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

The significance of marked eosinophilic infiltration in esophageal mucosal biopsy specimens was evaluated in 11 patients. The patients were generally young, with an average age of 14.6 years; all had diffuse intraepithelial eosinophilia in several biopsies. Ten patients (91%) had evidence for reflux esophagitis, which was associated with esophageal stricture in three of the six patients older than 1 year. Marked esophageal eosinophilia might therefore indicate prolonged or severe gastroesophageal reflux. One patient with peripheral eosinophilia, a history of asthma, and concurrent idiopathic eosinophilic gastroenteritis lacked evidence of reflux and represents a case of idiopathic esophagitis. Critical review of the literature establishes three additional cases. Idiopathic eosinophilic esophagitis is an unusual variant of idiopathic, but presumably allergic, eosinophilic infiltration of the gastrointestinal tract.
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PMID:Marked eosinophilia in esophageal mucosal biopsies. 409 Nov 82

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

Information on the utility of solid-phase gastric emptying studies (SPGES) in the evaluation of children with symptoms of upper gastrointestinal (GI) motor dysfunction is limited. This study was conducted to evaluate the impact of SPGES in the clinical management and outcome of children with upper GI symptoms suggestive of gastroparesis. The records of 45 children who underwent SPGES (31F; 3-17 years) were reviewed. All patients had GI symptoms suggesting gastroparesis. Patients were fed with Tc-99m-sulfur colloid-labeled chicken liver. Adult normal half-life (T1/2) values (F 103 +/- 14 minutes; M 66 +/- 13.6 minutes) were used. The relationships among symptoms, treatment, and outcome were evaluated. Of the 45 patients 9 had delayed, 16 had rapid, and 20 had normal gastric emptying. Six of 9 patients with delayed gastric emptying responded to cisapride. Four of 16 patients with rapid emptying were diagnosed with the dumping syndrome. Of the children with rapid gastric emptying, 87% were females. Twenty patients with normal emptying were diagnosed with gastroesophageal reflux (8), nonulcer dyspepsia (5), irritable bowel syndrome (2), Helicobacter pylori (1), lactose intolerance (1), eosinophilic gastroenteritis (1), duodenitis (1), and constipation (1). In patients who had SPGES for possible gastroparesis, 20% had gastroparesis, 36% had rapid gastric emptying, and 44% had normal gastric emptying. The high number of females in the rapid gastric emptying group might be secondary to normal adult female T1/2 values that were used. The practice of using adult normal T1/2 values in prepubertal girls may need to be revised. Patients with delayed gastric emptying responded to cisapride.
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PMID:The impact of solid-phase gastric emptying studies in the management of children with dyspepsia. 1455 21

Children with eosinophilic esophagitis, an isolated, severe esophageal eosinophilia, present with symptoms similar to gastroesophageal reflux but do not experience response to aggressive antireflux therapy. Increasingly, eosinophilic esophagitis is considered to be a separate entity from reflux disease. Current theory suggests that the former may be caused by cell-mediated food hypersensitivity or may be a subset of eosinophilic gastroenteritis. Reports support the efficacy of dietary restriction or corticosteroid therapy. Additional research is needed to determine etiology, allow earlier clinical recognition, and improve treatment.
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PMID:Eosinophilic esophagitis in children and adults. 1468 74

Elevated levels of eosinophils in the gastrointestinal tract is a common feature of numerous gastrointestinal disorders including food allergy, parasitic infections, gastro-oesophageal reflux, eosinophilic oesophagitis, eosinophilic gastroenteritis, allergic colitis and inflammatory bowel diseases. Recently, clinical and experimental studies have provided evidence that eosinophils have a critical role in the pathophysiology of eosinophil-associated gastrointestinal disease. Collectively, these studies have provided relevant insight into identifying key targets for therapeutic intervention. The present review describes recent experimental investigations on the role of eosinophils in the clinical manifestations of eosinophil-associated gastrointestinal disease and discusses future therapeutic approaches for the treatment of disease.
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PMID:Review article: The eosinophil as a therapeutic target in gastrointestinal disease. 1560 85

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

Previously considered a rare condition, eosinophilic oesophagitis (EoE) has become increasingly recognized as an important cause of dysphagia and food impactions in adults. This is likely attributable to a combination of an increasing incidence of EoE and a growing awareness of the condition. EoE may occur in isolation or in conjunction with eosinophilic gastroenteritis. However, the burgeoning field is likely attributable to the variant that uniquely affects the oesophagus. Adults classically present with symptoms of dysphagia, food impactions, and heartburn. Typical endoscopic features include concentric mucosal rings, linear furrowing, white plaques or exudates and a narrow caliber oesophagus. In some cases, the endoscopic features may appear normal. For years, EoE went unrecognized because eosinophilic infiltration was accepted as a manifestation of reflux, which continues to be a confounding factor in some patients. Current consensus is that the diagnosis of EoE is established by 1) the presence of symptoms, especially dysphagia and food impactions in adults, 2) > or =15 eosinophils per high power field in oesophageal tissue, and 3) exclusion of other disorders with similar presentations such as GERD. Current understanding of EoE pathophysiology and natural history are limited but the entity has been increasingly linked to food allergies and aeroallergens. The main treatment options for EoE are proton pump inhibitors, dietary manipulation, and topical or oral glucocorticoids. This review highlights recent insights into EoE in adults although, clearly, much of the available data overlap with pediatrics and, occasionally, with eosinophilic gastroenteritis.
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PMID:Eosinophilic oesophagitis in adults. 1937 34

Eosinophilic esophagitis (EoE) is a chronic and abnormal Th2 type immunological response characterized by intense eosinophilic inflammation localized within the esophagus. This leads to esophageal dysfunction and remodeling accompanied by subepithelial fibrosis. Recently, EoE has been recognized as one of the major causes of dysphagia or food impaction in adults. The prevalence of EoE has been increasing over the past several decades, particularly in Western countries. EoE should be differentiated from secondary esophageal eosinophilia (EE) in gastroesophageal reflux disease (GERD) and eosinophilic gastroenteritis, involving the entire gastrointestinal tract. EoE is an uncommon condition in Asia compared with Western countries. With the growing interest and awareness of this condition during the past decade, reports of this disease are increasingly emerging in Asian countries including Japan. Typical EoE does not respond to proton pump inhibitor (PPI) therapy according to the current Western diagnostic guidelines. However, some cases of EE exhibit symptomatic relief and histological improvement in response to PPI [i.e., PPI-responsive esophageal eosinophilia (PPI-REE)]. The understanding of the clinical manifestations and unique endoscopic images of EoE, differences and similarities between GERD, PPI-REE, and EoE will all serve as the differential diagnosis. Further knowledge of the indications and efficacy of PPI therapy and topical steroid therapy will also aid in the management of these diseases. In this article, we will review the current diagnosis and treatment of EoE in clinical practice.
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PMID:Diagnosis and treatment of eosinophilic esophagitis in clinical practice. 2824 77