Helicobacter pylori infection is associated with decreased odds for eosinophilic esophagitis in Mexican patients. / La infección por Helicobacter pylori se asocia con disminución del riesgo de esofagitis eosinofílica en pacientes mexicanos.

BACKGROUND: The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients. PATIENTS AND METHODS: We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning four controls per case. RESULTS: We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs. 70.4%, OR 0.21 95% CI 0.08-0.69, p = 0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs. 50.5% (OR 0.20, 95% CI 0.06-0.69, p < 0.001), particularly allergic rhinitis and food allergy. CONCLUSIONS: We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota, etc.) in order to clarify this relationship.

Impact of Dose Reduction of Topical Steroids to Manage Adrenal Insufficiency in Pediatric Eosinophilic Esophagitis.

OBJECTIVE: To evaluate the impact of type and dose of swallowed topical steroids (STS) and concurrent steroid therapy on the development and resolution of adrenal insufficiency (AI) in pediatric eosinophilic esophagitis (EoE). METHODS: We performed a retrospective case-control study of pediatric EoE subjects in a single tertiary care center, who were treated with STS for at least 3 months and diagnosed with AI based on a peak stimulated cortisol level of <18 µg/dL (500 nmol/L). Steroid forms and doses, and endoscopy data were collected at the time of AI diagnosis and AI resolution or the last known evaluation. Steroid formulations were converted to a fluticasone-equivalent dose for analysis. RESULTS: Thirty-two EoE subjects with AI were identified, and 20 had AI resolution, including 12 who remained on lower dose STS. Eight of the 32 patients were also treated with extended-release budesonide (ER budesonide), which resulted in a 7-fold higher total daily steroid dose, and thus were analyzed separately. When the 24 cases that were not on ER budesonide were compared to the 81 controls, no difference was found in the STS dose nor total daily steroid dose, although the inhaled steroid dose had marginal significance. Peak eosinophil counts tended to increase when STS doses were decreased, except in subjects on ER budesonide at AI diagnosis. CONCLUSION: Altering the total daily steroid regimen can lead to resolution of AI in patients with EoE, though this may come at the expense of disease control.

Seguridad de la endoscopia y biopsia esofágica en un paciente con esofagitis eosinofílica y enfermedad de Von Willebrand / Safety of esophageal endoscopy and biopsy in a patient with eosinophilic esophagitis and Von Willebrand disease

La esofagitis eosinofílica (EoE) es una enfermedad causada por una respuesta inmune frente a antígenos alimentarios en contacto con la mucosa esofágica; por su parte, la enfermedad de Von Willebrand (EVW) es el trastorno hemorrágico hereditario más común en los seres humanos. La característica central de todos los tipos de EVW, es la presencia de cantidades reducidas o de formas anormales del factor de Von Willebrand (FVW) en el torrente sanguíneo. Debido a que no se han reportado casos previos de EVW tipo 2A asociada a EoE, se describe este caso clínico con el objetivo principal de dar a conocer el hallazgo casual de estas dos patologías, la seguridad de la evaluación por endoscopia de vías digestivas altas y el pronóstico de posibles complicaciones

Eosinophilic esophagitis (EoE) is a disease caused by an immune response against food antigens in contact with the esophageal mucosa; alternatively, Von Willebrand disease (VWD) is the most common inherited bleeding disorder in humans. The central characteristic of all types of VWD is the presence of reduced amounts or abnormal forms of VWF in the bloodstream. Since no previous cases of VWD type 2A associated to EoE have been reported, this clinical case is described with the main objective to present the coincidental finding of these two pathologies, the safety of the evaluation by upper gastrointestinal endoscopy, and the prognosis of possible complications

Herpetic Esophagitis and Eosinophilic Esophagitis: A Potential Association.

