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

Eosinophilic esophagitis (EE) is an inflammatory disorder of the esophagus that affects both children and adults, and is different from gastro-esophageal reflux disease. The immunopathogenesis of EE involves an allergic response to environmental and food allergens, and the proinflammatory cytokines IL-5 and IL-13. EE may be associated with atopic disorders and peripheral eosinophilia, and may be familial in distribution. The most common presentation is dysphagia and food impaction in adults, with additional manifestations of epigastric pain, emesis, weight loss and failure to thrive in children. Typical endoscopic findings include ringed esophagus, linear furrows, strictures and narrow esophagus. Diagnosis is confirmed by the presence of 20 or more eosinophils per high power field in the esophagus. The available treatment options include elemental diet, avoidance of specific food allergens, topical and systemic corticosteroids, and humanized monoclonal antibodies against IL-5. This review summarizes the etiopathogenesis, clinical, endoscopic and histopathological findings in EE, and describes current available treatment options.
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PMID:Current concepts and treatment options in eosinophilic esophagitis. 1711 87

Eosinophilic esophagitis (EE) is an emerging disease caused by dense infiltration of the esophageal epithelium by eosinophilic leucocytes. It is originated from local hypersensitivity to food or airborne allergens. Although the physiopathologic mechanisms of the illness have not been fully discovered, EE is a loss of immunologic tolerance by the esophagus, meaning that it should be considered as an active immunologic organ. In our study, we investigated the immunologic capacity of the epithelium using immunohistochemistry and stereology, to determine the cellular density of eosinophils, T and B lymphocytes, Langerhans cells, mast cells, and cells manufacturing immunoglobulin E in endoscopic biopsies of patients with EE (taken before and after topical treatment with fluticasone propionate) compared with normal individuals and patients suffering from gastroesophageal reflux disease (GERD). We have observed that the density of eosinophils in EE is 300 times greater than in normal conditions and it is only in this disease where eosinophils show signs of activation and degranulation (positivity to major basic protein immunostaining). The number of T intraepithelial lymphocytes also significantly rose in EE, compared with other entities, where CD8 cells were predominant. However, the human esophagus is deficient in B lymphocytes and we only found intraepithelial plasma cells that excreted immunoglobulin E in EE. Under normal conditions mast cells exist in the thickness of the epithelium that are slightly higher in GERD and multiply in density by 17 in EE. Langerhans cells did not show any significant variation in density under the different tested conditions. After topical treatment with steroids, the density of the different cell components fell to similar levels to GERD. Using our study, we can conclude that the human esophagus may contribute to the development of local immunologic responses as it contains all the necessary cell components. EE represents growth of this esophageal capacity and its pathogeny could respond to mixed cellular and humoral mechanisms.
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PMID:Immunophenotypic characterization and quantification of the epithelial inflammatory infiltrate in eosinophilic esophagitis through stereology: an analysis of the cellular mechanisms of the disease and the immunologic capacity of the esophagus. 1741 8

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

Dysphagia can be caused by a number of disorders such as benign or malignant obstruction of the esophagus, inflammatory alterations of the mucosa or primary esophageal motility disorders. Endoscopic evaluation is recommended for all patients to exclude malignancy and to establish or confirm a diagnosis. This article provides an overview of the most frequent inflammatory and functional esophageal disorders causing dysphagia. Clinical findings, diagnostic procedures and therapeutic management of primary esophageal motility disorders such as achalasia and diffuse esophageal spasm as well as of GERD and eosinophilic esophagitis are discussed. The diagnosis of achalasia is made by barium swallow with fluoroscopy and by manometry. Therapeutic options for achalasia are pneumatic dilatation of the esophagogastric junction, laparoscopic cardiomyotomy combined with fundoplication and botulinum toxin injection of the lower esophageal sphincter Diffuse esophageal spasm is manometrically characterized by normal peristalsis intermittently interrupted by simultaneous contractions. Potential medical therapies are PPIs for underlying GERD, smooth-muscle relaxants and antidepressant medications. GERD is a multifaceted disease caused by abnormal reflux of gastric contents into the esophagus leading to chronic symptoms or mucosal damage. Therapy includes lifestyle modifications, acid suppressive medications mainly by PPI and laparoscopic fundoplication in selected patients. Eosinophilic esophagitis is a chronic inflammatory disorder of the esophagus diagnosed histologically. The main symptom of eosinophilic esophagitis is dysphagia for solid food with imminent risk of food impaction. Systemic or topical corticosteroids are the therapy of choice.
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PMID:[Esophageal dysphagia]. 1766 9

