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Query: UMLS:C0042963 (vomiting)
 31,883 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

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 and eosinophilic gastroenteritis is being recognized more frequently among the adult patients. The disease is characterized by massive infiltration of the wall of gastrointestinal tract by sheets of eosinophils. The clinical features depend upon the site of involvement. They include dyspepsia, dysphagia, nausea, vomiting, chest pain, diarrhea and protein-losing enteropathy. Eosinophilic esophagitis may present as chest pain, dysphagia or dyspepsia. The characteristic endoscopic feature of eosinophilic esophagitis is the formation of fine concentric mucosal rings (corrugated esophagus). Regarding the pathogenesis of these mucosal rings our hypothesis is that mast cells in the esophageal wall in response to allergens release histamine, eosinophilic chemotactic factor and platelet activating factor, etc. which activate eosinophils to release toxic cationic proteins. Activation of acetyl choline by histamine may cause contraction of the muscle fibers in the muscularis mucosae resulting in the formation of esophageal rings. This hypothesis can be tested by demonstrating the contraction of muscle layers of muscularis mucosae with the use of high frequency endoscopic ultrasonic probe introduced via the biopsy channel of an endoscope.
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PMID:Pathogenesis of esophageal rings in eosinophilic esophagitis. 1561 59

Eosinophilic esophagitis (EE) is an increasingly recognized disease of the esophagus with distinct clinicopathologic features. Adult and pediatric patients experience upper intestinal symptoms including food impaction, vomiting, abdominal pain, or dysphagia. Histopathologic analysis of the distal and proximal esophageal mucosa demonstrates dense eosinophilic infiltration despite proton pump inhibition. Few studies document the long-term outcomes of EE but current evidence suggests that EE is a chronic condition that can sometimes lead to esophageal strictures. Although the incidence of this complication is not yet known, it has sparked significant interest in defining safe, effective treatments. Once a diagnosis of EE is made, patients should seek the consultation of the allergist in an effort to identify possible food sensitivities. This is particularly important because the etiologic agent(s) that drive the eosinophilia are likely different for each patient. If the allergic evaluation identifies a specific food, this food should be strictly avoided as a first-line treatment. If a food is not identified, an elemental formula should be used to induce a remission. If an elemental diet cannot be used, topical steroids are effective in inducing a remission. The side effects associated with long-term steroid administration limit their use as a maintenance medication. Given the lack of prognostic data, the use of systemic corticosteroids should be reserved for severe cases when dietary elimination or topical steroids are ineffective. Most importantly, patients should remain under the care of a physician so that long-term outcomes can be identified. To date, diet restriction has been identified as the only effective maintenance treatment, but montelukast and topical cromolyn may also offer benefit. Anti-interleukin-5 antibody represents an emerging form of targeted therapy.
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PMID:Treatment of eosinophilic esophagitis in children. 1616 5

Eosinophilic esophagitis (EE) is a clinical-pathological disorder which is being increasingly diagnosed. It is etiologically associated with hypersensitivity to airborne allergens and/or dietary components. However, immediate hypersensitivity to foods has rarely been proven as the etiologic cause of the disorder. Two patients are presented with a history of rhinoconjunctivitis, allergic asthma, atopic dermatitis and food allergies which are currently under control and who show specific IgE to pulses and chicken respectively. These patients developed acute dysphagia and vomiting immediately after ingesting these foods and following appropriate examination were diagnosed as suffering from EE. The study also showed signs of blood hypereosinophilia while the esophageal manometry revealed a motor disorder characterized by aperistalsis and non-propulsive simultaneous waves affecting the lower two-thirds of the organ composed of smooth muscle. Topical treatment with fluticasone propionate was administered over a period of 3 months, in addition to a diet abstaining from the aforementioned foods and this led to remission of dysphagia and normalization of the endoscopic, histological and manometric studies of the esophagus. This situation remained stable for a considerable length of time after steroid treatment was discontinued, which showed that exposure to foods seemed to be the cause of the esophageal disorder. Similarly, allergies to inhalants and other digestive symptoms which appear upon immediate ingestion of the foods involved would not justify the sudden onset of dysphagia. We offer a pathophysiological explanation for the mechanisms of the disease based on the activation of eosinophils and mast cells by IgE and their ability to disturb the dynamic behavior of the neural and muscle components of the esophageal wall.
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PMID:Food allergies and eosinophilic esophagitis--two case studies. 1706 99

