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A Japanese case series of 12 patients with esophageal eosinophilia

  • Original Article—Alimentary Tract
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Abstract

Background

Eosinophilic esophagitis (EoE) has been a rarely recognized condition in Asian populations, and its clinical manifestation is rarely documented. Our aim was to describe clinically, endoscopically, and pathologically the features of patients with esophageal eosinophilia, including EoE.

Methods

Twelve patients histologically proven to have esophageal eosinophilia were investigated. The histological diagnostic cutoff value was defined as a peak of ≥15 eosinophils/high-power field (HPF) in esophageal biopsies. Symptoms, endoscopic and pathological findings, and treatment outcome were evaluated.

Results

Nine of the 12 patients were male and the 12 patients had a mean age of 47.7 years. Allergic conditions were concurrent in a total of 3 patients. Mild peripheral eosinophilia was observed in only 2 patients. The predominant symptom was solid-food dysphagia, but some patients complained of heartburn, or chest, epigastric, or back pain. Three asymptomatic subjects were also incidentally diagnosed during endoscopic screening. Linear furrows, concentric rings, and white exudates in the esophagus were frequently observed. In 4 of 5 patients who were administered a proton pump inhibitor (PPI), esophageal eosinophilia was histologically decreased or disappeared with symptom relief and endoscopic improvement. In 2 patients unresponsive to PPI, topical steroid therapy, administered by the swallowing of fluticasone propionate, led to symptomatic and histological remission.

Conclusions

The endoscopic recognition of linear furrows, concentric rings, and white exudates is important in the diagnosis of eosinophilic esophageal inflammation. In a subset of patients this condition improves clinicopathologically with PPI treatment, and typical EoE, as strictly defined by unresponsiveness to PPI, appears to be a rather rare condition.

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Fig. 1
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Abbreviations

EoE:

Eosinophilic esophagitis

HPF:

High-power field

PPI:

Proton pump inhibitor

FP:

Fluticasone propionate

References

  1. Rothenberg ME, Hogan SP. The eosinophil. Annu Rev Immunol. 2006;24:147–74.

    Article  CAS  PubMed  Google Scholar 

  2. Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, Bonis P, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133:1342–63.

    Article  CAS  PubMed  Google Scholar 

  3. Arora AS, Yamazaki K. Eosinophilic esophagitis: asthma of the esophagus? Clin Gastroenterol Hepatol. 2004;2:523–30.

    Article  PubMed  Google Scholar 

  4. Mackenzie SH, Go M, Chadwick B, Thomas K, Fang J, Kuwada S, et al. Eosinophilic oesophagitis in patients presenting with dysphagia––a prospective analysis. Aliment Pharmacol Ther. 2008;28:1140–6.

    Article  CAS  PubMed  Google Scholar 

  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;20:311–9.

    Article  CAS  PubMed  Google Scholar 

  6. Byrne KR, Panagiotakis PH, Hilden K, Thomas KL, Peterson KA, Fang JC. Retrospective analysis of esophageal food impaction: differences in etiology by age and gender. Dig Dis Sci. 2006;52:717–21.

    Article  Google Scholar 

  7. Furuta K, Adachi K, Kowari K, Mishima Y, Imaoka H, Kadota C, et al. A Japanese case of eosinophilic esophagitis. J Gastroenterol. 2006;41:706–10.

    Article  PubMed  Google Scholar 

  8. Lu HC, Lu CL, Chang FY. Eosinophilic esophagitis in an asymptomatic Chinese. J Chin Med Assoc. 2008;71:362–4.

    Article  PubMed  Google Scholar 

  9. 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;58:516–22.

    Article  PubMed  Google Scholar 

  10. 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;59:355–61.

    Article  PubMed  Google Scholar 

  11. 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;63:3–12.

    Article  PubMed  Google Scholar 

  12. Rodrigo S, Abboud G, Oh D, DeMeester SR, Hagen J, Lipham J, et al. High intraepithelial eosinophil counts in esophageal squamous epithelium are not specific for eosinophilic esophagitis in adults. Am J Gastroenterol. 2008;103:435–42.

    Article  PubMed  Google Scholar 

  13. Dubecz A, Mentrikoski M, Peters JH. Eosinophilic esophagitis with severe GERD. Am J Gastroenterol. 2009;104:527–9.

    Article  PubMed  Google Scholar 

  14. Molina-Infante J, Ferrando-Lamana L, Mateos-Rodríguez JM, Pérez-Gallardo B, Prieto-Bermejo AB. Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies: a review of the literature. World J Gastroenterol. 2008;14:1463–6.

