Esophageal Rupture in a Patient With Idiopathic Eosinophilic Esophagitis

Riou, P; Nicholson, Andrew G.; Pastorino, Ugo

doi:10.1016/s0003-4975(96)00553-x

Cited by 63 publications

(34 citation statements)

References 4 publications

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“…A trial with corticosteroids before bougienage may reduce the active inflammation and the complication rate [2] . Esophageal perforation is described as a complication [4] and one case was treated with subtotal esophagectomy [6] . Although a spontaneous circumferential mucosal dissection was already described [7] , we are not aware of any other cases associated with eosinophilic esophagitis.…”

Section: Discussionmentioning

confidence: 99%

Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

Liguori

Cortale²,

Cimino³

et al. 2008

WJG

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A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia. The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-desac in the lower part of the esophagus. Soon after the procedure, the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus, and a mediastinal emphysema. An emergency right thoracotomy was performed, followed by a total esophagectomy with esophagogastroplasty and jejunostomy. The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal, submucosal and muscular layers. The diagnosis was esophageal perforation in eosinophilic esophagitis.

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Section: Discussionmentioning

confidence: 99%

Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

Liguori

Cortale²,

Cimino³

et al. 2008

WJG

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“…Four perforations were related to endoscope passage and seven were spontaneous perforations (Boerhaave's syndrome). [45][46][47][48][49][50][51][52][53] Cohen et al …”

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confidence: 99%

Review article: oesophageal dilation in adults with eosinophilic oesophagitis

Bohm

Richter

2011

Alimentary Pharmacology &Amp; Therapeutics

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Alimentary Pharmacology and Therapeutics INTRODUCTIONEosinophilic oesophagitis (EoO) is a chronic inflammatory disorder of the oesophagus characterised by the proton pump inhibitor-refractory accumulation of eosinophils in the oesophageal epithelium [>15 intraepithelial eosinophils ⁄ high powered field (eos ⁄ hpf)] in combination with a range of symptoms including dysphagia, food impaction, chest pain, abdominal pain and vomiting. [1][2][3] The clinical manifestations of EoO vary with age. Nearly all adults complain of solid food dysphagia with many being 'slow eaters' who meticulously chew their food. More than 50% give a history of food impaction.The endoscopic features of EoO suggest a chronic disease with inflammatory features of furrows, microabscesses and plaques seen predominantly in paediatric patients and oesophageal remodelling characterised by the narrow calibre oesophagus, strictures and ring formation more commonly seen in adult EoO patients. Most likely these changes are progressive in nature, but this is a speculation yet to be defined with serial studies from childhood to adulthood. The treatments for these early inflammatory changes are anti-inflammatory medications (swallowed fluticasone, budesonide, prednisone) or restrictive and elemental diets. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] On the other hand, adult EoO patients typically show less active inflammation and more fibrotic changes due to collagen deposition in the epithelium and submucosa. Straumann et al. 19 performed a randomised, double-blind placebocontrolled trial with 36 adults and adolescents treating them with swallowed budesonide for 15 days. On followup oesophagogastroduodenoscopy, the oesophageal eosinophilia and furrowing drastically improved, but the corrugated rings persisted. Oesophageal dilation is often necessary to correct this fixed stenosis, which relieves the solid food dysphagia and alleviates the fear of food impaction, improving quality of life. Potential side effects of too aggressive dilation are concerning, but the longterm relief seems to outweigh these complications. This systematic narrative review will discuss the pathophysiology producing remodelling and strictures, review the available case series, discuss the technique of oesophageal dilation in the management of adult EoO patients and its potential complications. PathophysiologyOesophageal remodelling in EoO patients is a major factor contributing to the clinical complaint of solid food dysphagia. The process begins with an influx of inflammatory cells, especially eosinophils into the mucosa of the oesophagus. Over time, numerous microscopic changes occur including basal cell hyperplasia, elongated rete pegs, smooth muscle hypertrophy ⁄ hyperplasia, and lamina propria ⁄ subepithelial fibrosis. 20 These histopathologic changes are evident on endoscopy as strictures, narrowing and rings and on endoscopic ultrasound as diffuse thickening of all layers of the oesophagus. 21 Most of what we know about the remodelling process in EoO is based u...

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“…The optimal treatment regimen, long-term benefit, and side-effect profile of various management strategies, however, are unknown. There have been reports of esophageal perforation in patients with eosinophilic esophagitis: one spontaneous [35] and one after passage of an endoscope [6]. Even though neither case was the result of esophageal dilatation, these case reports highlight the fragility of the esophagus in this condition.…”

Section: Discussionmentioning

confidence: 91%

Intermittent Dysphagia for Solids Associated with a Multiringed Esophagus: Clinical Features and Response to Dilatation

et al. 2007

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The entity of the multiringed esophagus, generally presenting in adults as intermittent dysphagia for solids, is relatively uncommon and its pathogenesis is unknown. The goal of this study was to describe the demographic, clinical, and endoscopic features of patients presenting with this condition, their response to esophageal dilatation, and the relationship of multiple esophageal rings to eosinophilic esophagitis. Between 1989 and June 2004, 32 patients at this adult hospital fulfilled the following inclusion criteria: (1) intermittent dysphagia for solids, (2) multiple esophageal rings at endoscopy, and (3) esophageal dilatation(s) performed. Response to esophageal dilatation was measured by need for subsequent dilatations. Seventy-five percent of the patients were male. Median age at onset of dysphagia was 21 years and at presentation 36.5 years. All had multiple rings in the proximal or midesophagus on endoscopy and had undergone a total of 73 esophageal dilatations with no esophageal perforations. Median maximal dilator size was 15 mm; however, 16% developed significant esophageal mucosal tears even with 11-mm dilators. Sixty-six percent required repeat dilatation, with the median time interval before recurrence being 8 months. Eosinophilic esophagitis (mucosal eosinophil count > 20/HPF) was present in 50% of this cohort. From this study we conclude that a multiringed esophagus causing intermittent dysphagia occurs predominantly in young males, responds well to dilatation, but repeated dilatations are often necessary. Dilatation can lead to extensive mucosal tears and should be performed with caution. Eosinophilic esophagitis is commonly but not invariably associated with this entity. Frequent relapse of dysphagia highlights the need for effective pharmacotherapy.

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Esophageal Rupture in a Patient With Idiopathic Eosinophilic Esophagitis

Cited by 63 publications

References 4 publications

Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

Review article: oesophageal dilation in adults with eosinophilic oesophagitis

Intermittent Dysphagia for Solids Associated with a Multiringed Esophagus: Clinical Features and Response to Dilatation

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