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Abe Y, Kikuchi R, Sasaki Y, Mizumoto N, Yagi M, Onozato Y, Watabe T, Goto H, Miura T, Sato R, Ito M, Tsuchiya H, Ueno Y. Long-term course of untreated asymptomatic esophageal eosinophilia and minimally symptomatic eosinophilic esophagitis. Endosc Int Open 2024; 12:E545-E553. [PMID: 38628394 PMCID: PMC11018394 DOI: 10.1055/a-2280-8277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/04/2024] [Indexed: 04/19/2024] Open
Abstract
Background and study aims The long-term course of untreated asymptomatic esophageal eosinophilia (aEE) and minimally symptomatic eosinophilic esophagitis (mEoE) are not well understood. This study aimed to clarify this course. Patients and methods A total of 36 patients with EE who were endoscopically followed up for more than 5 years, and who underwent more than one endoscopy evaluation after the first diagnosis, were investigated. These patients were divided into two groups according to the presence or absence of the continuous treatment: no treatment group (NT group, n=22) and proton pump inhibitor/potassium competitive acid blocker group (Tx group, n=14). Symptoms and endoscopic and histological findings were retrospectively reviewed according to endoscopic phenotypes. Endoscopic assessment was performed using the EoE endoscopic reference score (EREFS). Results The median follow-up period was 84.5 months in the Tx group and 92 months in the NT group. During the follow-up period, about half of the patients in the Tx-diffuse group persisted EREFS >3, while the remaining half had EREFS ≤2. The total EREFS in the NT-diffuse group remained almost unchanged (median: 2-4) without apparent exacerbation. In contrast, EREFS in the NT-localized group exhibited an unchanged or gradually decreasing trend, with statistical significance from the first diagnosis to 72 to 83 months after. Conclusions Untreated aEE and mEoE are not likely to worsen even without treatment at least for a median follow-up of 7 years. Instead, the localized type may spontaneously improve, implying a different pathogenesis in the presence of the diffuse type. Further studies should clarify the long-term prognosis.
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Affiliation(s)
- Yasuhiko Abe
- Division of Endoscopy, Yamagata University Hospital, Yamagata, Japan
| | - Ryosuke Kikuchi
- Department of Gastroenterology, JR Sendai Hospital, Sendai, Japan
| | - Yu Sasaki
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Naoko Mizumoto
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Makoto Yagi
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Yusuke Onozato
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Takahiro Watabe
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Hiroki Goto
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Takahiro Miura
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Ryou Sato
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Minami Ito
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Hiroko Tsuchiya
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Yamagata Daigaku Igakubu Daigakuin Igakukei Kenkyuka, Yamagata, Japan
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Fujiwara Y, Sawada A, Ominami M, Fukunaga S, Otani K, Hosomi S, Nagami Y, Taira K, Tanaka F. Responses of Proton Pump Inhibitors and Potassium-Competitive Acid Blockers According to Outcomes of Symptom, Endoscopy, and Histology in Patients With Eosinophilic Esophagitis. J Clin Gastroenterol 2024; 58:337-341. [PMID: 37267311 DOI: 10.1097/mcg.0000000000001869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 04/24/2023] [Indexed: 06/04/2023]
Abstract
GOALS We aimed to examine the response rate to proton pump inhibitors (PPIs) and potassium-competitive acid blockers and the prevalence of topical corticosteroid (TCS) therapy as the second-line treatment for eosinophilic esophagitis (EoE). BACKGROUND Acid-suppressive drugs such as PPIs and potassium-competitive acid blockers are often used to treat EoE. Treatment response is based on outcomes including symptoms, endoscopy, and histology; however, the detailed response rate to PPI/P-CAB is unknown. STUDY In total, 236 patients with histologically confirmed EoE who received PPI/P-CAB as the first-line treatment were included. We assessed the symptoms, endoscopic reference score (EREFS), and histology [eosinophils per high-power field (eos/hpf)] 8 weeks after PPI/P-CAB administration. Complete normalization was defined as the disappearance of symptoms, EREFS score 0, or 0-1 eos/hpf, and response as disappearance or improvement of symptoms, EREFS score ≤2, or <15 eos/hpf. The prevalence of TCS therapy in each response group was assessed. RESULTS Complete normalization was achieved in 25%, 50%, 36%, and 8% of patients for symptoms, endoscopy, histology, and all 3 outcomes, respectively. The response rates were 81%, 87%, 87%, 75%, and 60% for symptoms, endoscopy, histology, and all 3 outcomes, respectively. TCS use was significantly lower (8%) in patients who achieved response of all 3 outcomes than in other groups and was dependent on the number of outcomes with nonresponse. CONCLUSIONS Complete normalization of symptoms, endoscopy, and histology using PPI/P-CAB is uncommon. Based on treatment efficacy by response/nonresponse, TCS was the secondary treatment in cases with an increase in the number of nonresponse outcomes.