    Article  PubMed  Google Scholar 

  15. Ngo P, Furuta GT, Antonioli DA, Fox VL. Eosinophils in the esophagus-peptic or allergic eosinophilic esophagitis? Case series of three patients with esophageal eosinophilia. Am J Gastroenterol. 2006;101:1666–70.

    Article  PubMed  Google Scholar 

  16. 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;61:795–801.

    Article  PubMed  Google Scholar 

  17. Gonsalves N, Policarpio-Nicolas M, Zhang Q, Rao MS, Hirano I. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastrointest Endosc. 2006;64:313–9.

    Article  PubMed  Google Scholar 

  18. Basavaraju KP, Wong T. Eosinophilic oesophagitis: a common cause of dysphagia in young adults? Int J Clin Pract. 2008;62:1096–107.

    Article  CAS  PubMed  Google Scholar 

  19. Bohm M, Richter JE. Treatment of eosinophilic esophagitis: overview, current limitations, and future direction. Am J Gastroenterol. 2008;103:2635–44.

    Article  CAS  PubMed  Google Scholar 

  20. Bordas JM, Feu F, Vilella A, Rodés J. Anaphylactic reaction to ethanolamine oleate injection in sclerotherapy of esophageal varices. Endoscopy. 1989;21:50.

    Article  CAS  PubMed  Google Scholar 

  21. Kinoshita Y, Kitajima N, Itoh T, Ishido S, Nishiyama K, Kawanami C, et al. Gastroesophageal reflux after endoscopic injection sclerotherapy. Am J Gastroenterol. 1992;87:282–6.

    CAS  PubMed  Google Scholar 

  22. Spechler SJ, Genta RM, Souza RF. Thoughts on the complex relationship between gastroesophageal reflux disease and eosinophilic esophagitis. Am J Gastroenterol. 2007;102:1301–6.

    Article  CAS  PubMed  Google Scholar 

  23. Isomoto H, Nishi Y, Kanazawa Y, Shikuwa S, Mizuta Y, Inoue K, et al. Immune and inflammatory responses in GERD and lansoprazole. J Clin Biochem Nutr. 2007;41:84–91.

    Article  CAS  PubMed  Google Scholar 

  24. De Jonge PJ, Siersema PD, Van Breda SG, Van Zoest KP, Bac DJ, Leeuwenburgh I, et al. Proton pump inhibitor therapy in gastro-oesophageal reflux disease decreases the oesophageal immune response but does not reduce the formation of DNA adducts. Aliment Pharmacol Ther. 2008;28:127–36.

    Article  PubMed  Google Scholar 

  25. Merwat SN, Spechler SJ. Might the use of acid-suppressive medications predispose to the development of eosinophilic esophagitis? Am J Gastroenterol. 2009;104:1897–902.

    Article  CAS  PubMed  Google Scholar 

  26. Moawad FJ, Veerappan GR, Wong RK. Eosinophilic esophagitis. Dig Dis Sci. 2009;54:1818–28.

    Article  PubMed  Google Scholar 

  27. Peterson KA, Thomas KL, Hilden K, Emerson LL, Wills JC, Fang JC. Comparison of esomeprazole to aerosolized, swallowed fluticasone for eosinophilic esophagitis. Dig Dis Sci. 2010;55:1313–9.

    Article  PubMed  Google Scholar 

  28. 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;56:615–20.

    Article  PubMed  Google Scholar 

  29. Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003;125:1660–9.

    Article  PubMed  Google Scholar 

  30. Shah A, Kagalwalla AF, Gonsalves N, Melin-Aldana H, Li BU, Hirano I. Histopathologic variability in children with eosinophilic esophagitis. Am J Gastroenterol. 2009;104:716–21.

    Article  PubMed  Google Scholar 

  31. Leung TF, Wong GW. The Asian side of asthma and allergy. Curr Opin Allergy Clin Immunol. 2008;8:384–90.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan

    Yasuhiko Abe, Katsunori Iijima, Tomoyuki Koike, Nobuyuki Ara, Kaname Uno, Naoki Asano, Akira Imatani & Tooru Shimosegawa

  2. Department of Gastroenterology, Tohoku Rousai Hospital, Sendai, Miyagi, Japan

    Shuichi Ohara

  3. Cancer Detection Center, Miyagi Cancer Society, Sendai, Miyagi, Japan

    Katsuaki Kato & Daisuke Shibuya

Authors
  1. Yasuhiko Abe
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  2. Katsunori Iijima
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  3. Shuichi Ohara
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Correspondence to Yasuhiko Abe.

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Abe, Y., Iijima, K., Ohara, S. et al. A Japanese case series of 12 patients with esophageal eosinophilia. J Gastroenterol 46, 25–30 (2011). https://doi.org/10.1007/s00535-010-0295-4

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  • DOI: https://doi.org/10.1007/s00535-010-0295-4

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