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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Gastroesophageal reflux (GER) is a common problem confronting physicians involved in the care of children and adults. With the association of GER with asthma and chronic cough, physicians specializing in allergy/immunology require information on the pathogenesis, diagnosis, and management of GER. Eosinophilic esophagitis or eosinophilic gastroenteritis are poorly understood entities that may also lead to symptoms mimicking GER and are associated in many cases with underlying hypersensitivity of unknown immunologic mechanism.
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PMID:Gastroesophageal reflux: pathogenesis, diagnosis, and treatment. 1007 9

Eosinophilic gastroenteritis (EG) was first described over 50 years ago. Despite its long history, it remains an ill-defined and poorly understood entity. EG can present in a number of ways, none of which are exclusive to the disorder. EG has features of allergy and immune dysregulation but does not clearly fit into the category of allergic or immune disorder. While EG has been reported to affect all locations and layers of the gastrointestinal tract, the vast majority of reported cases have demonstrated mucosal involvement of the gastric antrum and small intestine in addition to disease activity of other locations of the gastrointestinal tract. Recently, several reports have identified a disease consisting of an isolated esophageal eosinophilia. Eosinophilic esophagitis (EE), also known as primary eosinophilic esophagitis or idiopathic eosinophilic esophagitis, occurs in adults and in children and represents a subset of EG with an isolated severe esophageal eosinophilia. Patients with EE present with symptoms similar to those of gastroesophageal reflux but are unresponsive to antireflux medication. Reports have demonstrated that patients with EE respond to either dietary restriction or corticosteroids.
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PMID:Eosinophilic esophagitis: A subset of eosinophilic gastroenteritis. 1098 Sep 58

Eosinophilic esophagitis (EE) is an important esophageal disorder with distinct clinicopathologic features, and the condition is associated with a high prevalence of food allergies and atopy. In the past decade, we have improved our ability to recognize the phenotype of EE, but our ability to treat EE effectively remains limited despite several reports of successful treatment using elemental or elimination diets, and systemic and topical corticosteroids. The limitations for developing effective treatment regimens are due to some still unresolved and ambiguous aspects of the pathogenesis of EE. Neither the predisposing factors for developing EE in a subset of patients with atopy, nor the variable responsiveness to control measures for allergens are fully understood. There also remain questions about the precise role of gastroesophageal reflux, and the natural history of the disorder, contingent on which is the optimal treatment of EE. In devising treatment for a patient with EE, all attempts should be made to identify and control food and other allergies. In patients who have no diagnosed allergies or who are unresponsive to allergy treatment, topical steroids are a safe and effective treatment option. Systemic steroids should be reserved for those patients who are refractory to topical steroids. Beyond the initial phase of induction treatment, it is crucial to develop effective and safe maintenance treatment regimens based on ongoing allergen control and mast cell inhibitors. There are limited but encouraging data to support further exploration of the role of leukotriene and interleukin-5 inhibitors as safe, effective, and steroid-sparing treatment options.
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PMID:Treatment of Eosinophilic Esophagitis in Children. 1220 60

Eosinophilic esophagitis is a disease that has moved from relative obscurity, known to a few pediatricians, to one of emerging interest and attention in both the pediatric and adult literature. In part, this is due to the underrecognition of the disease, its increasing description in adults, and the fact that it may be a great imitator of gastroesophageal reflux disease. Symptoms may be protean including heartburn, dysphagia, nausea, vomiting, and abdominal pain accompanied by a history of atopic illnesses. Similarly, endoscopic and radiographic appearances may vary, ranging from stricture and "ring" formation to a completely normal-appearing esophagus, with diagnosis made only on biopsy sampling throughout the entire esophagus. Because this disease is thought to be allergic in origin, primary therapy is an attempt to identify and exclude possible food allergens through skin testing. Owing to the inability to identify an allergen or, conversely, poor compliance with a diet avoiding multiple food allergens, steroids may be useful in this disease. Strictures often require dilation as well owing to the chronic and fibrotic nature of these lesions.
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PMID:Eosinophilic Esophagitis. 1252 72

Eosinophilic esophagitis, long known to be a feature of acid reflux, has recently been described in patients with food allergies and macroscopically furrowed esophagus. The pathophysiology and optimal management of patients with eosinophilic esophagitis is unclear. We describe our clinical experience related to eosinophilic esophagitis and obstructive symptoms in children and propose etiopathogenesis and management guidelines. Twelve children with obstructive esophageal symptoms (11 male), median age 5 years, and identified to have eosinophilic esophagitis with > 5 eosinophils per high-power field (eos/hpf) are reported. Of these, four had strictures, six had impactions, and two had only dysphagia. A diagnostic evaluation included esophagogastroduodenoscopy with biopsies in all and upper gastrointestinal series, IgE, radioallergosorbent tests, and skin tests for food allergies in some cases. Esophageal histology specimens were independently analyzed for eosinophil density by two authors. Four of five children with > 20 eos/hpf responded to elimination diets/steroids. The fifth child responded to a fundoplication. Seven children had 5-20 eos/hpf and three of them with no known food allergies responded to antireflux therapy alone. Three others in this group with positive food allergies responded to treatment with elimination diets and/or steroids. The seventh patient in this group was lost to follow-up. In conclusion, on the basis of response to therapy, eosinophilic esophagitis can be subdivided into two groups: those with likely gastroesophageal reflux disease if < 20 eos/hpf and no food allergies, and others with allergic eosinophilic esophagitis associated with food allergies and often with > 20 eos/hpf.
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PMID:Eosinophilic esophagitis: strictures, impactions, dysphagia. 1264 86

