Clinical presentation and endoscopic findings in adult patients with eosinophilic esophagitis
Eosinophilic esophagitis in adults
Keywords:
Eosinophilic esophagitis, Endoscopic examination, Histopathological examination, Eosinophil countAbstract
Background/Aim: The frequency of eosinophilic esophagitis has been rising over the last decades. It is diagnosed primarily based on symptoms and endoscopic and histopathological examination findings. Although eosinophilic esophagitis is not associated with malignancy, it remains an important condition affecting both children and adults, as it is associated with morbidity such as dysphagia, food impaction, and esophageal strictures. This study aimed to define clinical and endoscopic characteristics of adult patients diagnosed with eosinophilic esophagitis based on recently recommended histopathological criteria.
Methods: This retrospective cross-sectional descriptive study included 54 adult patients (mean age: 33.6 yr, range: 16–61 yr) who underwent upper gastrointestinal system endoscopy for dyspeptic complaints (epigastric pain, reflux, dysphagia, or food impaction) and diagnosed with eosinophilic esophagitis based on the latest histopathological criteria (≥15 eosinophils per high-power field). Patients with a history of malignancy were excluded. Patients’ clinical, endoscopic, and histopathological data were examined.
Results: In patients diagnosed with eosinophilic esophagitis, the most common presenting complaint was dysphagia (61.1%), followed by dyspepsia (24.0%), regurgitation (16.6%), chest pain (16.6%), epigastric pain (12.9%), food impaction (11.1%), and halitosis (3.7%), without any age predilection for the complaints. White papules and linear furrow were the most frequent findings on endoscopic examination (35.1% each), followed by circular rings (24.0%), paleness (22.2%), normal endoscopic finding (20.3%), and small-caliber esophagus (11.1%).
Conclusion: The diagnosis of eosinophilic esophagitis remains challenging due to considerable variations in definitions and in the relative frequencies of endoscopic findings. Therefore, we recommend combining clinical, endoscopic, and histologic criteria to establish diagnosis. The identification of standards for diagnosis in future studies is warranted.
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Landres RT, Kuster GG, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978;74(6):1298-301. DOI: https://doi.org/10.1016/0016-5085(78)90710-2
Lucendo AJ, Molina-Infante J, Arias A, von Arnim U, Bredenoord AJ, Bussmann C, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017;5(3):335-58. doi: 10.1177/2050640616689525. DOI: https://doi.org/10.1177/2050640616689525
Rothenberg ME, Mishra A, Collins MH, Putnam PE. Pathogenesis and clinical features of eosinophilic esophagitis. J Allergy Clin Immunol. 2001;108(6):891-4. doi: 10.1067/mai.2001.120095. DOI: https://doi.org/10.1067/mai.2001.120095
Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol. 2002;109(2):363-8. DOI: https://doi.org/10.1067/mai.2002.121458
Simon D, Marti H, Heer P, Simon HU, Braathen LR, Straumann A. Eosinophilic esophagitis is frequently associated with IgE-mediated allergic airway diseases. J Allergy Clin Immunol. 2005;115(5):1090-2. doi: 10.1016/j.jaci.2005.01.017. DOI: https://doi.org/10.1016/j.jaci.2005.01.017
