Esophageal Intraepithelial Eosinophils in Dysphagic Patients with Gastroesophageal Reflux Disease

Ayazi, Shahin; Hagen, Jeffrey A.; Chandrasoma, Parakrama; Gholami, Parviz; Zehetner, Joerg; Oezcelik, Arzu; Lipham, John C.; DeMeester, Steven R.; DeMeester, Tom R.; Kline, Michael M.

doi:10.1007/s10620-009-1067-y

Cited by 3 publications

(2 citation statements)

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“…In GERD patients with unexplained dysphagia, Ayazi et al, found that the number of intraepithelial eosinophils correlated with dysphagia severity. Eosinophils secrete products which antagonize muscarinic M2 receptors and cause vagal dysregulation and decreased esophageal muscle contractility, and this may be the probable mechanism of dysphagia in GERD patients [ 30 ]. In achalasia patients, neurotoxic secretory products released from eosinophils in the epithelium and the myenteric plexus may play a role in disease pathogenesis [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease

et al. 2021

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: Achalasia, a rare primary esophageal motility disorder, is often misdiagnosed as refractory gastroesophageal reflux disease (GERD). This study is aimed to identify the clinical and histopathologic features that may help to differentiate these two entities. Patients with untreated achalasia and those with refractory reflux symptoms despite ≥8 weeks of proton-pump inhibitor treatment were enrolled prospectively. All patients underwent validated symptom questionnaires, esophagogastroduodenoscopy with biopsy, and high-resolution impedance manometry (HRIM). Histopathology of esophageal mucosa was compared based on four pre-determined histological criteria: basal cell hyperplasia or papillae elongation, eosinophilic infiltration, petechiae formation, and hypertrophy of the muscularis mucosae (MM). Compared with the GERD patients, patients with achalasia had similar reflux symptoms, but higher Eckardt scores, fewer erosive esophagitis and hiatal hernia, more esophageal food retention on endoscopy, and higher prevalence of hypertrophy of the MM and petechiae formation on histopathology. Multivariate logistic regression based on Eckardt score ≥4, normal esophagogastric junction morphology or esophageal food retention, and coexistence of petechiae formation and hypertrophy of the MM, established the best prediction model for achalasia. Therefore, combination of routinely accessible variables, including Eckardt score, endoscopic features, and histopathology obtained via esophageal mucosal biopsy, may provide an earlier identification of achalasia.

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Section: Discussionmentioning

confidence: 99%

Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease

et al. 2021

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“…Recently Ayazi et al [12] from the famous DeMeester group in Los Angeles demonstrated a positive association between dysphagia and an increased number of intraepithelial eosinophils within biopsies obtained from GERD patients. Eosinophils represent a major source of pro-in- flammatory chemokines and growth factors, which may affect sensation and transport function of the esophagus [6].…”

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confidence: 99%

Respond as reflux dials CDX 2

Riegler

2010

Eur Surg

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Mucosal neuroimmune mechanisms in gastro-oesophageal reflux disease (GORD) pathogenesis

Leech,

Peiris

2024

J Gastroenterol

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Gastro-oesophageal reflux disease (GORD) is a chronic condition characterised by visceral pain in the distal oesophagus. The current first-line treatment for GORD is proton pump inhibitors (PPIs), however, PPIs are ineffective in a large cohort of patients and long-term use may have adverse effects. Emerging evidence suggests that nerve fibre number and location are likely to play interrelated roles in nociception in the oesophagus of GORD patients. Simultaneously, alterations in cells of the oesophageal mucosa, namely epithelial cells, mast cells, dendritic cells, and T lymphocytes, have been a focus of GORD research for several years. The oesophagus of GORD patients exhibits both macro- and micro-inflammation as a response to chronic acidic reflux at the epithelium. In other conditions of the GI tract, such as IBS and IBD, well-characterised bidirectional processes between immune cells and mucosal nerve fibres contribute to pathogenesis and symptom generation. Sensory alterations in these conditions such as nerve fibre outgrowth and hypersensitivity can be driven by inflammatory processes, which promote visceral pain signalling. This review will examine what is currently known of the molecular pathways linking inflammation and sensory perception leading to the development of GORD symptoms and explore potentially relevant mechanisms in other GI regions which may indicate new areas in GORD research.

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Esophageal Intraepithelial Eosinophils in Dysphagic Patients with Gastroesophageal Reflux Disease

Abstract: An association exists between the number of intraepithelial eosinophils and dysphagia in GERD patients, with the highest number of eosinophils in those with the primary symptom of dysphagia.

Cited by 3 publications

References 18 publications

Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease

Combination of Symptom Profile, Endoscopic Findings, and Esophageal Mucosal Histopathology Helps to Differentiate Achalasia from Refractory Gastroesophageal Reflux Disease

Respond as reflux dials CDX 2

Mucosal neuroimmune mechanisms in gastro-oesophageal reflux disease (GORD) pathogenesis

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