Subepithelial collagen deposition, profibrogenic cytokine gene expression, and changes after prolonged fluticasone propionate treatment in adult eosinophilic esophagitis: A prospective study

Collagenous gastritis: a morphologic and immunohistochemical study of 40 patients

“…19,27 Fibrosis with subepithelial collagen deposition is also a feature of eosinophilic esophagitis. 28 The prominent lamina propria eosinophilia in many of our patients' biopsies was further rationale for testing the tissue for eotaxin. The absence of appreciably increased eotaxin staining means we are unable to implicate increased eotaxin levels in the pathogenesis of collagenous gastritis.…”

Adult versus pediatric eosinophilic esophagitis: important differences and similarities for the clinician to understand

“…In this context, a direct correlation between endoscopic severity (whitish exudative lesions on the esophageal surface), histological severity (detachment of the most superficial epithelial strata) and the density and activation of eosinophilic inflammatory infiltration has also been reported for adult EoE patients [34]. Moreover, the number of eosinophils in the lamina propria is also higher in EoE patients [56,59], with a count of more than 5 per hpf considered to be an exclusive characteristic of EoE [60]. It is difficult to establish whether eosinophil density in esophageal mucosa varies over time since contradictory information has been reported for children and adults [18,41].…”

“…Eosinophilic infiltration in EoE involves the entire esophagus, but often in a patchy manner, requiring multiple biopsies at different levels for an accurate diagnosis. Various studies have reported that the density of eosinophilic infiltration is similar in the distal and proximal thirds of the esophagus [51] in both pediatric [55] and adult patients [34,41,56]; a good diagnostic strategy thus involves collecting samples from both of these thirds. Comparisons between various studies are difficult since the usual assessment entails counting the number of eosinophils in more densely inflamed fields using a 400× power lens (number per high power field or hpf).…”

“…The most clinically relevant components of this phenomenon are smooth muscle hypertrophy and collagen subepithelial deposition since they can lead to the narrowing of the bronchia and impairment of respiratory function. Fibrous remodeling has been demonstrated in both pediatric [71] and adult EoE patients [56,72]; while it constitutes a reversible phenomenon in the former [59], it tends to persist in the latter [56,72]. In addition to digestive motor disturbances [73], fibrous remodeling also explains the strictures commonly associated with EoE and the obstructive symptoms found in many reported cases.…”

Non-IgE Medicated Food Allergy: Eosinophilic Esophagitis Update on the Pathogenesis, Clinical Features, and Management of Eosinophilic Esophagitis in Children

“…Both increased smooth muscle contraction and decreased smooth muscle relaxation were independent of eosinophilia, and smooth muscle hypertrophy and hyperplasia relied on esophageal mastocytosis [45,46]. With regard to fibrosis, CCL18 has been found to be elevated in EoE [47]. Studies by the Luster laboratory identified CCR8 as the CCL18 receptor, and both were found to be elevated in active EoE biopsies [48].…”