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 a disease that is being recognized with increasing frequency. In children it is responsible for feeding disorders, vomiting, reflux symptoms and abdominal pain and in adults it causes dysphagia and esophageal food impactions. The diagnosis requires the histologic finding of > 20 eosinophils per high powered field in esophageal squamous mucosa. The most common treatment regimens in children and adults involve the ingestion of topical corticosteroids. Symptomatic relapse after one treatment course is common, and many patients require repeated courses of treatment. The long-term prognosis of EE is largely unknown.
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PMID:Eosinophilic esophagitis: an update. 1722 2

Eosinophilic esophagitis is a growing problem in adults in Western countries. It is characterized by nausea, vomiting, dysphagia, food impaction, epigastralgia, heart burn and chest pain. Histologic survey is the most potent diagnostic tool. The diagnostic hallmark is the presence of more than 20 eosinophils per high-powered field on esophageal specimen and the absence of mucosal eosinophilia in the stomach. We herein report an asymptomatic Chinese male with eosinophilic esophagitis, which to the best of our knowledge is the first reported case in Asia. The unusual feature of the current case was the lack of symptoms. This case confirms that a dense infiltration of esophageal eosinophils can occur asymptomatically.
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PMID:Eosinophilic esophagitis in an asymptomatic Chinese. 1929 28

Eosinophilic esophagitis has become a diagnosis familiar to allergists and immunologists who treat pediatric patients presenting with complaints of recurrent vomiting, feeding difficulty, abdominal pain, dysphagia, and food impaction. Over the past 3 years, published research has addressed several clinically important issues, including incidence among special patient populations, adult patients and familial cases, diagnostic features, natural history and complications, therapies with topical steroids, and pathogenesis with distinct genetic markers of the disorder.
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PMID:Gastrointestinal eosinophil-mediated disorders and their treatment. 1906 21

Eosinophilic esophagitis (EoE), esophageal inflammation that occurs in the absence of acidification, is characterized by mucosal eosinophilia and epithelial proliferative changes. Depending on the patient's age, EoE may present as a feeding disorder, vomiting, abdominal pain, dysphagia, or food impaction. In the absence of a well-delineated natural history, case reports suggest that in some individuals with EoE, the disease progresses to esophageal fibrosis and then presumably irreversible esophageal dysfunction. Successful management of EoE in children requires (1) identifying the causative agents for a given patient, (2) implementing effective medical and/or nutrition therapies, and (3) establishing a continuum of long-term care that delivers the child to adulthood without esophageal dysfunction.
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PMID:Medical and nutrition management of eosinophilic esophagitis in children. 2041 97

Eosinophilic esophagitis (EoE) is a chronic, eosinophil-predominant inflammatory condition that can affect esophageal mucosa at any age. Distinguished from gastroesophageal reflux disease in the mid 1990's, it has seemed to be increasingly prevalent, and is usually a manifestation of food allergy. The endoscopic and histologic features are well described. The clinical manifestations vary considerably by age, with adolescents and adults complaining primarily of dysphagia. Younger children may present with pain, vomiting, other evidence for food allergy, or feeding difficulties. Treatment options include swallowed (non-systemic) steroids and dietary antigen elimination, and must be maintained indefinitely due to the extremely high rate of recurrence off therapy. The complications of untreated disease include fibrosis of the esophageal lamina propria and stricture formation that result in chronic dysphagia, risking food impaction and perforation.
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PMID:Eosinophilic esophagitis. 2048 52


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