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Affiliation(s)
- Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University, Osaka, Japan
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Tanaka F, Kanamori A, Sawada A, Ominami M, Nadatani Y, Fukunaga S, Otani K, Hosomi S, Kamata N, Nagami Y, Taira K, Fujiwara Y. Correlation between anxiety and decreased quality of life in patients with non-esophageal eosinophilic gastrointestinal diseases. JGH Open 2024; 8:e13025. [PMID: 38268958 PMCID: PMC10805507 DOI: 10.1002/jgh3.13025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/15/2023] [Accepted: 12/06/2023] [Indexed: 01/26/2024]
Abstract
Background and Aim Mental status such as anxiety and depression in patients with non-esophageal eosinophilic gastrointestinal diseases (non-EoE EGIDs) has not been studied. The aim of this study was to evaluate whether patients with non-EoE EGIDs had mental disorders and decreased mental-health-related quality of life (QOL) similar to those in patients with disorders of gut-brain interaction (DGBI). Methods We enrolled patients with non-EoE EGIDs and DGBI visiting the Osaka Metropolitan University Hospital, and the measures listed below were compared between the groups. We collected data using the following questionnaires: hospital anxiety and depression scale, and short form (SF)-8 including mental component summary (MCS)-8. Results We evaluated 21 and 17 patients with non-EoE EGIDs and DGBI, respectively. The anxiety score was not significantly different between the groups. The proportion of patients with possible anxiety was not significantly different between the groups (19.0% vs 33.3%). These results show that patients with non-EoE EGIDs had anxiety that might be equivalent to that of patients with DGBI. The depression score and proportion of patients with possible depression in the non-EoE EGID group tended to be lower than those in the DGBI group. MCS-8 scores were not significantly different between the non-EoE EGID and DGBI groups, which might imply an equivalent decrease in mental-health-related QOL in both groups of patients. In patients with non-EoE EGIDs, the anxiety score had a significant inverse association with the MCS-8 score. Conclusions Patients with non-EoE EGIDs may have anxiety that correlates with decreased mental-health-related QOL.
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Affiliation(s)
- Fumio Tanaka
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Atsushi Kanamori
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
- Department of Premier Preventive MedicineGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Akinari Sawada
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Masaki Ominami
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Yuji Nadatani
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
- Department of Premier Preventive MedicineGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Shusei Fukunaga
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Koji Otani
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Shuhei Hosomi
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Noriko Kamata
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Yasuaki Nagami
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Koichi Taira
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
| | - Yasuhiro Fujiwara
- Department of GastroenterologyGraduate School of Medicine, Osaka Metropolitan UniversityOsakaJapan
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Fujiwara Y, Sawada A, Higashimori A, Nakata R, Tanoue K, Nishida Y, Maruyama H, Ominami M, Fukunaga S, Otani K, Hosomi S, Kamata N, Tanaka F, Nagami Y, Taira K. The impact of COVID-19 on Japanese patients with eosinophilic gastrointestinal disorders during the vaccination era. JGH Open 2023; 7:702-707. [PMID: 37908294 PMCID: PMC10615174 DOI: 10.1002/jgh3.12969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 11/02/2023]
Abstract
Background Eosinophilic gastrointestinal disorders (EGIDs) are chronic allergic diseases categorized as eosinophilic esophagitis (EoE) and non-EoE EGIDs. Few studies regarding the association between EGIDs and coronavirus disease 2019 (COVID-19) have been reported. Although most Japanese individuals received the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine, the incidence of COVID-19 remained high in 2022. This study examines the incidence of COVID-19 in patients with EGIDs during the vaccination era. Methods Patients with EGIDs who visited our department between October and December 2022 were enrolled in the study. The incidence and severity of COVID-19 prior to October 1, 2022 were determined. Patients who reported having COVID-19 also reported their hospitalization history, intensive care unit admissions, and EGID flares. The number of SARS-CoV-2 vaccinations received and treatment for EGIDs were obtained from the patients' medical records. Results Of 111 patients with EGIDs (65 with EoE and 46 with non-EoE EGIDs) included in this study, 31 (28%) patients reported having COVID-19, including 14 (22%) with EoE and 17 (37%) with non-EoE EGIDs. Fifty-nine (84%) patients received two or more vaccinations, and 11 (16%) patients received no vaccinations. COVID-19 was mild in all but one patient who had moderate symptoms. COVID-19 was not associated with EGID flares. EGID treatments and an unvaccinated status were not associated with an increased risk of COVID-19. Conclusion COVID-19 was mild in patients with EGIDs and not associated with EGIDs flares during the vaccination era. There was a relatively high incidence of COVID-19 among patients with non-EoE EGIDs.
