A Japanese case of eosinophilic esophagitis

Abstract

Eosinophilic esophagitis (EE) is a rarely diagnosed condition involving eosinophilic infiltration of the esophageal mucosa. Here we present a case of EE in a 69-year-old Japanese man, who presented with abdominal pain, appetite loss, and a history of bronchial asthma. Laboratory findings included peripheral eosinophilia and an increased serum immunoglobulin E level. Computed tomography showed diffuse severe thickening of the esophageal wall, and a barium esophagogram revealed a small caliber of the middle and lower portion of the esophagus, without normal peristaltic contractions. Endoscopy of the esophagus showed a pale mucosa, with adherent whitish exudates resembling fungal infection, and prominent ring-like contractions. Histologic examination of a biopsy specimen revealed marked eosinophil infiltration into the esophageal mucosa. Endoscopic ultrasonography (EUS) demonstrated marked circumferential thickening of the esophageal submucosal layer, and an esophageal manometry study showed a high percentage of ineffective esophageal peristalsis and high-amplitude esophageal body contractions. EUS findings showed no change even after oral corticosteroid therapy, although the histological findings were improved. This is thought to be the first documented Japanese case of EE. EE should be considered in the differential diagnosis in cases of esophageal motility disturbance, even if the patients do not complain of dysphagia.

A Multicenter Study on the Prevalence of Eosinophilic Esophagitis and PPI-Responsive Esophageal Eosinophilic Infiltration

“…Only 1 case of an asymptomatic Chinese patient with EoE was reported in 2008 (12). Furuta et al reported the first case of a Japanese patient with EoE in 2006 (11), and several cases of symptomatic or asymptomatic EEI, including EoE and PPI-R EEI, were reported (13,14). Fujishiro et al conducted a large epidemiological study of EoE (15).…”

“…Although there are many studies of EoE from Western counties (5-10), there are only a few case reports or series of adult EoE in Asia (11)(12)(13)(14)(15). Only 1 case of an asymptomatic Chinese patient with EoE was reported in 2008 (12).…”

“…Most Western studies show a significant increase in the rate of EoE (7,8). However, there are only a few studies on EoE conducted in Asia, including Japan (11)(12)(13)(14)(15). The purpose of this study was to determine the prevalence of EoE and PPI-R EEI in Japanese adult patients in a multicenter study.…”

Diagnosis and treatment of eosinophilic esophagitis in clinical practice

“…In Japan, EoE was first reported by Furuta et al [28]. The prevalence of EE or EoE is estimated to be 0.02-6.6% (Table 1) in the recent studies reported from the east Asia including Japan, in which studied population have undergone an endoscopy for a health check-up or for gastrointestinal symptoms suggestive of EoE [29][30][31][32][33][34][35][36][37].…”

Optimal Biopsy Protocol to Evaluate Histological Effectiveness of Proton Pump Inhibitor Therapy in Patients with Eosinophilic Esophagitis

“…EoE is one of the important pathogenic factors associated with proton pump inhibitor (PPI) refractory gastroesophageal reflux disease [7]. EoE prevalence has been increasing in Western [6] as well as Asian countries including Japan [8][9][10][11][12][13]. EoE diagnosis is based on histological examination of biopsy specimens for peak eosinophil count, defined as the maximum number of eosinophils in an area of high-density intraepithelial infiltration.…”