BACKGROUND Gastroesophageal reflux disease, infectious esophagitis, and eosinophilic esophagitis are the most frequent causes of esophagitis, the latter 2 etiologies being generally considered independently. However, the association between both entities has been suggested through case reports in immunocompetent patients. CASE REPORT We present the case of an immunocompetent 26-year-old man presenting with fever, adynamia, retrosternal pain, and dysphagia. Endoscopy was performed, showing whitish lesions in circular plates with erosions, and in some depressed areas in the middle and distal esophagus. Biopsies showed the presence of ulcerated foci covered by fibrinoleukocyte exudate in granulation tissue and nuclear inclusions with a viral appearance. The immunohistochemical study for herpes simplex virus (HSV) was positive. The patient was treated symptomatically and progressed favorably. The endoscopic control carried out at 3 months showed longitudinal grooves and trachealization, findings compatible with the diagnosis of eosinophilic esophagitis and with biopsies that confirmed the etiology by showing an increase in eosinophil count >20 per field, without isolating HSV. CONCLUSIONS This clinical case confirms the possible relationship between esophagitis caused by HSV and eosinophilic esophagitis. Alterations at the immune level and damage to the esophageal mucosa barrier may explain this relationship. In this scenario, an endoscopic follow-up should be considered.

Hemorragia digestiva alta como complicação de esofagite eosinofílica / Upper gastrointestinal bleeding as a complication of eosinophilic esophagitis

A hemorragia digestiva alta (HDA) é uma condição médica comum, que permanece com uma taxa de mortalidade aproximadamente de 10%. Doenças alérgicas habitualmente não configuram risco para HDA. Entretanto, o aumento recente de doenças alérgicas que afetam cronicamente o trato digestório poderia mudar esse cenário. Este artigo relata um caso de HDA após hematêmese provocada por impactação alimentar. Realizada endoscopia digestiva alta (EDA) e diagnosticada esofagite eosinofílica (EoE), que após tratamento adequado, apresentou melhora dos sintomas. A EoE é uma doença inflamatória crônica esofágica emergente, com aumento do número de casos diagnosticados ao redor do mundo. Atualmente, considera-se a causa mais prevalente de disfagia e impactação alimentar em crianças e adultos jovens. Os sintomas de EoE não são específicos para cada faixa etária, e podem variar desde sintomas mais leves, como sintomas de doença do refluxo gastroesofágico, até disfagia e impactação alimentar. Existe atraso no diagnóstico e tratamento, propiciando um aumento de complicações, cujo risco mais temido seria rotura do esôfago. Revisando a literatura até o presente relato, constatamos que a EoE nunca foi descrita como uma causa de HDA. Além da apresentação incomum da HDA levando ao diagnóstico de EoE, esse caso ressalta a importância do atendimento multidisciplinar e cooperação entre especialidades. Portanto, há necessidade de diagnóstico mais precoce e preciso, buscando ampliar o conhecimento para não negligenciar características específicas da disfagia, e evitar complicações com o tratamento adequado.

Upper gastrointestinal bleeding (UGIB) is a common medical condition whose mortality rate remains at about 10%. Allergic diseases are no usual risk for UGIB. However, the recent increase in allergic diseases that chronically affect the gastrointestinal tract could change this scenario. This article reports a case of UGIB after hematemesis caused by food impaction. Upper gastrointestinal endoscopy was performed and eosinophilic esophagitis (EoE) was diagnosed. EoE is an emerging chronic esophageal inflammatory disease with an increasing number of diagnosed cases around the world. Currently, it is considered the most prevalent cause of dysphagia and food impaction in children and young adults. EoE symptoms are not specific to each age group and may range from mild symptoms such as those of gastroesophageal reflux disease to dysphagia and food impaction. There is a delay in diagnosis and treatment that leads to increased complications, including esophageal rupture, the most feared risk. Our literature review showed that EoE had never been described as a cause of UGIB. In addition to the unusual presentation of UGIB leading to the diagnosis of EoE, this case highlights the importance of multidisciplinary care and cooperation between specialties. Therefore, there is a need for earlier and more accurate diagnosis, which would lead to expanded knowledge that could be used to not disregard specific characteristics of dysphagia and avoid complications with appropriate treatment.

The potential for malignancy from atopic disorders and allergic inflammation: A systematic review and meta-analysis.