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Affiliation(s)
- Yasuhiro Fujiwara
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Akinari Sawada
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Akira Higashimori
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Rieko Nakata
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Kojiro Tanoue
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Yu Nishida
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | | | - Masaki Ominami
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Shusei Fukunaga
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Koji Otani
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Shuhei Hosomi
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Noriko Kamata
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Fumio Tanaka
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Yasuaki Nagami
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
| | - Koichi Taira
- Department of GastroenterologyOsaka Metropolitan UniversityOsakaJapan
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Dutta P, Shah-Riar P, Bushra SS, Haque SN, Rafa ZI, Hawa F, Chakrabarty S, Dev Nath S, Afrin H, Shama N, Khair F, Maisha S, Kapuria P, Dam B. Recent Trends in the Management of Eosinophilic Esophagitis: A Systematic Review. Cureus 2023; 15:e43221. [PMID: 37692685 PMCID: PMC10490439 DOI: 10.7759/cureus.43221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Eosinophilic esophagitis (EoE) is a chronic immune-mediated condition characterized by inflammation and eosinophilic accumulation of the esophagus, resulting in dysphagia and food impaction. While the exact etiology of EoE remains unclear, it is believed to be triggered by food allergens and dynamic environmental factors, resulting in various clinical manifestations, from inflammation to fibrosis. Although clinical presentation varies with age, the number of eosinophils in esophagogastroduodenal endoscopy remains the diagnostic gold standard. While diet elimination, proton pump inhibitors (PPIs), topical corticosteroids, and biological therapy are promising treatment options for EoE, there are insufficient data to determine the optimal therapeutic treatment approach. Combination therapies - the use of dietary therapies in conjunction with other treatment modalities, such as PPIs, topical corticosteroids, or biologic agents - have also emerged as a potential management strategy for EoE. In this systematic review, we attempt to highlight the recent advances in EoE therapies and provide updated guidance to their management. From 2017 to 2022, we conducted a comprehensive electronic search of PubMed (MEDLINE) using specific keywords related to our objective and eventually included a total of 44 articles.
