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Query: UMLS:C0011168 (dysphagia)
 15,644 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

BACKGROUND: Eosinophilic gastritis is related to eosinophilic gastroenteritis, varying only in regards to the extent of disease and small bowel involvement. Common symptoms reported are similar to our patient's including: abdominal pain, epigastric pain, anorexia, bloating, weight loss, diarrhea, ankle edema, dysphagia, melaena and postprandial nausea and vomiting. Microscopic features of eosinophilic infiltration usually occur in the lamina propria or submucosa with perivascular aggregates. The disease is likely mediated by eosinophils activated by various cytokines and chemokines. Therapy centers around the use of immunosuppressive agents and dietary therapy if food allergy is a factor. CASE PRESENTATION: The patient is a 31 year old Caucasian female with a past medical history significant for ulcerative colitis. She presented with recurrent bouts of vomiting, abdominal pain and chest discomfort of 11 months duration. The bouts of vomiting had been reoccurring every 7-10 days, with each episode lasting for 1-3 days. This was associated with extreme weakness and cachexia. Gastric biopsies revealed intense eosinophilic infiltration. The patient responded to glucocorticoids and azathioprine. The differential diagnosis and molecular pathogenesis of eosinophilic gastritis as well as the molecular effects of glucocorticoids in eosinophilic disorders are discussed. CONCLUSIONS: The patient responded to a combination of glucocorticosteroids and azathioprine with decreased eosinophilia and symptoms. It is likely that eosinophil-active cytokines such as interleukin-3 (IL-3), granulocyte macrophage colony stimulating factor (GM-CSF) and IL-5 play pivotal roles in this disease. Chemokines such as eotaxin may be involved in eosinophil recruitment. These mediators are downregulated or inhibited by the use of immunosuppressive medications.
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PMID:Eosinophilia in a patient with cyclical vomiting: a case report. 1514 61

Gastroesophageal reflux (GER), defined as passage of gastric contents into esophagus, and GER disease (GERD), defined as symptoms or complications of GER, are common pediatric problems encountered by both primary and specialty medical providers. Clinical manifestations of GERD in children include vomiting, poor weight gain, dysphagia, abdominal or substernal pain, esophagitis and respiratory disorders. On the other hand, recurrent vomiting is the symptom of hydronephrosis, brain tumor, food allergy, uremia, other metabolic disease, obstruction of intestine etc. It is very important for clinicians dealing with children and infants to understand GERD. The evaluation and treatment of gastroesophageal reflux in infants and children were reviewed here.
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PMID:[Evaluation and treatment of gastroesophageal reflux in infants and children]. 1534 50

In children with medically refractory gastroesophageal reflux disease (GERD), fundoplication is effective and safe. However, in a subset of patients, gastrointestinal dysfunction occurs postoperatively. Symptoms include chest pain, persistent dysphagia in 5%, gas bloat in 2% to 4%, diarrhea in up to 20%, and dumping syndrome in up to 30%. Symptoms are often nonspecific, arising from recurrent or persistent GERD, anatomic complications such as disrupted or herniated wrap, functional disturbances such as rapid gastric emptying or altered gastric accommodation, or alternative diagnoses such as cyclic vomiting syndrome or food allergy. Detailed investigation, including various combinations of pHmetry, videofluoroscopy, endoscopy, motility studies, and dumping provocation testing, may be required to clarify pathophysiology and guide management.
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PMID:Gastrointestinal complications of fundoplication. 1591 82

Foods that account for 90% of allergic reactions in children are cow's milk protein, eggs, peanut, soy, tree nuts, fish, and wheat. Food allergy can manifest as urticaria/angioedema, anaphylaxis, atopic dermatitis, respiratory symptoms, or a gastrointestinal (GI) disorder. GI allergic manifestations can be classified as immunoglobulin E (IgE) mediated (immediate GI hypersensitivity and oral allergy syndrome); "mixed" GI allergy syndromes (involving some IgE components and some non-IgE or T-cell-mediated components) include eosinophilic esophagitis and eosinophilic gastroenteritis. Non-IgE-mediated or T-cell-mediated allergic GI disorders include dietary protein enteropathy, protein-induced enterocolitis, and proctitis. All these conditions share a common denominator: the response of the immune system to a specific protein leading to pathologic inflammatory changes in the GI tract. This immunological response can elicit symptoms such as diarrhea, vomiting, dysphagia, constipation, or GI blood loss, symptoms consistent with a GI disorder. The detection of food allergies can be accomplished by the use of radioallergosorbent (RAST) testing and skin prick tests in helping to assess the IgE-mediated disorders. Patch tests may help evaluate delayed hypersensitivity reactions. Treatment of GI allergic disorders ranges from strict dietary elimination of offending food(s), use of protein hydrolysates, and use of L-amino acid-based formula when protein hydrolysates fail. Treatment with topical (for eosinophilic esophagitis) or systemic steroids is used if all dietary measures are unsuccessful. Maternal breast feeding or the use from birth of hydrolysate formulas (extensive or partial hydrolysates) may be efficacious in the prevention of atopic disease in "high-risk" families (with at least 1 parent or sibling with a history of atopic disease).
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PMID:Gastrointestinal manifestations of food allergies in pediatric patients. 1620 93