OBJECTIVE: While chronic inflammation is a well-established risk factor for malignancy, studies evaluating the relationship between allergic inflammation and cancer have revealed conflicting results. Here, we aimed to assess the association between allergic inflammation in the lung (asthma), skin (eczema) or oesophagus (eosinophilic oesophagitis; EoE) and cancer at the organ site. DESIGN: We conducted a systematic review of the literature to identify observational studies (case-control, cohort and cross-sectional) evaluating the association between asthma and lung cancer, eczema and skin cancer, or EoE and oesophageal cancer. Random-effects meta-analysis was performed to define pooled estimates of effects. DATA SOURCES: PubMed, EMBASE and Web of Science. ELIGIBILITY CRITERIA FOR SELECTION: Included studies evaluated the incidence of cancer. RESULTS: Thirty-two studies met the inclusion criteria, 27 in the lung, four in the skin and one in the oesophagus. Meta-analysis of the three studies with prospective data collection of asthma diagnosis revealed a positive association with incident lung cancer (OR 1.27, 95% CI 1.09-1.44); however, this result was not consistently supported by the larger dataset of retrospective studies (OR 1.37, 95% CI 0.90-1.83). Overall, studies in the lung displayed significant heterogeneity (I2 98%, P < .0001), but no significant effect modification on the association between asthma and lung cancer was identified for the variables of sex, smoking or study design. Meta-analysis could not be applied to the four papers reviewed in the skin, but three suggested an association between eczema and non-melanoma skin cancer, while the remaining study failed to identify an association between melanoma and eczema. A single study meeting inclusion criteria showed no association between EoE and oesophageal malignancy. CONCLUSIONS: The current data cannot exclude the possibility of an association between atopy and malignancy the lung, skin and oesophagus. The relationship between allergy and cancer should be explored further in prospective studies that any association identified between these conditions has the potential for significant public health implications.

Acute dysphagia presentation and its association with esophagitis dissecans and concomitant diseases. A diagnostic challenge.

Esophagitis dissecans (ESD) is an uncommon disease that is associated with eosinophilic esophagitis (EoE), candidiasis and/or drugs. We aim to characterize the clinical, endoscopic and histological damage of the mucosal in subjects with dysphagia, its relation to concomitant entities and the treatment response. This is a retrospective observational study in patients with dysphagia and esophageal mucosal damage We included 23 patients (mean age = 55 years) who had GERD symptoms, dysphagia and/or odynophagia. There were 10, 9 and 4 cases of esophagitis dissecans, desquamative/esfacelante (ESD/ES) and fibrostenotic, respectively. ESD/SE is a rare entity with variable clinical, endoscopic and histological spectrum. The association with GERD was frequent.

La esofagitis disecante (ESD) es una enfermedad rara que puede asociarse a esofagitis eosinofílica, candidiásica o medicamentos. Se analizaron las características clinico-endoscópicas e histopatológicas en sujetos con disfagia de corta evolución asociada a afecciones concurrentes. Estudio observacional de cohorte retrospectiva con disfagia y daño mucoso. Se ingresaron 23 pacientes con edad media de 55 años. Todos tuvieron síntomas de reflujo gastroesofágico (ERGE), disfagia y odinofagia. Fueron 10, 9 y 4 casos de ESD, descamativa/esfacelante (ESD/ES) y fibroestenosis, respectivamente. La ESD/SE es una afección rara, con un espectro clínico, endoscópico e histológico variable.

Helicobacter pylori infection does not protect against eosinophilic esophagitis: results from a large multicenter case-control study.

OBJECTIVES: Rising trends in eosinophilic esophagitis (EoE) have been repeatedly linked to declining Helicobacter pylori (H. pylori) infection, mostly in retrospective studies. We aimed to prospectively evaluate this inverse association. METHODS: Prospective case-control study conducted in 23 centers. Children and adults naïve to eradication therapy for H. pylori were included. Cases were EoE patients, whereas controls were defined by esophageal symptoms and <5 eos/HPF on esophageal biopsies. H. pylori status was diagnosed by non-invasive (excluding serology) or invasive testing off proton pump inhibitor (PPI) therapy for 2 weeks. Atopy was defined by the presence of IgE-mediated conditions diagnosed by an allergist. RESULTS: 808 individuals, including 404 cases and 404 controls (170 children) were enrolled. Overall H. pylori prevalence was 38% (45% children vs. 37% adults, p 0.009) and was not different between cases and controls (37% vs. 40%, p 0.3; odds ratio (OR) 0.97; 95% confidence interval (CI) 0.73-1.30), neither in children (42% vs. 46%, p 0.1) nor in adults (36% vs. 38%, p 0.4). Atopy (OR 0.85; 95%CI 0.75-0.98) and allergic rhinitis (OR 0.81; 95%CI 0.68-0.98) showed a borderline inverse association with H. pylori infection in EoE patients. This trend was not confirmed for asthma or food allergy. CONCLUSIONS: H. pylori infection was not inversely associated with EoE, neither in children nor in adults. A borderline inverse association was confirmed for atopy and allergic rhinitis, but not asthma of food allergy. Our findings question a true protective role of H. pylori infection against allergic disorders, including EoE.

