Endoscopic, bioptic, and manometric findings in eosinophilic esophagitis before and after steroid therapy: a case series

Background and aim: Eosinophilic esophagitis can be associated with a wide range of endoscopic patterns. The aim of the present case series report is to describe and classify endoscopic appearances before and after corticoid therapy in relation to histopathology and manometry.

Patients and methods: In 30 patients (m : f, 27 : 3; mean age 36.2 years) with eosinophilic esophagitis, endoscopic findings were prospectively classified according to luminal diameter and mucosal pattern. Manometric and bioptic histopathologic findings were also recorded. Endoscopy was repeated following a 3-month course of steroid therapy.

Results: In total, 20 % of patients showed a concentric esophageal stricture, and in 57 % simultaneous contraction rings were visible. Mucosal alterations consisted of granular mucosa (20 %), longitudinal furrows (33 %) and transversal undulations (3 %). Lower esophageal sphincter dysfunction and distal esophageal dysfunctional manometry were seen in 73 % and 57 % of cases, respectively. Following steroids, the esophagus showed a normal caliber in 97 % of patients, and 63 % of patients had normal mucosa.

Conclusions: The most frequent findings were narrowing of the esophageal lumen, which returned to normal following steroid treatment to a larger extent than mucosal alterations.

References

• 1 Sgouros S N, Bergele C, Mantides A. Eosinophilic esophagitis in adults: what is the clinical significance?.  Endoscopy. 2006;  38 515-520
• 2 Sgouros S N, Bergele C, Mantides A. Eosinophilic esophagitis in adults: a systematic review.  Eur J Gastroenterol Hepatol. 2006;  18 211-217
• 3 Croese J, Fairley S K, Masson J W. et al . Clinical and endoscopic features of eosinophilic esophagitis in adults.  Gastrointest Endosc. 2003;  58 516-522
• 4 Remedios M, Campbell C, Jones D M, Kerlin P. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate.  Gastrointest Endosc. 2006;  63 3-12
• 5 Fox V L, Nurko S, Furuta G T. Eosinophilic esophagitis: it's not just kid's stuff.  Gastrointest Endosc. 2002;  56 260-270
• 6 Arora A S, Yamazaki K. Eosinophilicesophagitis: asthma of the esophagus?.  Clin Gastroenterol Hepatol. 2004;  2 523-530
• 7 Lim J R, Gupta S K, Croffie J M. et al . White specks in the esophageal mucosa: an endoscopic manifestation of non-reflux eosinophilic esophagitis in children.  Gastrointest Endosc. 2004;  59 835-838
• 8 De la Santa E, Lazo M D, Cordero C. et al . Esofagitis eosinofílica. Presentación de tres casos y reflexión sobre el papel de la endoscopia en una enfermedad probablemente infradiagnosticada.  Libro de comunicaiones de la XXVI Jornada Nacional de la Sociedad Española de Endoscopia Digestiva,. 2004;  48
• 9 Gonsalves N, Policarpio-Nicolas M, Zhang Q. et al . Histopathologic variability in eosinophil concentrations in eosinophilic esophagitis necessitates multiple biopsy sampling [abstract].  Gastroenterology. 2005;  128 (Suppl 2) A-7
• 10 Lucendo A J, Navarro M, Comas C. et al . Immunophenotypic characterisation and quantification of the epithelial inflammatory infiltrate in eosinophilic esophagitis through stereology: an analysis of the disease's cellular mechanisms and the esophagus's immunological capacity.  Am J Surg Pathol. 2007;  31 598-606
• 11 Stein H J, De Meester T R, Peters J H, Fuchs K H. Technique, indications, and clinical use of ambulatory 24-hour gastric pH monitoring in a surgical practice.  Surgery. 1994;  116 758-766