Eosinophilic oesophagitis (EOE) is a newly described clinicopathological entity that is being diagnosed with increasing frequency both in children and in adults. It is presumed to be an atopic disease involving both immediate and delayed-type hypersensitivity to inhaled and ingested allergens. Because of the reflux-type symptomatology, it is commonly misdiagnosed and treated as severe gastro-oesophageal reflux disease (GORD) before an appropriate diagnosis is made. Pathologically, EOE is an inflammatory disorder with a predominantly eosinophilic infiltrate that is unresponsive to acid suppression therapy. The diagnosis of this disease requires histological confirmation with oesophageal biopsy specimens showing an intense eosinophilic infiltration. Although precise criteria or a specific cutoff point for the diagnosis of eosinophilic oesophagitis have not been established, many authors suggest that one high-power field with >20 eosinophils or multiple high-power fields with >15 eosinophils, together with clinical and endoscopic findings, should be sufficient for diagnosis. Recognition of EOE and differentiation from GORD are important, since allergen elimination or anti-inflammatory therapy appears to be more effective than acid suppression in these patients. This review focuses on clinicopathological features and diagnosis of EOE in adults and children.
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PMID:Clinical and pathological features of eosinophilic oesophagitis: a review. 1803 8

Eosinophilic esophagitis (EE) is an inflammatory disease of the esophagus characterized by eosinophilic infiltration of the esophageal mucosa. Symptoms of EE are variable, and include gastroesophageal reflux symptoms, abdominal pain, growth failure, and dysphagia. Dysphagia is a more common presentation in adults and older children. Serious complications of EE consisting of esophageal food impactions necessitating urgent endoscopic removal of the food and esophageal strictures requiring endoscopic balloon dilatations are also seen. The potential severity of these symptoms points to the importance of proper recognition and management of the disease, especially given that EE has become more prevalent over the past decade. In this article, available evidence on the epidemiology and etiology of EE is discussed.
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PMID:Epidemiology and etiology of eosinophilic esophagitis. 1806 Nov

Eosinophilic esophagitis is a condition characterized by a dense infiltration of eosinophils within the epithelium that may extend into the deeper layers of the esophagus associated with distinctive endoscopic changes. The changes are frequently found in patients who have hypersensitivity to various foods and aeroallergens but overlap exists with gastroesophageal reflux disease. It is essential for all endoscopists to become familiar with the endoscopic findings of eosinophilic esophagitis to avoid delays or errors in diagnosis and to optimally assess outcomes of treatment.
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PMID:Eosinophilic esophagitis: endoscopic findings. 1806 Nov 1

Eosinophilic esophagitis (EE) is an inflammatory disease of the esophagus characterized by eosinophilic infiltration of the esophageal epithelium. EE is a relatively new disease from clinical and research standpoints. A recent surge in basic and translational studies has emerged to understand its pathogenesis since its recognition as a separate entity from acid-induced gastroesophageal reflux disease in 1995. Our understanding of this disease is still limited, however. In this article, available evidence from translational studies on EE is discussed, focusing on the allergic nature of the disease and highlighting the role of various inflammatory cells found in the esophagus of patients who have EE. Esophageal remodeling in EE is also discussed.
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PMID:Translational research on the pathogenesis of eosinophilic esophagitis. 1806 Nov 8

Eosinophilic esophagitis (EE) is characterized by eosinophilic infiltration of the esophageal wall including mucosa, submucosa, and muscle proper. EE is a condition involving both pediatrics and adults. Patients with EE are predominantly young males, commonly related to atopy. The typical clinical presentation includes dysphasia, food impaction, and symptoms mimicking gastroesophageal reflux disease. Endoscopic examination reveals mucosal fragility, ring or corrugated mucosa, whitish plaques, or small caliber esophagus. Histologic finding of >20 eosinophils/HPF (high power field) is the diagnostic hallmark of EE. Elemental formula, systemic or topical corticosteroid, anti-inflammatory drugs such as leukotriene receptor antagonists, anti-interleukin (IL)-5, and anti-IL-13 monoclonal antibodies have been used to manage EE. Esophageal dilation is considered in adult patients with severe obstructive symptoms due to stricture.
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PMID:[Eosinophilic esophagitis]. 1815 59

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.
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PMID:Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies: a review of the literature. 1832 68


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