Eosinophilic esophagitis and esophageal atresia: coincidence or causality? / Esofagitis eosinofílica y atresia esofágica: ¿casualidad o causalidad?

Eosinophilic esophagitis is an immune-mediated chronic disease of the esophagus characterized by symptoms related to esophageal dysfunction and tissue eosinophilia. In the endoscopy, the esophageal mucosa may appear normal or show exudates, rings, edema, furrows, and strictures. Its management is based on elimination diet, topical corticosteroids and/or esophageal dilation. Atresia is the most common congenital alteration of the esophagus; it requires surgical repair and poses potential complications, such as gastroesophageal reflux, strictures, and esophageal dysmotility. Up to 2015, 48 cases of eosinophilic esophagitis and esophageal atresia were reported, with dysmotility, reflux, and long-term acid suppression involvement. Prevalent clinical signs include dysphagia, difficulty eating, and reflux symptoms, so an esophagogastroduodenoscopy with biopsy is recommended to rule out associated eosinophilic esophagitis in patients with esophageal atresia and persistent symptoms before performing an esophageal dilation and/or anti-reflux surgery. If eosinophilic esophagitis is confirmed, it should be managed with the corresponding drugs, and the subsequent therapeutic approach will depend on its clinical course.

La esofagitis eosinofílica es una enfermedad crónica del esófago, inmunomediada, caracterizada por síntomas de disfunción esofágica y eosinofilia tisular. Endoscópicamente, la mucosa esofágica puede ser normal o tener exudados, anillos, edema, surcos y estenosis. El tratamiento se basa en dieta de exclusión, corticoterapia tópica y/o dilatación esofágica. La atresia es la alteración congénita más frecuente del esófago, requiere corrección quirúrgica con posibles complicaciones, como reflujo gastroesofágico, estenosis y dismotilidad esofágica. Hasta el año 2015, fueron comunicados 48 casos de esofagitis eosinofílica en atresia esofágica, en los que tuvo participación la dismotilidad, el reflujo y la supresión ácida prolongada. Clínicamente, predominan la disfagia, las dificultades en la alimentación y los síntomas de reflujo, por tanto, se sugiere la endoscopía digestiva alta con biopsias para descartar esofagitis eosinofílica asociada en pacientes con atresia esofágica y síntomas persistentes antes de realizar dilatación esofágica y/o cirugía antirreflujo. Si se confirma esofagitis eosinofílica, debe tratarse con medicación apropiada y subsiguientes conductas terapéuticas dependerán de su evolución.

Propofol Use in Pediatric Patients With Food Allergy and Eosinophilic Esophagitis.

Propofol is a safe, well-tolerated anesthetic that is labeled as contraindicated in patients with egg or soy allergy. This contraindication has become increasingly problematic given the rising incidence of food allergy and eosinophilic esophagitis (EoE). To address this issue, we studied practice patterns of propofol use for esophagogastroduodenoscopies in children with EoE and food allergies at our institution. A retrospective observational study of 1365 esophagogastroduodenoscopies from January 2013 to June 2014 was performed. Data were analyzed using Student t tests, chi square tests, Fisher exact tests, and multivariable logistic regression. We found that propofol was used significantly less in patients with egg or soy allergy, and in patients with EoE, even after adjusting for the presence of food allergy. There was no difference in complication rates relative to propofol use. Propofol was used safely in pediatric patients with EoE and food allergy in this limited single-center review.

Esophageal motility in eosinophilic esophagitis.

