Contribution of endoscopy in the management of eosinophilic esophagitis

Abstract

Eosinophilic esophagitis (EoE) is a clinicopathological entity characterized by a set of symptoms similar to gastroesophageal reflux disease and eosinophilic infiltration of the esophageal epithelium. EoE is an emerging worldwide disease as documented in many countries. Recent reports indicate that EoE is increasingly diagnosed in both pediatric and adult patients although the epidemiology of this new disease entity remains unclear. It is unclear whether EoE is a new disease or a new classification of an old esophageal disorder. Esophagogastroduodenoscopy (EGD) and biopsies with histological examination of esophageal mucosa are required to establish the diagnosis of EoE, verify response to therapy, assess disease remission, document and dilate strictures and evaluate symptom recurrence of EoE. Repeated endoscopies with biopsies are necessary for monitoring of disease progression and treatment efficacy. EGD has a fundamental role in the diagnosis and management of EoE, forming an essential part of the investigation and follow-up of this condition. EoE is now considered a systemic disorder and not only a local condition with an important immunological background. One of the aims of research in EoE is to study non-invasive markers, such as immune indicators found in plasma, that correlate with local presence of EoE in esophageal tissues. Studies over the next few years will provide new information about diagnosis, pathogenesis, endoscopic/histologic criteria, non-invasive markers, novel and more efficacious treatments, as well as establishing natural history. Randomized clinical trials are urgently called for to inform non-invasive diagnostic tests, hallmarks of natural history and more efficacious treatment approaches for patients with EoE. The collaboration between pediatric and adult clinical and experimental studies will be paramount in the understanding and management of this disease.

Esophageal dilations in eosinophilic esophagitis: A single center experience

“…EoE has been documented in most racial groups, although many studies have reported predominance in Caucasian males [22] . The prevalence of EoE in an outpatient population undergoing upper endoscopy was reported 0.4%-0.5% [23] , but EoE was found in 12% of …”

Der besondere Fall - „Bockwurst-Denny ist wieder da!”

“…Beschrieben werden auch eine "Krepppapier-Schleimhaut", eine erhöhte Vulnerabilität der Ösophagusschleimhaut mit Auftreten von longitudinalen Schleimhauteinrissen während der Endoskopie und Schatzki-Ringe. Weitere histologische Befunde neben der erhöhten Eosinophilenzahl sind das Vorkommen eosinophiler Mikroabszesse, eosinophile Degranulation, oberflächliche Verteilung der Eosinophilen und Hyperplasie der epithelialen Basalzone [1,4,7]. Optimal ist es, wenn die Biopsien nach 4-wöchiger Vorbehandlung mit einem Protonenpumpeninhibitor (PPI) entnommen werden, da auch bei GERD im distalen Ösophagus ein eosinophiles Entzündungsinfiltrat auftreten kann.…”

“…Auch bei Fehlen typischer endoskopischer Befunde sollten Proben aus der normalen Schleimhaut entnommen werden. Sinnvoll sind mindestens 5 Biopsien aus mehreren Ösophagusabschnitten [3,4,7]. Zusätzliche Biopsien aus Magen und Duodenum zielen auf die mögliche Diagnose eines Morbus Crohn oder einer eosinophilen Gastroenteritis [3,4].…”

“…Die Behandlung beruht auf den 3 "D": Diät, Drugs (Medikamente) und Dilatation [3][4][5]7]. Der positive Effekt einer Eliminationsdiät (beruhend z.…”

Systematic review of histological remission criteria in eosinophilic esophagitis

“…In children, commonly reported symptoms include feeding difficulties, vomiting, and failure to thrive 4, 5, 6, 7, 8, 9, 10, 11. Among the adolescent and adult populations with EoE, dysphagia, vomiting, and chest pain are the common presenting symptoms.…”