Eosinophilic Esophagitis

Video Endoscopic Sequence 1 of 6.

Eosinophilic Esophagitis

Endoscopy may reveal a ringed appearance or linear furrows. Standard biopsy findings reveal severe eosinophilic infiltration; more than 15-20 eosinophils per high-magnification microscopic field are necessary for diagnosis

In contrast to GERD, eosinophilic esophagitis involves the mucosa, submucosa, and, possibly, the muscularis.

Multiple food antigens (eg, eggs, nuts, beef, wheat, fish, shellfish, corn, soy) can induce eosinophilic esophagitis; cow's milk protein is the most common precipitant.

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Eosinophilic esophagitis

Video Endoscopic Sequence 2 of 6.

Eosinophilic esophagitis is a new disease commonly confused with gastroesophageal reflux disease. Because of different treatments, recognition of eosinophilic esophagitis is important.

Eosinophilic esophagitis is an allergy-based disorder. It presents commonly in adults as long standing dysphagia, sometimes with food impaction. Radiography is useful but will miss subtle signs of eosinophilic esophagitis. Treatment options are limited to steroid formulations or avoidance of food allergens though compliance, particularly with elemental formulas, remains problematic.


Eosinophilic Esophagitis

Video Endoscopic Sequence 3 of 6.

The patient presents two submucosal mass the one of the antrum that is compatible with Heterotopic Pancreas.




Heterotopic Pancreas.

Video Endoscopic Sequence 4 of 6.

Heterotopic Pancreas.

More images and video clips of the submucosal mass

 


Eosinophilic Esophagitis

Video Endoscopic Sequence 5 of 6.

Eosinophilic Esophagitis

Endoscopic findings are quite typical and include multiple mucosal rings, strictures, linear furrowing, narrowed esophagus, and multiple white papules, although a small percent of patients will have a normal-appearing esophagus.

Recognition of this disease for the gastroenterologist has become paramount because of its differentiation from gastroesophageal reflux not only from an etiologic but especially from a treatment point of view.

Most studies on treatment and follow-up of eosinophilic esophagitis have been of the order of months to a few years in small populations of patients. food avoidance therapies but long-term trials are desperately needed to elucidate the time course needed for these treatment.

Eosinophilic esophagitis is an evolving disease. Recent
data continue to support a key role for allergy in its
pathogenesis, though gastroesophageal reflux disease as a
potential co-factor, particularly in adults, needs further
attention.




eosinophilic esophagitis

Video Endoscopic Sequence 6 of 6.

One of the fascinating issues in eosinophilic esophagitis is understanding the causes of eosinophilic infiltration of the esophagus, an organ normally devoid of eosinophils as compared with blood and the remainder of the gastrointestinal tract.

Eosinophilic esophagitis can be suspected clinically, but diagnosis requires pathologic confirmation by finding large numbers of intraepithelial eosinophils throughout the esophagus.

The etiology of eosinophilic esophagitis is unknown but atopy and eosinophilia are common, suggesting that eosinophilic infiltration of the esophagus may be a response to environmental allergens, leading to esophageal inflammation by the release of a variety of interleukins and cytotoxic proteins.

Eosinophils (5-10 per high power field) in the distal
esophagus is characteristic of reflux esophagitis, but large
numbers of eosinophils (>20 per high power field)
infiltrating the esophagus is distinctly unusual.




 

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