Localized esophageal eosinophilia: Is it an early manifestation of eosinophilic esophagitis or a subtype of gastroesophageal reflux disease?

Abstract

Esophageal eosinophilia can be localized in a small area, especially above the esophagogastric junction. Gastric acid reflux or contact may influence this condition in addition to its allergic pathogenesis.

A prospective open clinical trial of a proton pump inhibitor, elimination diet and/or budesonide for eosinophilic oesophagitis

“…We also speculate that the lower oesophagus is most important in initiating a recurrence of eosinophilia to trigger foods, possibly due to increased exposure to food antigens due to reflux of gastric contents, in a time‐dependent manner. The effect of gastric refluxate in causing lower oesophageal eosinophilia, possibly by influencing barrier integrity, has been proposed previously and warrants further study …”

Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors

“…Patients were divided into two groups based on endoscopic findings of esophageal eosinophilia regardless of histological eosinophilic distribution in the esophagus as described in the previous report: (1) rings defined as a corrugated appearance or as trachealization; (2) white plaques which appeared as punctate white nodules, dispersant flocculant material, or in a granular pattern; (3) linear furrows representative of mucosal edema and thickening with vertical lines along the length of the esophageal mucosa; and (4) strictures 7 . LEoE was defined as having any of these findings in any one-third of the esophagus: upper, middle, and lower ( Fig.…”

“…EoE often has characteristic endoscopic findings, such as linear furrows, rings, white exudates, and strictures 6 . Although these findings are usually found distributed throughout the entire esophagus, Abe et al reported some cases of EoE with endoscopic findings localized to a small part of the esophagus, especially above the esophagogastric junction (EGJ) 7 . The authors suggested that gastric acid reflux might be involved with this type of esophageal eosinophilia.…”

Diagnosis and treatment of eosinophilic esophagitis in clinical practice

“…In some case, most of whom have no symptom, these endoscopic abnormalities is localized in a narrow area just above the esophagogastric junction ( Fig. 6) [37,40]. According to a meta-analysis conducted by Kim et al consisting primarily of retrospective studies involving adult cohorts, the overall pooled prevalence of endoscopic findings in patients with EoE was 44% rings, 21% strictures, 9% narrow caliber esophagus, 48% linear furrows, 27% white exudates, and 41% decreased vascularity, with a wide variation in the prevalence of those endoscopic findings between each report.…”