• 12 Grupo español de motilidad digestiva .Técnicas para el estudio de la actividad motora digestiva: protocolos metodológicos. Barcelona; Menarini Labs 2003
• 13 Desai T K, Stecevic V, Chang C-H. et al . Association of eosinophilic inflamation with esophageal food impactation in adults.  Gastrointest Endosc. 2005;  61 795-801
• 14 Straumann A, Spichtin H P, Bucher K A. et al . Eosinophilic esophagitis: red on microscopy, white on endoscopy.  Digestion. 2004;  70 109-116
• 15 Yan B M, Shaffer E A. Eosinophilic esophagitis: a newly established cause of dysphagia.  World J Gastroenterol. 2006;  12 2328-2334
• 16 Lucendo Villarín A J, Carrión Alonso G, Navarro Sánchez M. et al . Eosinophilic eosinophilic in adults, an emerging cause of dysphagia. Description of 9 cases.  Rev Esp Enf Dig. 2005;  97 229-239
• 17 Cantù P, Velio P, Prada A, Penagini R. Ringed oesophagus and idiopathic eosinophilic oesophagitis in adults: an association in two cases.  Dig Liv Dis. 2005;  37 129-134
• 18 Straumann A, Spichtin H P, Grize L. et al . Natural history of primary eosinophilic esophagitis: a follow-up of 30 adult patients for up to 11. 5 years.  Gastroenterology. 2003;  125 1660-1669
• 19 Straumann A, Rossi L, Simon H U, Heer P. Fragility of the esophageal mucosa: a pathognpmonic endoscopic sign of primary eosinophilic esophagitis?.  Gastrointest Endosc. 2003;  57 407-412
• 20 Vasilopoulos S, Murphy P, Auerbach A. et al . The small-caliber esophagus: an unappreciated cause of dysphagia for solids in patients with eosinophilic esophagitis.  Gastrointest Endosc. 2002;  55 99-106
• 21 Gonsalves N, Kahrilas P J, Hitano I. Eosinophilic esopahgitis (EE) in adults: emerging entity or misdiagnosed malady [abstract].  Gastrointest Endosc. 2005;  61 AB132
• 22 Dahms B B. Reflux esophagitis: sequelae and dufferential diagnosis in infants and children including eosinophilic esophagitis.  Pediatr Dev Pathol. 2004;  7 5-16
• 23 Rothenberg M E, Mishra A, Collins M H, Putman P E. Pathogenesis and clinical features of eosinophilic esophagitis.  J Allergy Clin Immunol. 2001;  108 891-894
• 24 Orenstein S R, Shalaby T M, Di Lorenzo C. et al . The spectrum of pediatric eosinophilic esophagitis beyong infancy: a clinical series of 30 children.  Am J Gastroenterol. 2000;  95 1422-1430
• 25 Steiner S J, Kernek K M, Fitzgerald J F. Severity of basal cell hyperplasia differs in reflux versus eosinophilic esophagitis.  J Pediatr Gastroenterol Nutr. 2006;  42 506-509
• 26 Mueller S, Aigner T, Neureiter D, Stolte M. Eosinophil infiltration and degranulation in esophageal mucosa from adult patients with eosinophilic esophagitis (EE). A retrospective comparative pathologic biopsy study.  J Clin Pathol. 2006;  59 1175-1180
• 27 Ravelli A M, Villanacci V, Ruzzenenti N. et al . Dilated intercellular spaces: a mayor morphological feature of esophagitis.  J Pediatr Gastroenterol Nutr. 2006;  42 510-515
• 28 Mann N S, Leung J W. Pathogenesis of esophageal ring in eosinophilic esophagitis.  Med Hypotheses. 2005;  64 520-523
• 29 Kita H, Adolphson C R, Gleich G J. Biology of eosinophils. In: Middletown's Allergy, principles and practise, 6th edn Philadelphia, Pennsylvania; Mosby 2003: 305-332
• 30 Lucendo A J, Castillo P, Martín-Chávarri S. et al . Manometric findings in adult eosinophilic oesophagitis: a study of 12 cases.  Eur J Gastroenterol Hepatol.. 2007;  19 417-424