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Eosinophilic Oesophagitis (eosinophilic + oesophagitis)
Selected AbstractsEosinophilic oesophagitis is common: a difficult message to swallow?INTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2008S. E. Attwood No abstract is available for this article. [source] The pharyngeal mucosa is not involved in eosinophilic oesophagitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009M. BOVE Summary Background, Eosinophilic oesophagitis is thought to be an isolated oesophageal disease associated with biopsy-verified eosinophilia of the squamous cell epithelium of the oesophagus. Food- or aeroallergens have been suggested to be the cause of eosinophilic oesophagitis; however, as these allergens pass through the pharynx sharing the same squamous cell epithelium, eosinophilic infiltration could be expected also here. Whether this is true or not has hitherto not been clarified. Aim, To find out whether eosinophilia is present also within the pharyngeal epithelium in patients with eosinophilic oesophagitis. Methods, In all, 10 patients (median age 34, range 15,70) with biopsy-verified eosinophilic oesophagitis [peak count >20 eosinophils per high power field (hpf)] were biopsied also in the pharynx. The biopsies underwent histopathological examination and at each level, the peak number of eosinophils per hpf was counted. Results, None of the patients examined was found to have eosinophilia within the squamous cell epithelium of the pharynx (median peak count 0, range 0,1). Conclusions, The pronounced eosinophilic infiltration in eosinophilic oesophagitis appears to be an isolated oesophageal phenomenon not shared by the adjoining organ sites and in particular, not by the pharynx. This may have implications for future research. [source] Eosinophilic oesophagitis and coeliac disease: is there an association?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2007L. QUAGLIETTA Aim, To report a series of 17 children affected by eosinophilic oesophagitis. Six of them also received a diagnosis of coeliac disease. Methods, Seventeen children with history of dyspeptic symptoms were investigated. Results, Six patients (M/F:2/4; mean age ± s.d.: 5.6 ± 1.3 years, range: 4,7 years; Group A) affected by eosinophilic oesophagitis also received a diagnosis of coeliac disease. The other 11 children (M/F:10/1, mean age ± s.d.:7.5 ± 2.3 years, range: 4,10 years, Group B) were affected solely by eosinophilic oesophagitis. All children underwent a change in dietary regimen. Group A received a gluten-free diet. Group B attempted dietary restriction based on the allergy testing results. After 6 months follow-up, all patients in Group A showed a complete disappearance of symptoms and three of them, who underwent upper gastrointestinal endoscopy, showed histologic remission. Patients from Group B had moderate clinical improvement and in seven of them (64%) a repeated upper gastrointestinal endoscopy showed a statistically significant reduction in eosinophilic infiltration. Conclusions, This is the first reported group of patients with an association between coeliac disease and eosinophilic oesophagitis. To date, it is not possible to exclude that in a subgroup of children with coeliac disease the oesophageal eosinophilic infiltration could be caused by coeliac disease itself. [source] Eosinophilic oesophagitis in adultsNEUROGASTROENTEROLOGY & MOTILITY, Issue 10 2009N. Gonsalves Abstract, Previously considered a rare condition, eosinophilic oesophagitis (EoE) has become increasingly recognized as an important cause of dysphagia and food impactions in adults. This is likely attributable to a combination of an increasing incidence of EoE and a growing awareness of the condition. EoE may occur in isolation or in conjunction with eosinophilic gastroenteritis. However, the burgeoning field is likely attributable to the variant that uniquely affects the oesophagus. Adults classically present with symptoms of dysphagia, food impactions, and heartburn. Typical endoscopic features include concentric mucosal rings, linear furrowing, white plaques or exudates and a narrow caliber oesophagus. In some cases, the endoscopic features may appear normal. For years, EoE went unrecognized because eosinophilic infiltration was accepted as a manifestation of reflux, which continues to be a confounding factor in some patients. Current consensus is that the diagnosis of EoE is established by 1) the presence of symptoms, especially dysphagia and food impactions in adults, 2) ,15 eosinophils per high power field in oesophageal tissue, and 3) exclusion of other disorders with similar presentations such as GERD. Current understanding of EoE pathophysiology and natural history are limited but the entity has been increasingly linked to food allergies and aeroallergens. The main treatment options for EoE are proton pump inhibitors, dietary manipulation, and topical or oral glucocorticoids. This review highlights recent insights into EoE in adults although, clearly, much of the available data overlap with pediatrics and, occasionally, with eosinophilic gastroenteritis. [source] Interleukin-13 directly promotes oesophagus production of CCL11 and CCL24 and the migration of eosinophilsCLINICAL & EXPERIMENTAL ALLERGY, Issue 3 2010C. V. Neilsen Summary Background Eosinophilic oesophagitis (EE) is a clinico-pathologically defined oesophageal disorder that is characterized by eosinophil migration into oesophageal tissues. There is growing support for EE being an allergic disease and for a contribution of T-helper type 2 (Th2)-associated cytokines in disease pathogenesis. The respiratory system has been shown to be critical