BACKGROUND: Eosinophilic esophagitis (EoE) is characterized by eosinophilic infiltration of the esophagus and is a potential cause of dysphagia and food impaction, most commonly affecting young men. Esophageal manometry findings vary from normal motility to aperistalsis, simultaneous contractions, diffuse esophageal spasm, nutcracker esophagus or hypotonic lower esophageal sphincter (LES). It remains unclear whether esophageal dysmotility plays a significant role in the clinical symptoms of EoE. AIM: Our aim is to review the pathogenesis, diagnosis, and effect of treatment on esophageal dysmotility in EoE. METHODS: A literature search utilizing the PubMed database was performed using keywords: eosinophilic esophagitis, esophageal dysmotility, motility, manometry, impedance planimetry, barium esophagogram, endoscopic ultrasound, and dysphagia. RESULTS: Fifteen studies, totaling 387 patients with eosinophilic esophagitis were identified as keeping in accordance with the aim of this study and included in this review. The occurrence of abnormal esophageal manometry was reported to be between 4 and 87% among patients with EoE. Esophageal motility studies have shown reduced distensibility, abnormal peristalsis, and hypotonicity of the LES in patients with EoE, which may also mimic other esophageal motility disorders such as achalasia or nutcracker esophagus. Studies have shown conflicting results regarding the presence of esophageal dysmotility and symptoms with some reports suggesting a higher rate of food impaction, while others report no correlation between motor function and dysphagia. CONCLUSIONS: Motility dysfunction of the esophagus in EoE has not been well reported in the literature and studies have reported conflicting evidence regarding the clinical significance of dysmotility seen in EoE. The correlation between esophageal dysmotility and symptoms of EoE remains unclear. Larger studies are needed to investigate the incidence of esophageal dysmotility, clinical implications, and effect of treatment on patients with EoE.

Esophageal eosinophilia in pediatric patients with cerebral palsy.

OBJECTIVE: To describe the clinical picture, test results, and clinical evolution of patients with cerebral palsy associated with diagnosis of eosinophilic esophagitis, monitored at tertiary centre. METHODS: Cross-sectional, retrospective and descriptive study that evaluated the medical records data of pediatric patients with diagnosis of cerebral palsy and eosinophilic esophagitis in a tertiary center of pediatric gastroenterology between August 2005 and August 2013. RESULTS: Seven out of 131 patients with cerebral palsy had the diagnosis of eosinophilic esophagitis. The mean age at diagnosis of eosinophilic esophagitis was 52.3 months and the mean number of eosinophils in esophagus was 35 per high-power field. Symptoms more frequent were recurrent vomiting and disphagia. Endoscopic alterations found were mucosal thickening, vertical lines, mucosal opacificacion and white plaques. CONCLUSION: The frequency of eosinophilic esophagitis found was higher than in general pediatric population. The investigation of eosinophilic esophagitis should be done regularly in those patients, once this entity could overlap other gastrointestinal diseases.

Clinical manifestations, treatment, and outcomes of children and adolescents with eosinophilic esophagitis.

OBJECTIVE: This study aimed to describe the clinical, endoscopic, and histologic characteristics, as well as the response to conventional treatment of pediatric patients with the classical form of eosinophilic esophagitis (EoE). METHODS: Study of clinical, laboratory, endoscopic, and histologic data and response to conventional treatment of 43 previously followed pediatric patients with the classical form of EoE. RESULTS: A total of 43 patients diagnosed with EoE were included in the study, of which 37 were males (86%), with a mean age of 8.4 years. The most common symptoms were: nausea, vomiting, and abdominal pain (100%) in children younger than 7 years, and loss of appetite (60%), heartburn (52%), and food impaction (48%) in children older than 7 years and adolescents. Regarding the endoscopic findings, 12 (28%) patients had whitish plaques on the esophageal lining, 8 (18.5%) had longitudinal grooves, 2 (4.5%) had concentric rings, 3 (7%) had longitudinal grooves and whitish plaques, and the remaining 18 (42%) had esophageal mucosa with normal appearance. Despite the initial favorable response, 76.7% of patients required more than one course of corticosteroid therapy (systemic or aerosol) and diet (exclusion or elimination of food or elementary allergens). Persistence of eosinophil infiltration was found in some patients despite favorable clinical response. CONCLUSIONS: The classic form of EoE typically shows different symptoms according age range. A significant number of patients required more than one treatment cycle to show clinical remission. Endoscopic and histologic improvement was observed; however, eosinophilic infiltration persisted in some patients.