Surdea-Blaga T, Popovici E, Fadgyas Stanculete M, Dumitrascu DL, Scarpignato C. Eosinophilic Esophagitis: Diagnosis and Current Management. J Gastrointestin Liver Dis. 2020;29(1):85-97. doi: 10.15403/jgld-768. DOI: https://doi.org/10.15403/jgld-768
Katzka DA. Eosinophilic Esophagitis. Ann Intern Med. 2020;172(9):ITC65-ITC80. doi: 10.7326/AITC202005050. DOI: https://doi.org/10.7326/AITC202005050
Straumann A, Simon HU. Eosinophilic esophagitis: escalating epidemiology? J Allergy Clin Immunol. 2005;115(2):418-9. doi: 10.1016/j.jaci.2004.11.006. DOI: https://doi.org/10.1016/j.jaci.2004.11.006
Prasad GA, Alexander JA, Schleck CD, Zinsmeister AR, Smyrk TC, Elias RM, et al. Epidemiology of eosinophilic esophagitis over three decades in Olmsted County, Minnesota. Clin Gastroenterol Hepatol. 2009;7(10):1055-61. doi: 10.1016/j.cgh.2009.06.023. DOI: https://doi.org/10.1016/j.cgh.2009.06.023
Veerappan GR, Perry JL, Duncan TJ, Baker TP, Maydonovitch C, Lake JM, et al. Prevalence of eosinophilic esophagitis in an adult population undergoing upper endoscopy: a prospective study. Clin Gastroenterol Hepatol. 2009;7(4):420-6, 6 e1-2. doi: 10.1016/j.cgh.2008.10.009. DOI: https://doi.org/10.1016/j.cgh.2008.10.009
Navarro P, Arias A, Arias-Gonzalez L, Laserna-Mendieta EJ, Ruiz-Ponce M, Lucendo AJ. Systematic review with meta-analysis: the growing incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther. 2019;49(9):1116-25. doi: 10.1111/apt.15231. DOI: https://doi.org/10.1111/apt.15231
Watts MM, Saltoun C, Greenberger PA. Eosinophilic esophagitis. Allergy Asthma Proc. 2019;40(6):462-4. doi: 10.2500/aap.2019.40.4272. DOI: https://doi.org/10.2500/aap.2019.40.4272
Aceves SS. Eosinophilic Esophagitis. Immunol Allergy Clin North Am. 2015;35(1):145-59. doi: 10.1016/j.iac.2014.09.007. DOI: https://doi.org/10.1016/j.iac.2014.09.007
Wilson JM, McGowan EC. Diagnosis and Management of Eosinophilic Esophagitis. Immunol Allergy Clin North Am. 2018;38(1):125-39. doi: 10.1016/j.iac.2017.09.010. DOI: https://doi.org/10.1016/j.iac.2017.09.010
Potter JW, Saeian K, Staff D, Massey BT, Komorowski RA, Shaker R, et al. Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gastrointest Endosc. 2004;59(3):355-61. DOI: https://doi.org/10.1016/S0016-5107(03)02713-5
Croese J, Fairley SK, Masson JW, Chong AK, Whitaker DA, Kanowski PA, et al. Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc. 2003;58(4):516-22. DOI: https://doi.org/10.1067/S0016-5107(03)01870-4
Remedios M, Campbell C, Jones DM, Kerlin P. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointest Endosc. 2006;63(1):3-12. doi: 10.1016/j.gie.2005.07.049. DOI: https://doi.org/10.1016/j.gie.2005.07.049
Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133(4):1342-63. doi: 10.1053/j.gastro.2007.08.017. DOI: https://doi.org/10.1053/j.gastro.2007.08.017
Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108(5):679-92; quiz 93. doi: 10.1038/ajg.2013.71. DOI: https://doi.org/10.1038/ajg.2013.71
Gomez-Aldana A, Jaramillo-Santos M, Delgado A, Jaramillo C, Luquez-Mindiola A. Eosinophilic esophagitis: Current concepts in diagnosis and treatment. World J Gastroenterol. 2019;25(32):4598-613. doi: 10.3748/wjg.v25.i32.4598. DOI: https://doi.org/10.3748/wjg.v25.i32.4598