in driving the development of EE in animal models. However, the mechanisms underlying the recruitment of eosinophils into the oesophagus remain unclear. Objective We sought to investigate the influence of Th2-associated cytokines on the production of eosinophil-specific chemokines from the oesophagus directly. Methods In order to eliminate the potential involvement of the lung, we utilized isolated oesophageal rings. These were treated in vitro with IL-4 or IL-13 and the expression and production of CCL11 and CCL24 were determined. Results Our data demonstrate that IL-13 is a potent and direct inducer of both CCL11 and CCL24 production from the oesophagus, as is IL-4 also. The expression of CCL11 precedes CCL24 by several hours but then diminishes over time, as well as at high concentrations of IL-13. We demonstrate that there is an up-regulation of the inhibitory IL-13 receptor, IL-13R,2 but that IL-13R,1 remains unaltered. Oesophagus rings isolated from STAT6,/, mice were unable to produce CCL11 or CCL24 upon IL-13 treatment. Lastly, we demonstrate that oesophageal production of CCL11 and CCL24 upon IL-13 stimulation is sufficient to promote eosinophil migration. Conclusions IL-13 is capable of directly stimulating oesophageal tissue to produce eosinophil-attracting chemokines and drive eosinophil migration. Cite this as: C. V. Neilsen and P. J. Bryce, Clinical & Experimental Allergy, 2010 (40) 427,434. [source] Eosinophilic oesophagitis and pollenCLINICAL & EXPERIMENTAL ALLERGY, Issue 11 2005J. M. Spergel No abstract is available for this article. [source] Systematic review: the epidemiology of eosinophilic oesophagitis in adultsALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2010R. J. Sealock Summary Background, The epidemiology of eosinophilic oesophagitis (EoE) in adults remains unclear. Aim, To estimate the prevalence and incidence of EoE through a systematic review of published literature. Methods, We conducted systematic literature searches in PubMed in September 2009. Studies were excluded if they contained any participants below 18 years of age, published in languages other than English, or had no exact reporting of prevalence or incidence rates. Results, Nine studies fulfilled the criteria; one evaluated a population-based sample, one examined patients referred from a defined geographical region and seven studies examined the prevalence in a total of 6018 patients in clinic or hospital settings. The lowest prevalence was reported in population-based studies (4 and 0.23 per 1000), followed by studies of unselected patients (1.0%, 6.5%) and highest in the other five clinic/hospital based studies (2.2,48.2%). Men were more affected in seven of eight studies (64.5,100%). The sample size weighted average prevalence from the population-based studies was 0.03%. For studies evaluating symptomatic patients, it was 2.8%. Conclusions, The prevalence of EoE in adults varies considerably based on the study sampling frame: high in dysphagia patients, quite low in population-based studies and intermediate among unselected endoscopy patients. [source] Correlation between eosinophilic oesophagitis and aeroallergensALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 4 2010F. J. MOAWAD Aliment Pharmacol Ther,31, 509,515 Summary Background, Aeroallergens have been implicated in the pathogenesis of eosinophilic oesophagitis. Aim, To determine whether a seasonal variation exists in the diagnoses of eosinophilic oesophagitis and whether there is a correlation with seasonal pollen count. Methods, A retrospective review was performed from January 2006 to November 2008 to identify eosinophilic oesophagitis patients. Cases were classified by endoscopic date. Daily pollen counts for grass, trees and weeds were obtained from a certified counting station. Per cent of eosinophilic oesophagitis cases were collated seasonally and compared with mean pollen counts for grass, trees and weeds during the same time period. Results, A total of 127 eosinophilic oesophagitis cases were identified (median age 41, range 19,92 years, 84% men). The highest percentage of cases (33.0%; Binomial P = 0.022) was diagnosed in the spring, while the least percentage (16%; Binomial P = 0.0.010) occurred in the winter. There was a significant association between per cent eosinophilic oesophagitis cases diagnosed seasonally and mean grass pollen count (rs = 1.000, P < 0.01), but not with trees (rs = 0.400, P = 0.600) or weeds (rs = 0.800, P = 0.200). Conclusions, A seasonal variation was seen in the diagnosis of eosinophilic oesophagitis which correlated with pollen counts. These findings have important implications regarding the pathogenesis of eosinophilic oesophagitis, suggesting a potential role for aeroallergens. [source] Diagnostic yield of oesophagogastroduodenoscopy in children with abdominal painALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 6 2009K. THAKKAR Summary Background, Abdominal pain is the most common indication for oesophagogastroduodenoscopy (OGD) in children. However, existing studies examining the diagnostic outcomes of OGD in children with abdominal pain are limited. Aim, To examine the diagnostic yield of OGD with biopsy in the evaluation of abdominal pain and to describe the endoscopic and histological findings in patients undergoing OGD for abdominal pain of unclear aetiology. Methods, We performed a retrospective cross-sectional cohort study in children under 18 years of age who had OGD for the primary indication of abdominal pain, at Texas Children's Hospital and Children's Hospital of The King's Daughters from 1 January 2002 to 30 June 2005. Results, Overall, OGD was diagnostic in 454 (38.1%) of the 1191 