Feeding refusal is often described in conjunction with the diagnosis of eosinophilic esophagitis (EE) in pediatric patients; however, there are little data regarding the specific clinical manifestations and effective management of this condition in very young children. The aim of this study was to evaluate the presentation of EE in infants and toddlers referred to the Interdisciplinary Feeding Team Clinic of a tertiary referral center and to document responses to treatment. Database matching was performed (from January 2000 to June 2003) to identify infants and toddlers diagnosed with EE who had been referred to the Interdisciplinary Feeding Team Clinic. Endoscopic features required for a diagnosis of EE included esophageal mucosal furrowing, erythema, exudates, or decreased vascular markings. Histologic features of EE were more than 24 eosinophils per high-power field (HPF), thickening of basal cell layer, and papillary (rete peg) lengthening or elongation. All study patients were treated with a combination of proton pump inhibitors (PPI) and fluticasone (swallowed). In addition, elemental diet was instituted in those documented to have a food allergy. Treatment success was defined by an improved oral intake, adequate weight gain, and improved endoscopic and histologic findings at 3-6-month followup. A total of 15 subjects [mean age = 19.9 months (SD = 9.7 months)] who fulfilled the entry criteria during the study period were identified. All 15 children had documented endoscopic improvement and 14/15 children had histologic resolution of EE after therapy. In 13 of the 15 children, this translated to clinical improvement as well.
Dysphagia 2007 Jan
PMID:Eosinophilic esophagitis in infants and toddlers. 1702 45

Eosinophilic esophagitis is an inflammatory condition of the esophagus characterized by eosinophilic infiltration. It is a condition mainly affecting children; the adult form has only recently gained recognition as a distinct entity. The major symptom among adults with eosinophilic esophagitis is dysphagia. It is often misdiagnosed as gastroesophageal reflux disease because of the similarity in symptoms. An endoscopic biopsy is required to distinguish between the conditions. The cause of eosinophilic esophagitis is poorly understood, but food allergy has been implicated. Topical steroids are the most effective and convenient method for the treatment of eosinophilic esophagitis in adults. The long-term prognosis of eosinophilic esophagitis is uncertain; however, data suggests a benign course. We herein present two eosinophilic esophagitis cases that were the first to be diagnosed in our clinic.
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PMID:Eosinophilic esophagitis: case report. 1760 57

Approximately 7% to 8% of children are affected by food allergies, the most common being cow's milk allergy (CMA), and egg and peanut allergies. The occurrence of CMA decreases with age, but it is often replaced by other allergic manifestations. CMA affects mainly the skin and gastrointestinal tract, and reactions mediated via immunoglobulin E manifest differently to those that are not. Gastroesophageal reflux disease is frequently present in the first year of life and may be associated with CMA. Eosinophilic oesophagitis is related to food allergy and aeroallergens, less common than gastroesophageal reflux disease, and generally occurs in older children. Eosinophilic oesophagitis manifests as classic symptoms of reflux plus dysphagia. Treatment includes allergen avoidance and local steroid treatment. Other manifestations of CMA include eosinophilic gastroenteritis and proctocolitis. Accurate diagnosis of food allergy and the causative food is important because the condition is present in only about one third of patients with suspected food allergy, may be due to foods other than those originally suspected, and elimination diets may be detrimental to the child's health. Differential diagnosis is important to rule out upper and/or lower gastrointestinal disorders. Food allergy is generally treated with a hypoallergenic diet; antihistamines and leukotriene receptor antagonists may be used in specific conditions.
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PMID:Food allergy as seen by a paediatric gastroenterologist. 1893 1

