, as shown in this report.

关键词： Eosinophils eosinophilic esophagitis Gastroesophageal reflux Proton pump inhibitors Overlap

Significance of feeding dysfunction in eosinophilic esophagitis

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World Journal of Gastroenterology 2014年第31期20卷 11019-11022页

作者： Calies Menard-Katcher Michelle Henry Glenn T Furuta Dan Atkins Nancy Creskoff Maune Angela M Haas Department of Pediatrics Digestive Health Institute Section of Pediatric Gastroenterology Hepatology and Nutrition Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases Program University of Colorado School of MedicineAurora CO 80045 United States Department of Clinical Nutrition Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases ProgramAurora CO 80045 United States Department of Pediatrics Digestive Health Institute Section of Pediatric Gastroenterology Hepatology and Nutrition Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases Program Mucosal Inflammation Program University of Colorado School of MedicineAurora CO 80045 United States Section of Pediatric Allergy Children’s Hospital Colorado Gastrointestinal Eosinophilic Diseases Program Department of Pediatrics University of Colorado School of MedicineAurora CO 80045 United States Department of Occupational Therapy Children’s Hospital ColoradoAurora CO80045 United States Department of Audiology Speech-Language Pathology Learning Services Children’s Hospital Colorado Aurora CO 80045 United States

Feeding dysfunction is a frequent presenting symptom of eosinophilic esophagitis(EoE). Here we present 3 children of various ages whose manifestations of EoE associated feeding dysfunction led to significant and life altering impact on their growth and development. Early identification of presenting symptoms of EoE will allow for prompt diagnosis and initiation of appropriate treatments. Recognition of salient features of dysfunction and treatment by feeding therapists and nutritionists led to symptom resolution and growth.

关键词： eosinophilic esophagitis eosinophilic oesophagitis Feeding dysfunction Feeding therapy oral motor skills Mealtime dynamics esophagitis Oesophagitis

Histological remission of eosinophilic esophagitis under asthma therapy with IL-5 receptor monoclonal antibody:A case report

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World Journal of Clinical Cases 2022年第14期10卷 4502-4508页

作者： Marc Huguenot Anne-Catherine Bruhm Manfred Essig Department of Gastroenterology and Internal Medicine Tiefenau HospitalBern 3004Switzerland

BACKGROUND Benralizumab is a monoclonal antibody targeting the IL-5 receptor used in the treatment of *** use of benralizumab in other conditions is only emerging and could represent a therapeutic option for other eosinophil-associated ***,we report the case of a patient suffering from eosinophilic esophagitis and asthma who achieved histological remission of eosinophilic esophagitis(EoE)under benralizumab treatment for his *** SUMMARY Our patient was a 56-year-old white male with a history of eosinophilic esophagitis and severe *** years of usual treatments,including topical steroids,biological treatment with mepolizumab,and standard asthma treatment,only poor control of both conditions was obtained.A control gastroscopy after the initiation of benralizumab showed complete histological remission of his *** Our case shows the effects of therapy with a novel agent not yet approved for this condition but for other diseases,with histological resolution of EoE after *** clinical remission was not observed,which exemplifies the complex nature of EoE,its associated psychosomatic burden,and the chronification of the ***,monoclonal antibodies targeting the Th2 response and,in our case,an IL5 receptor antagonist,achieved complete histological remission,which was not the case with an antibody against IL-5,which was also initiated to treat asthma.

关键词： eosinophilic esophagitis Benralizumab,eosinophilic asthma Case report

Animal models of eosinophilic esophagitis,review and perspectives

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Animal Models and Experimental Medicine 2024年第2期7卷 127-135页

作者： Dong Li Yujia Wei Jing Wang Bo Wang Department of Dermatology Huazhong University of Science and Technology Tongji Medical College Tongji HospitalWuhanChina Health Management Center Huazhong University of Science and Technology Tongji Medical College Tongji HospitalWuhanChina Department of Gastroenterology Huazhong University of Science and Technology Tongji Medical College Tongji HospitalWuhanChina

eosinophilic oesophagitis(EoE)is an allergen/immune-mediated chronic esophageal disease characterized by esophageal mucosal eosinophilic infiltration and esophageal *** the disease was originally attributed to a delayed allergic reaction to allergens and a Th2-type immune response,the exact pathogenesis is complex,and the efficacy of existing treatments is ***,the study of the pathophysiological process of EOE has received increasing *** models have been used extensively to study the molecular mechanism of EOE pathogenesis and also provide a preclinical platform for human clinical intervention studies of novel therapeutic *** maximize the use of existing animal models of EOE,it is important to understand the advantages or limitations of each modeling *** paper systematically describes the selection of experimental animals,types of allergens,and methods of sensitization and excitation during the preparation of animal models of *** also discusses the utility and shortcomings of each model with the aim of providing the latest perspectives on EoE models and leading to better choices of animal models.

关键词： anaphylaxis disease models animal eosinophilic esophagitis methods

Esophageal squamous papillomas with focal dermal hypoplasia and eosinophilic esophagitis

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World Journal of Gastroenterology 2017年第12期23卷 2246-2250页

作者： Eric A Pasman Theresa A Heifert Cade M Nylund Pediatric Residency Program National Capital Consortium Pediatric Gastroenterology Hepatology and Nutrition Fellowship ProgramNational Capital Consortium Department of Pediatrics F.Edward Hebert School of MedicineUniformed Services University

Focal dermal hypoplasia(FDH) is a rare disorder of the mesodermal and ectodermal tissues. Here we present an eight-year-old female known to have FDH who presents with poor weight gain and dysphagia. She was diagnosed with multiple esophageal papillomas and eosinophilic esophagitis. She was successfully treated with argon plasma coagulation and ingested fluticasone propionate, which has not been described previously in a child.

关键词： Focal dermal hypoplasia Papilloma Argon plasma coagulation Eosinophils eosinophilic esophagitis Esophageal diseases Dysphagia