Arsie E, Cantu P, Penagini R. The role of endoscopy in eosinophilic esophagitis: from diagnosis to therapy. Minerva Gastroenterol (Torino). 2022;68(1):9-22. doi: 10.23736/S2724-5985.20.02786-5. DOI: https://doi.org/10.23736/S2724-5985.20.02786-5
Fiocca R, Mastracci L, Milione M, Parente P, Savarino V. Microscopic esophagitis and Barrett's esophagus: the histology report. Dig Liver Dis. 2011;43 Suppl 4:S319-30. doi: 10.1016/S1590-8658(11)60588-4. DOI: https://doi.org/10.1016/S1590-8658(11)60588-4
Dixon MF, Genta RM, Yardley JH, Correa P. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20(10):1161-81. DOI: https://doi.org/10.1097/00000478-199610000-00001
Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, Bonis PA, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128(1):3-20. doi: 10.1016/j.jaci.2011.02.040. DOI: https://doi.org/10.1016/j.jaci.2011.04.016
Cengiz C. Serum eosinophilic cationic protein is correlated with food impaction and endoscopic severity in eosinophilic esophagitis. Turk J Gastroenterol. 2019;30(4):345-9. doi: 10.5152/tjg.2019.18529. DOI: https://doi.org/10.5152/tjg.2019.18529
Kinoshita Y, Ishimura N, Oshima N, Ishihara S. Systematic review: Eosinophilic esophagitis in Asian countries. World J Gastroenterol. 2015;21(27):8433-40. doi: 10.3748/wjg.v21.i27.8433. DOI: https://doi.org/10.3748/wjg.v21.i27.8433
Soubra M, Assouline-Dayan Y, Schey R. The epidemiology of eosinophilic esophagitis: an ongoing enigma. Isr Med Assoc J. 2015;17(4):239-44.
Hirano I, Chan ES, Rank MA, Sharaf RN, Stollman NH, Stukus DR, et al. AGA Institute and the Joint Task Force on Allergy-Immunology Practice Parameters Clinical Guidelines for the Management of Eosinophilic Esophagitis. Gastroenterology. 2020;158(6):1776-86. doi: 10.1053/j.gastro.2020.02.038. DOI: https://doi.org/10.1053/j.gastro.2020.03.069
Carr S, Chan ES, Watson W. Correction to: Eosinophilic esophagitis. Allergy Asthma Clin Immunol. 2019;15:22. doi: 10.1186/s13223-019-0336-3. DOI: https://doi.org/10.1186/s13223-019-0336-3
Kinoshita Y, Furuta K, Ishimaura N, Ishihara S, Sato S, Maruyama R, et al. Clinical characteristics of Japanese patients with eosinophilic esophagitis and eosinophilic gastroenteritis. J Gastroenterol. 2013;48(3):333-9. doi: 10.1007/s00535-012-0640-x. DOI: https://doi.org/10.1007/s00535-012-0640-x
De la Cruz-Patino E, Ruiz Juarez I, Meixueiro Daza A, Grube Pagola P, Roesch-Dietlen F, Remes-Troche JM. Eosinophilic esophagitis prevalence in an adult population undergoing upper endoscopy in southeastern Mexico. Dis Esophagus. 2015;28:524-9. doi: 10.1111/dote.12238. DOI: https://doi.org/10.1111/dote.12238
Altun R, Akbas E, Yildirim AE, Ocal S, Korkmaz M, Selcuk H. Frequency of eosinophilic esophagitis in patients with esophageal symptoms: a single-center Turkish experience. Dis Esophagus. 2013;26(8):776-81. doi: 10.1111/j.1442-2050.2012.01395.x. DOI: https://doi.org/10.1111/j.1442-2050.2012.01395.x
Sperry SL, Crockett SD, Miller CB, Shaheen NJ, Dellon ES. Esophageal foreign-body impactions: epidemiology, time trends, and the impact of the increasing prevalence of eosinophilic esophagitis. Gastrointest Endosc. 2011;74(5):985-91. doi: 10.1016/j.gie.2011.06.029. DOI: https://doi.org/10.1016/j.gie.2011.06.029
