Esophagitis with Eosinophil Infiltration Associated with Congenital Esophageal Atresia and Stenosis

Abstract

Background: The esophagus is physiologically devoid of eosinophils, so their presence would suggest some underlying pathology. The prevalence of eosinophilic esophagitis (EoE) has steadily increased in Western countries. Previous studies have described EoE in association with congenital esophageal atresia (CEA), which is the most common congenital anomaly of the esophagus. However, the association remains unclear. Methods: We performed a retrospective histological analysis examining for eosinophil infiltration in the esophagus of patients with CEA following surgical repair or congenital esophageal stenosis (CES) who underwent esophageal biopsy or surgical resection in our hospital between 2005 and 2012. Results: There were 6 patients with CEA following surgical repair or CES who had eosinophil-dominant infiltration in the esophagus. All had associated allergic disorders, including food allergies in 4. Moreover, all except for one fulfilled the histological criteria of EoE. Impairment of eosinophil infiltration and symptomatic improvement were observed in those treated with a proton pump inhibitor (PPI), either alone or in combination with steroids after esophageal dilatation. Conclusions: These findings suggest that CEA repair or CES in conjunction with allergic conditions and coexisting gastroesophageal reflux disease (GERD) may induce greater esophageal eosinophilic inflammation. In addition, esophageal dilatation followed by PPI treatment, alone or with steroids, may be a therapeutic strategy that can provide symptomatic relief by reducing eosinophilic inflammation in esophageal strictures or GERD associated with CEA or CES.

Eosinophilic esophagitis and esophageal atresia: coincidence or causality?

“…In relation to the clinical presentation, this study found a significantly higher incidence of GERD symptoms, such as vomiting and dysphagia, among patients with EoE compared to those without EoE. 6,18,22 As it is known in EoE, in all series, associated atopy was frequent (Dhaliwal: 50%; Batres: 66%; Gorter: 50%). 3,18,23 A normal endoscopy, linear furrows, edema, and white exudates were described as endoscopic findings.…”

“…3,18,23 A normal endoscopy, linear furrows, edema, and white exudates were described as endoscopic findings. 18,21,22 Multiple biopsies of both the proximal and distal parts of the anastomosis are recommended for EoE diagnosis. 19 In EA, anastomotic stricture occurs in 5-15% of patients, mainly in the first year of life.…”

Food Protein-Induced Non-Immunoglobulin E-Mediated Allergic Colitis in Infants and Older Children: What Cytokines Are Involved?

“…Like the infantile form of FPIAP, these patients presented with rectal bleeding as the major and often only clinical manifestation. Apart from primary eosinophilic gastrointestinal diseases, eosinophil accumulation in the colon is a common feature of a variety of conditions, including inflammatory bowel disease, enteric infections, parasitic manifestations, drug reactions, and vasculitis [23,24,25,26]. …”

Esofagitis eosinofílica y atresia esofágica: ¿casualidad o causalidad?

“…Respecto a la clínica, en este mismo estudio, la incidencia de síntomas de ERGE, como vómitos y disfagia, fue significativamente más alta en pacientes con EEo comparada al grupo sin EEo. 6,18,22 Como es conocido en EEo, en todas las series, fueron frecuentes las condiciones atópicas asociadas (Dhaliwal: 50%; Batres: 66%; Gorter: 50%). 3,18,23 Los hallazgos endoscópicos descritos fueron endoscopía normal, surcos lineales, edema y exudados blanquecinos.…”

“…3,18,23 Los hallazgos endoscópicos descritos fueron endoscopía normal, surcos lineales, edema y exudados blanquecinos. 18,21,22 Para el diagnóstico de EEo, se recomiendan múltiples biopsias, tanto proximal y distal a la anastomosis. 19 En AE, la estenosis de la anastomosis ocurre en 5-15%, principalmente, en el primer año de vida.…”