Eosinophilic oesophagitis (EO) is an infrequent disorder that is currently underdiagnosed. It has been described in both adults and in children, and is more prevalent among males. The etiology of EO is not clear, though atopy has been suggested as playing an important role in the development of the disease. The clinical presentation of EO is varied, and a differential diagnosis with other digestive tract disorders is required particularly gastro-oesophageal re-flux. Dysphagia and food bolus impactation within the oesophagus are the most characteristic symptoms. Diagnostic confirmation is obtained from multiple oesophageal biopsy, with the detection in some sample or samples of over 15 eosinophils per high-magnification microscopic field. An allergological study is needed to evaluate the existence of allergens (perennial or seasonal environmental allergens and food allergens) responsible for the eosinophilic infiltration found at oesophageal level. There is no specific treatment for EO, and topical corticosteroids (swallowed) are currently the pharmacological treatment of choice. Dietary therapy in children with food allergy as the causal factor may prove effective, though the existence of polysensitisation complicates the correct implementation of such treatment. Oesophageal dilatation is reserved for cases with severe dysphagia, and is not without complications. Treatment with anti-IL-5, antileukotrienes, azathioprine, 6-mercaptopurine, anti-IgE, etc., could constitute alternatives to topical corticosteroids, although information is still lacking on their long-term safety and efficacy in the paediatric population.
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PMID:Eosinophilic oesophagitis: clinical manifestations and treatment options. The role of the allergologist. 1915 36

To survey pediatric (PGI) and adult gastroenterologists (AGI) regarding their perceptions about the etiology, diagnosis, and management of eosinophilic esophagitis (EoE), and to assess whether differences in the clinical approach to EoE exist between these subspecialists. A 21-item survey related to EoE was emailed to PGI who subscribe to the PEDSGI Bulletin Board, and to two AGI per Electoral College vote in the US, randomly selected from each state. The survey was voluntary, and consent was assumed based on survey submission. The responses were submitted anonymously and results compiled in a secure Web site. A total of 249 physicians from across the globe responded to the survey, 68% of whom were PGI. The majority of respondents worked primarily in an academic institution or teaching hospital. Respondents revealed diagnosing an average of six cases (median 8, range 0-30) of EoE in the past 6 months. Ninety-two percent of AGI who see a patient with dysphagia and suspected EoE proceed to endoscopy with biopsies, compared to only 54% of PGI (P < 0.05); 38% of PGI would first perform an upper GI study. Both subspecialties agreed that biopsies of the proximal and distal esophagus are needed to make a definitive diagnosis of EoE. Fifty-eight percent PGI and 44% AGI defined EoE as an eosinophilic density of > or =20 per high power field (hpf) in esophageal biopsies. Seventy-seven percent of PGI but only 16% of AGI reported routine referral of patients for food allergy evaluation (P < 0.05). While 77% PGI and 91% of AGI would rely on a symptom-based follow-up, 27% PGI versus 9% AGI follow patients with biopsies according to a pre-determined schedule and another 38% repeat biopsies as needed, versus 15% AGI. This survey exposes a few inconsistencies among gastroenterologists in the diagnosis, management, and follow-up of patients with EoE. The currently available practice guidelines for the diagnosis and management of EoE are largely based on retrospective studies and expert opinion. The results of this survey suggest that a collaborative effort based on robust research is required upon us to develop evidence for how we care for these patients.
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PMID:Eosinophilic esophagitis: perspectives of adult and pediatric gastroenterologists. 1939 Sep 67

Over the past decade, there has been a significant increase in the number of children and adults with eosinophilic esophagitis (EE). This recently recognized form of chronic pan-esophagitis is characterized by dense eosinophilic infiltration of the esophageal mucosa. EE is closely associated with male gender and allergic disorders, such as food allergy, eczema and asthma. The diagnosis relies on demonstration of increased numbers of eosinophils (>/= 15 per high power field) in esophageal biopsies. There is clinical overlap between EE and gastroesophageal reflux disease (GERD). Patients with EE typically present with reflux symptoms but are unresponsive to proton pump inhibitor therapy. While dysphagia, regurgitation and retrosternal pain are the clinical hallmarks of EE, many patients are asymptomatic. Treatment aims to prevent long-term complications, such as acute food bolus impaction or esophageal strictures. In childhood, treatment relies on elemental or elimination diets. Skin prick and atopy patch testing have proved useful in guiding specific dietary elimination. In adolescents and adults, broad-based elimination diets are commonly not tolerated or may be ineffective. These patients may respond to swallowed corticosteroid aerosols or other immune-modulating drugs. Further prospective clinical trials are needed to outline the most effective long-term treatment of EE.
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PMID:Eosinophilic esophagitis: example of an emerging allergic manifestation? 1971 May 18


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