procedures, including reflux oesophagitis (23%, n = 271), Helicobacter pylori infections (5%, n = 55), peptic ulcers (3%, n = 32), eosinophilic oesophagitis (2%, n = 25), celiac disease (1%, n = 9) and Crohn's disease (0.5%, n = 7). Male gender, older age, elevated C-reactive protein and vomiting were associated with increased diagnostic yield. Conclusions, Our findings suggest that OGD is valuable for the evaluation of chronic abdominal pain in children, with a diagnostic yield of 38%. The majority of alarm symptoms and routine laboratory tests are not significantly associated with diagnostic yield. [source] The pharyngeal mucosa is not involved in eosinophilic oesophagitisALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 5 2009M. BOVE Summary Background, Eosinophilic oesophagitis is thought to be an isolated oesophageal disease associated with biopsy-verified eosinophilia of the squamous cell epithelium of the oesophagus. Food- or aeroallergens have been suggested to be the cause of eosinophilic oesophagitis; however, as these allergens pass through the pharynx sharing the same squamous cell epithelium, eosinophilic infiltration could be expected also here. Whether this is true or not has hitherto not been clarified. Aim, To find out whether eosinophilia is present also within the pharyngeal epithelium in patients with eosinophilic oesophagitis. Methods, In all, 10 patients (median age 34, range 15,70) with biopsy-verified eosinophilic oesophagitis [peak count >20 eosinophils per high power field (hpf)] were biopsied also in the pharynx. The biopsies underwent histopathological examination and at each level, the peak number of eosinophils per hpf was counted. Results, None of the patients examined was found to have eosinophilia within the squamous cell epithelium of the pharynx (median peak count 0, range 0,1). Conclusions, The pronounced eosinophilic infiltration in eosinophilic oesophagitis appears to be an isolated oesophageal phenomenon not shared by the adjoining organ sites and in particular, not by the pharynx. This may have implications for future research. [source] Eosinophilic oesophagitis and coeliac disease: is there an association?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2007L. QUAGLIETTA Aim, To report a series of 17 children affected by eosinophilic oesophagitis. Six of them also received a diagnosis of coeliac disease. Methods, Seventeen children with history of dyspeptic symptoms were investigated. Results, Six patients (M/F:2/4; mean age ± s.d.: 5.6 ± 1.3 years, range: 4,7 years; Group A) affected by eosinophilic oesophagitis also received a diagnosis of coeliac disease. The other 11 children (M/F:10/1, mean age ± s.d.:7.5 ± 2.3 years, range: 4,10 years, Group B) were affected solely by eosinophilic oesophagitis. All children underwent a change in dietary regimen. Group A received a gluten-free diet. Group B attempted dietary restriction based on the allergy testing results. After 6 months follow-up, all patients in Group A showed a complete disappearance of symptoms and three of them, who underwent upper gastrointestinal endoscopy, showed histologic remission. Patients from Group B had moderate clinical improvement and in seven of them (64%) a repeated upper gastrointestinal endoscopy showed a statistically significant reduction in eosinophilic infiltration. Conclusions, This is the first reported group of patients with an association between coeliac disease and eosinophilic oesophagitis. To date, it is not possible to exclude that in a subgroup of children with coeliac disease the oesophageal eosinophilic infiltration could be caused by coeliac disease itself. [source] Proton pump inhibitor failure in gastro-oesophageal reflux disease , what about eosinophilic oesophagitis?ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 8 2006S. N. Sgouros No abstract is available for this article. [source] Eosinophilic oesophagitis in adultsNEUROGASTROENTEROLOGY & MOTILITY, Issue 10 2009N. Gonsalves Abstract, Previously considered a rare condition, eosinophilic oesophagitis (EoE) has become increasingly recognized as an important cause of dysphagia and food impactions in adults. This is likely attributable to a combination of an increasing incidence of EoE and a growing awareness of the condition. EoE may occur in isolation or in conjunction with eosinophilic gastroenteritis. However, the burgeoning field is likely attributable to the variant that uniquely affects the oesophagus. Adults classically present with symptoms of dysphagia, food impactions, and heartburn. Typical endoscopic features include concentric mucosal rings, linear furrowing, white plaques or exudates and a narrow caliber oesophagus. In some cases, the endoscopic features may appear normal. For years, EoE went unrecognized because eosinophilic infiltration was accepted as a manifestation of reflux, which continues to be a confounding factor in some patients. Current consensus is that the diagnosis of EoE is established by 1) the presence of symptoms, especially dysphagia and food impactions in adults, 2) ,15 eosinophils per high power field in oesophageal tissue, and 3) exclusion of other disorders with similar presentations such as GERD. Current understanding of EoE pathophysiology and natural history are limited but the entity has been increasingly linked to food allergies and aeroallergens. The main treatment options for EoE are proton pump inhibitors, dietary manipulation, and topical or oral glucocorticoids. This review highlights recent insights into EoE in adults although, clearly, much of the available data overlap with pediatrics and, occasionally, with eosinophilic gastroenteritis. [source] | ||||||||||