Manifestações clínicas, terapêutica e evolução de crianças e adolescentes com esofagite eosinofílica / Clinical manifestations, treatment, and outcomes of children and adolescents with eosinophilic esophagitis

OBJECTIVE: This study aimed to describe the clinical, endoscopic, and histologic characteristics, as well as the response to conventional treatment of pediatric patients with the classical form of eosinophilic esophagitis (EoE). METHODS: Study of clinical, laboratory, endoscopic, and histologic data and response to conventional treatment of 43 previously followed pediatric patients with the classical form of EoE. RESULTS: A total of 43 patients diagnosed with EoE were included in the study, of which 37 were males (86%), with a mean age of 8.4 years. The most common symptoms were: nausea, vomiting, and abdominal pain (100%) in children younger than 7 years, and loss of appetite (60%), heartburn (52%), and food impaction (48%) in children older than 7 years and adolescents. Regarding the endoscopic findings, 12 (28%) patients had whitish plaques on the esophageal lining, 8 (18.5%) had longitudinal grooves, 2 (4.5%) had concentric rings, 3 (7%) had longitudinal grooves and whitish plaques, and the remaining 18 (42%) had esophageal mucosa with normal appearance. Despite the initial favorable response, 76.7% of patients required more than one course of corticosteroid therapy (systemic or aerosol) and diet (exclusion or elimination of food or elementary allergens). Persistence of eosinophil infiltration was found in some patients despite favorable clinical response. CONCLUSIONS: The classic form of EoE typically shows different symptoms according age range. A significant number of patients required more than one treatment cycle to show clinical remission. Endoscopic and histologic improvement was observed; however, eosinophilic infiltration persisted in some patients.

OBJETIVO: O objetivo deste estudo foi descrever as características clínicas, endoscópicas e histológicas, assim como a resposta ao tratamento convencional de pacientes pediátricos com a forma clássica de esofagite eosinofílica (EEo). MÉTODOS: Levantamento de dados clínicos, laboratoriais, endoscópicos, histológicos e da resposta ao tratamento convencional de 43 pacientes pediátricos acompanhados previamente com a forma clássica de EEo. RESULTADOS: Foram incluídos 43 pacientes com diagnóstico de EEo, sendo 37 do sexo masculino (86%), com idade média de 8,4 anos. Os sintomas mais encontrados foram: náusea, vômito e dor abdominal (100%) em crianças menores de sete anos; e inapetência (60%), queimação retroesternal (52%) e impactação alimentar (48%) em crianças maiores de sete anos e adolescentes. Em relação aos achados endoscópicos, 12 (28%) pacientes apresentavam placas esbranquiçadas na mucosa do esôfago, oito (18,5%) sulcos longitudinais, dois (4,5%) anéis concêntricos, três (7%) sulcos longitudinais e placas esbranquiçadas, e os outros 18 (42%) apresentavam aparência normal da mucosa esofágica. Apesar da resposta favorável inicial, 76,7% dos pacientes necessitaram realizar mais de um ciclo terapêutico com corticoterapia (aerossol ou sistêmica) e dieta (de exclusão ou eliminação dos alérgenos alimentares ou elementares). Persistência do infiltrado eosinofílico foi encontrada em uma parcela dos pacientes, a despeito da resposta clínica favorável. CONCLUSÕES: A forma clássica da EEo apresenta sintomas diferentes segundo a faixa etária. Parcela expressiva dos pacientes necessitou de mais de um ciclo terapêutico para apresentar remissão clínica. Observou-se melhora endoscópica e histológica; no entanto, a infiltração eosinofílica persistiu em parcela dos pacientes.

Eosinophilic esophagitis: manometric and pHmetric findings.

CONTEXT: Eosinophilic esophagitis is an entity characterized by an esophageal inflammatory infiltrate of eosinophils, manifested by dysphagia, intermittent food impactions and symptoms similar to gastroesophageal reflux disease (GERD), that predominantly affects young adults. There may be association of eosinophilic esophagitis with GERD, and motor abnormalities have been described. OBJECTIVE: The main objectives of this study are to describe the findings at esophageal manometry and pH monitoring in patients with eosinophilic esophagitis. METHODS: Cross-sectional study of 20 patients with a diagnosis of eosinophilic esophagitis, submitted to esophageal manometry and 24h pH monitoring. Were analysed the manometric changes and the presence of abnormal reflux on pH monitoring. RESULTS: Twenty patients (15 men, 5 women) had a mean age of 29 years. Motility disorders were found in 25% (5/20) patients with ineffective esophageal motility being the most common finding. pH monitoring revealed abnormal reflux on 25%, without any relationship with manometric findings. CONCLUSIONS: Manometric abnormalities were observed in 25% of patients and abnormal reflux on pH monitoring also in 25%. This study showed no relationship between abnormal reflux and the presence of manometric changes.

