Spontaneous circumferential esophageal dissection in a young man with eosinophilic esophagitis

Quiroga, Jorge; Prim, Jose Maria Garcia; Moldes, Milagros; Ledo, Ramiro

doi:10.1510/icvts.2009.208975

Cited by 18 publications

(17 citation statements)

References 10 publications

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“…15) Upon further review of the literature, we identified two recent reports linking eosinophilic esophagitis to esophageal dissections. 9,14) In both reports, the dissection was circumferential and associated with complications: perforation in one report and abscess formation in the other. To our knowledge, this is the first documented case of a noncircumferential esophageal dissection observed in a patient with eosinophilic esophagitis.…”

Section: Discussionmentioning

confidence: 99%

“…Management options for eosinophilic esophagitis involve diet restriction, medical management (systemic or inhaled corticosteroids, leukotriene receptor antagonists, proton pump inhibitors, and monoclonal antibodies), and endoscopic dilation when necessary. 9) Most patients respond well to treatment, and do not develop life threatening complications. Although uncommon, it is hypothesized that chronic eosinophilic infiltration may result in a friable esophageal mucosa and fragile wall which allows superficial lacerations to secondarily propagate into deeper esophageal layers resulting in dissection.…”

Section: Discussionmentioning

confidence: 99%

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Intramural Esophageal Dissection in a Young Man with Eosinophilic Esophagitis

Predina

Anolik

Judy

et al. 2012

ATCS

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Intramural esophageal dissection is a rare disorder that should be considered in patients presenting with chest pain, dysphagia, and hematemesis. Although most commonly occurring in elderly women with impaired coagulation, esophageal dissection has also been observed in other demographics including in those with eosinophilic esophagitis. In our report, we present the case of a 19-year-old man who was found to have an intramural esophageal dissection in the setting of undiagnosed eosinophilic esophagitis. There have been multiple, proposed management strategies; however, we implemented a nonoperative approach and obtained successful results. Intramural esophageal dissection is an important diagnosis for thoracic surgeons to be aware of as these patients often present as surgical emergencies, but often do not require an acute surgical intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Intramural Esophageal Dissection in a Young Man with Eosinophilic Esophagitis

Predina

Anolik

Judy

et al. 2012

ATCS

View full text Add to dashboard Cite

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“…146,[152][153][154][155][156][157][158][159] Five postendoscopy perforations without preceding esophageal dilation were partial tears. [160][161][162] Of the 19 perforations reported, 7 patients required surgical intervention (ie, 4 primary repairs and 3 esophageal resections).…”

Section: Disease Complications Update Of 2007 Recommendationsmentioning

confidence: 99%

Eosinophilic esophagitis: Updated consensus recommendations for children and adults

Liacouras¹,

Furuta²,

Hirano³

et al. 2011

Journal of Allergy and Clinical Immunology

1,849

2,393

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Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.

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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 49 reported the remaining three perforations, but it is unclear what intervention or clinical scenario precipitated them. There were no deaths reported in the literature from oesophageal perforations suffered in EoO patients.…”

Section: Safety and Potential Complicationsmentioning

confidence: 99%

“…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 …”

mentioning

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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Spontaneous circumferential esophageal dissection in a young man with eosinophilic esophagitis

Cited by 18 publications

References 10 publications

Intramural Esophageal Dissection in a Young Man with Eosinophilic Esophagitis

Intramural Esophageal Dissection in a Young Man with Eosinophilic Esophagitis

Eosinophilic esophagitis: Updated consensus recommendations for children and adults

Review article: oesophageal dilation in adults with eosinophilic oesophagitis

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