Desai TK, Stecevic V, Chang CH, Goldstein NS, Badizadegan K, Furuta GT. Association of eosinophilic inflammation with esophageal food impaction in adults. Gastrointest Endosc. 2005;61(7):795-801. DOI: https://doi.org/10.1016/S0016-5107(05)00313-5
Pasha SF, DiBaise JK, Kim HJ, De Petris G, Crowell MD, Fleischer DE, et al. Patient characteristics, clinical, endoscopic, and histologic findings in adult eosinophilic esophagitis: a case series and systematic review of the medical literature. Dis Esophagus. 2007;20(4):311-9. doi: 10.1111/j.1442-2050.2007.00721.x. DOI: https://doi.org/10.1111/j.1442-2050.2007.00721.x
Ma X, Xu Q, Zheng Y, Zhao Y, Lu J, Wang R, et al. Prevalence of Esophageal Eosinophilia and Eosinophilic Esophagitis in Adults: A Population-Based Endoscopic Study in Shanghai, China. Dig Dis Sci. 2015;60:1716-23. doi: 10.1007/s10620-014-3512-9. DOI: https://doi.org/10.1007/s10620-014-3512-9
Gonsalves NP, Aceves SS. Diagnosis and treatment of eosinophilic esophagitis. J Allergy Clin Immunol. 2020;145(1):1-7. doi: 10.1016/j.jaci.2019.11.011. DOI: https://doi.org/10.1016/j.jaci.2019.11.011
Muller M, Eckardt AJ, Fisseler-Eckhoff A, Haas S, Gockel I, Wehrmann T. Endoscopic findings in patients with Schatzki rings: evidence for an association with eosinophilic esophagitis. World J Gastroenterol. 2012;18(47):6960-6. doi: 10.3748/wjg.v18.i47.6960. DOI: https://doi.org/10.3748/wjg.v18.i47.6960
Soylu A, Altintas A, Cakmak S, Poturoglu S, Kaya H, Sevindir I, et al. The coexistence of eosinophilic esophagitis with allergic rhinitis. Eur Rev Med Pharmacol Sci. 2016;20(11):2315-23.
Furuta GT, Katzka DA. Eosinophilic Esophagitis. N Engl J Med. 2015;373(17):1640-8. doi: 10.1056/NEJMra1502863. DOI: https://doi.org/10.1056/NEJMra1502863
Katzka DA. Recent advances in understanding/managing eosinophilic esophagitis in adults. F1000Res. 2015;4(F1000 Faculty Rev):592. doi: 10.12688/f1000research.6942.1. DOI: https://doi.org/10.12688/f1000research.6942.1
Ronkainen J, Talley NJ, Aro P, Storskrubb T, Johansson SE, Lind T, et al. Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study. Gut. 2007;56(5):615-20. doi: 10.1136/gut.2006.107714. DOI: https://doi.org/10.1136/gut.2006.107714
Dellon ES, Peery AF, Shaheen NJ, Morgan DR, Hurrell JM, Lash RH, et al. Inverse association of esophageal eosinophilia with Helicobacter pylori based on analysis of a US pathology database. Gastroenterology. 2011;141(5):1586-92. doi: 10.1053/j.gastro.2011.06.081. DOI: https://doi.org/10.1053/j.gastro.2011.06.081
Zhang L, Duan L, Ding S, Lu J, Jin Z, Cui R, et al. Eosinophilic gastroenteritis: clinical manifestations and morphological characteristics, a retrospective study of 42 patients. Scand J Gastroenterol. 2011;46(9):1074-80. doi: 10.3109/00365521.2011.579998. DOI: https://doi.org/10.3109/00365521.2011.579998
Furuta K, Adachi K, Aimi M, Ishimura N, Sato S, Ishihara S, et al. Case-control study of association of eosinophilic gastrointestinal disorders with Helicobacter pylori infection in Japan. J Clin Biochem Nutr. 2013;53(1):60-2. doi: 10.3164/jcbn.13-15. DOI: https://doi.org/10.3164/jcbn.13-15
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