Eosinophilic esophagitis is an uncommon pathology that generally affects children with a history of allergies and intrinsic asthma. We present a clinical case of eosinophilic esophagitis in a 16-year-old boy with upper dysphagia for solids since childhood. The analytical study showed only a repeat serum eosinophilia. Barium transit disclosed a reduction in caliber of the whole esophagus. Functional esophageal tests with pH monitoring and manometry were normal. Endoscopy showed a small-diameter esophagus and fibrosis with a very friable mucosa. The histological study of the esophageal biopsies revealed a full thickness major eosinophil infiltration of the esophagus. These findings suggest a differential diagnosis with a great variety of pathologies that can cause similar lesions in the esophagus, especially between primary eosinophilic esophagitis and eosinophilic esophagitis secondary to gastro-esophageal reflux disease (GERD). We implemented medical treatment with oral corticoids and total suppression of allergens from the diet, and the patient was asymptomatic.
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PMID:Primary eosinophilic esophagitis. 1282 22

Eosinophilic esophagitis is a rare entity, characterized by eosinophilic infiltration of the oesophagal mucosae, with no gastroesophageal reflux. Food allergies are often involved. We report 3 paediatric cases of eosinophilic esophagitis, revealed by dysphagia, with or without stricture. Eosinophilic esophagitis is a rare disease, but its frequency is probably underestimated. Symptoms are sometimes unusual. Oesogastroscopy with biopsy is essential for the diagnosis. Food allergies can be involved and must be systematically investigated.
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PMID:[Eosinophilic esophagitis: 3 case reports]. 1573 99

Eosinophilic esophagitis in adults is a recently described entity occurring in young males with dysphagia, in whom esophageal biopsies show eosinophilic infiltration. This study defines the clinical and histological features of patients with eosinophilic esophagitis, distinguishing it from gastroesophageal reflux disease. Esophageal biopsies from patients with dysphagia or esophagitis were reviewed blindly, and assessed for: epithelial eosinophil counts, presence of eosinophilic microabscesses, edema, basal zone hyperplasia, lamina propria papillae elongation, eosinophils and fibrosis. Clinical and endoscopic findings were obtained. Eosinophilic esophagitis was diagnosed with epithelial eosinophils > or = 15 in > or = 2 high-power fields (hpfs) or > or = 25 in any hpf. Analysis was performed with Mann-Whitney, chi2 and ANOVA tests. Of 157 cases, 41 had eosinophilic esophagitis. Male gender (81%) and age < or = 45 (54%) were commoner in patients with eosinophilic esophagitis (P = 0.001, 0.010, respectively). Dysphagia was more common in eosinophilic esophagitis patients (63%, P < 0.001); heartburn was more common in noneosinophilic esophagitis patients (53%, P < 0.001). Endoscopic rings were more common in eosinophilic esophagitis patients (27%, P = 0.023); hiatus hernia was more common in noneosinophilic esophagitis patients (11%, P = 0.022). Eosinophils were more numerous in eosinophilic esophagitis biopsies (mean 39/hpf, P < or = 0.001). Only eosinophilic esophagitis biopsies had eosinophilic microabscesses (42%, P < or = 0.001). Edema, basal zone hyperplasia, lamina propria papillae elongation and lamina propria eosinophils were commoner in eosinophilic esophagitis (P < or = 0.001-0.002), while lamina propria fibrosis was specific for eosinophilic esophagitis (39%, P < 0.001). Eosinophilic esophagitis is a disease with a predilection for young males with dysphagia and rings on endoscopy. Biopsies in eosinophilic esophagitis have high epithelial eosinophil counts, averaging nearly 40/hpf. Increased awareness of eosinophilic esophagitis is necessary, since treatment with allergen elimination or anti-inflammatory therapy may be more effective than acid suppression.
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PMID:Eosinophilic esophagitis in adults: distinguishing features from gastroesophageal reflux disease: a study of 41 patients. 1625 5

Eosinophilic esophagitis (EE) is characterized by eosinophilic infiltration of the esophageal mucosa and results in clinical signs and symptoms that may be indistinguishable from those of gastroesophageal reflux disease (GERD). While demographic, clinical, and endoscopic features may be suggestive of EE, esophageal biopsy with tissue eosinophils averaging 24 per 400 x microscopic field remains the most specific diagnostic criterion. Previously rare, EE has been diagnosed in adults and children with increased frequency over the last decade; it appears to be a chronic disease and has a yearly incidence approximating 1:10,000 in the pediatric population. Dietary and respiratory antigen exposure with subsequent production of inflammatory chemokines is essential for development of EE in animal models of the disease. In humans, glucocorticoids and elimination of relevant dietary antigens have proved efficacious treatments for EE, resolving the disease at the mucosal level. Other therapies, including montelukast, partial dietary elimination, and bouginage have reduced symptoms without affecting mucosal inflammation. Evidence-based guidelines for the management of EE are not currently available. Current medical practice involving the management of reflux merits awareness and understanding of this emerging mimic. We present a review of the current understanding of this disorder.
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PMID:Eosinophilic esophagitis -- a mimic of GERD. 1650 9

Eosinophilic esophagitis (EE) is a recently recognized disorder characterized by the accumulation of eosinophils in the esophagus. Symptoms of EE frequently mimic those of gastroesophageal reflux disease, but the 2 diseases are quite distinct in terms of the histopathology and response to therapy. We demonstrate that EE involves the interplay of numerous genes, especially the eosinophil chemoattractant eotaxin-3, allowing molecular distinction from other forms of esophagitis and consideration of targeted therapeutic intervention.
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PMID:Eosinophilic esophagitis: pathogenesis, genetics, and therapy. 1708 29


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