Eosinophilic esophagitis: manometric and pHmetric findings / Esofagite eosinofílica: achados manométricos e pHmétricos

CONTEXT: Eosinophilic esophagitis is an entity characterized by an esophageal inflammatory infiltrate of eosinophils, manifested by dysphagia, intermittent food impactions and symptoms similar to gastroesophageal reflux disease (GERD), that predominantly affects young adults. There may be association of eosinophilic esophagitis with GERD, and motor abnormalities have been described. OBJECTIVE: The main objectives of this study are to describe the findings at esophageal manometry and pH monitoring in patients with eosinophilic esophagitis. METHODS: Cross-sectional study of 20 patients with a diagnosis of eosinophilic esophagitis, submitted to esophageal manometry and 24h pH monitoring. Were analysed the manometric changes and the presence of abnormal reflux on pH monitoring. RESULTS: Twenty patients (15 men, 5 women) had a mean age of 29 years. Motility disorders were found in 25% (5/20) patients with ineffective esophageal motility being the most common finding. pH monitoring revealed abnormal reflux on 25%, without any relationship with manometric findings. CONCLUSIONS: Manometric abnormalities were observed in 25% of patients and abnormal reflux on pH monitoring also in 25%. This study showed no relationship between abnormal reflux and the presence of manometric changes.

CONTEXTO: A esofagite eosinofílica é uma doença inflamatória crônica, caracterizada por infiltrado eosinofílico no esôfago e se manifesta por disfagia, impactações alimentares e sintomas similares aos da doença do refluxo gastroesofágico (DRGE), com maior incidência em adultos jovens. Pode haver associação da esofagite eosinofílica com a DRGE, e anormalidades motoras têm sido descritas. OBJETIVO: Os principais objetivos deste estudo são descrever as alterações manométricas e a presença de refluxo anormal à pHmetria esofágica em pacientes com esofagite eosinofílica. MÉTODOS: Estudo transversal de 20 pacientes com diagnóstico de esofagite eosinofílica, submetidos a esofagomanometria e pHmetria esofagiana de 24 h. Foram analisadas as alterações manométricas e a presença de refluxo anormal à pHmetria. RESULTADOS: Vinte pacientes (15 homens, 5 mulheres) com média de idade de 29 anos. Distúrbios da motilidade esofagiana foram encontrados em 25% dos pacientes, com predomínio da motilidade esofagiana ineficaz. A pHmetria revelou refluxo anormal também em 25%, sem relação entre os achados manométricos e pHmétricos. CONCLUSÕES: Anormalidades manométricas foram encontradas em 25% dos pacientes e refluxo anormal à pHmetria também em 25%. Neste estudo, não houve relação entre refluxo anormal e a presença de alterações à esofagomanometria.

Eosinophilic esophagitis in patients with typical gastroesophageal reflux disease symptoms refractory to proton pump inhibitor.

BACKGROUND: TREATMEN The contribution of eosinophilic esophagitis (EoE) to refractory gastroesophageal reflux disease (GERD) remains unknown. When EoE and GERD overlap, the clinical, endoscopic and histological findings are nonspecific and cannot be used to distinguish between the two disorders. Limited data are available on this topic, and the interaction between EoE and GERD is a matter of debate. AIM: We have conducted a prospective study of adult patients with refractory GERD to evaluate the overlap of reflux and EoE. METHODS: Between July 2006 and June 2008, we consecutively and prospectively enrolled 130 male and female patients aged 18 to 70 years old who experienced persistent heartburn and/or regurgitation more than twice a week over the last 30 days while undergoing at least six consecutive weeks of omeprazole treatment (at least 40 mg once a day). The patients underwent an upper digestive endoscopy with esophageal biopsy, and intraepithelial eosinophils were counted after hematoxylin/eosin staining. The diagnosis of EoE was based on the presence of 20 or more eosinophils per high-power field (eo/HPF) in esophageal biopsies. RESULTS: Among the 103 studied patients, 79 (76.7%) were females. The patients had a mean age of 45.5 years and a median age of 47 years. Endoscopy was normal in 83.5% of patients, and erosive esophagitis was found in 12.6%. Only one patient presented lesions suggestive of EoE. Histological examination revealed >20 eo/HPF in this patient. CONCLUSION: Our results demonstrated a low prevalence of EoE among patients with refractory GERD undergoing omeprazole treatment.