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Affiliation(s)
- Priyata Dutta
- Internal Medicine, Trinity Health Ann Arbor, Ypsilanti, USA
| | - Prince Shah-Riar
- Internal Medicine, Ibn Sina Medical College, Dhaka, BGD
- Internal Medicine, University Muslim Medical Association Community Clinic, Los Angeles, USA
| | | | | | - Zahin Islam Rafa
- Internal Medicine, Ibn Sina Medical College and Hospital, Dhaka, BGD
| | - Fadi Hawa
- Internal Medicine, St. Joseph Mercy Ann Arbor Hospital, Ann Arbor, USA
- Internal Medicine/Gastroenterology and Hepatology, University of Michigan, Ann Arbor, USA
| | | | - Supti Dev Nath
- Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, USA
| | | | - Nishat Shama
- Internal Medicine, Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders, Dhaka, BGD
| | - Farzana Khair
- Internal Medicine, Bangladesh Medical College & Hospital, Dhaka, BGD
| | - Sadia Maisha
- Internal Medicine, Sher-e-Bangla Medical College, Barisal, BGD
| | - Progga Kapuria
- Internal Medicine, Z.H. Sikder Women's Medical College and Hospital, Dhaka, BGD
| | - Barna Dam
- Internal Medicine, Kumudini Women's Medical College, Tangail, BGD
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6
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Fujiwara Y, Kanamori A, Sawada A, Ominami M, Fukunaga S, Otani K, Hosomi S, Nagami Y, Taira K, Tanaka F. Prevalence of elderly eosinophilic esophagitis and their clinical characteristics. Scand J Gastroenterol 2023; 58:1222-1227. [PMID: 37292015 DOI: 10.1080/00365521.2023.2220854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
BACKGROUND AND AIMS Eosinophilic esophagitis (EoE) is predominantly found in middle-aged men among adults. There are few reports about EoE in the elderly, despite an ageing population. The study aimed to define the prevalence and clinical characteristics of EoE amongst older adults. METHODS Elderly patients (defined as those ≥65 years) were compared to younger adults (18-64) in terms of clinical characteristics (age, gender, presenting symptoms, comorbidities), histological activity (eosinophil count), treatment modality and response to treatment. A pre- existing prospectively generated database of all EoE patients presenting to our department between February 2010 and December 2022 was interrogated. 309 patients who underwent endoscopy and esophageal biopsy and were found to have ≥15 eosinophils/HPF were defined as having EoE and were included for study. Statistical analyses were performed using Fisher's extract test or Mann-Whitney U test. RESULTS 309 cases of EoE were recorded, mean age 45.7, range (21-88 years), of which20 patients were aged 65 years and over. Compared to younger patients, those aged ≥65 had more medical comorbidities (15 [75%] vs 111[38%], p = 0.002), and instead a non-significant trend toward less fibrosis (0.25 vs 0.46, p = 0.117). Although rate of cases required topical steroid (TCS) therapy was similar, none received repeated or maintenance TCS therapy in elderly. CONCLUSION In our cohort, only 20 patients (6%) were aged 65 years or older, suggesting that EoE is uncommon in the elderly. The clinical characteristics of EoE in the older age group were similar to the younger patients. Future studies with prospective data collection may determine if EoE disappears with age, or if the younger mean age is reflective of an increasing prevalence in recent years, that may be realized in the elderly EoE population in the future.
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Affiliation(s)
- Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Atsushi Kanamori
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Akinari Sawada
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Masaki Ominami
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Shusei Fukunaga
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Koji Otani
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Shuhei Hosomi
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka Metropolitan University, Abenoku, Japan
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7
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Two cases of eosinophilic gastrointestinal disorder due to newly appearing food allergies after cord blood transplantation. Transpl Immunol 2023; 77:101781. [PMID: 36603700 DOI: 10.1016/j.trim.2022.101781] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 12/30/2022] [Indexed: 01/04/2023]
Abstract
Eosinophilic gastrointestinal disorders (EGIDs) are infrequent complications after allogeneic hematopoietic cell transplantation (allo-HCT). Furthermore, it is well-known that allergic diseases are transferable after allo-HCT from allergic donors to non-allergic recipients. However, the type of graft-versus host disease (GVHD) prophylaxis that leads to allergic disease transfer is unclear. Furthermore, no study has reported a case of acquired food allergy resulting in EGID that was detected based on the clinical course and the detection of antigen-specific immunoglobulin E after allo-HCT. We encountered two patients with acute leukemia accompanied by eosinophilic esophagitis (EoE) and eosinophilic gastroenteritis (EGE) due to newly appearing food allergy after cord blood transplantation (CBT) with T-cell non-depletion GVHD prophylaxis. Despite having no history of allergic disease, the patients experienced allergic symptoms due to dairy products (Case 1) and eggs (Case 2) after CBT. They subsequently experienced severe nausea, heartburn, and anorexia (Case 1) and diarrhea (Case 2). Cases 1 and 2 were diagnosed with EoE and EGE, respectively, based on endoscopic and histological examinations. Dietary treatment without steroids improved the symptoms in both cases. These cases highlight that the unexpected transfer of food allergy after CBT can lead to EGIDs, especially in patients receiving T-cell non-depletion GVHD prophylaxis.
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8
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Eosinophilic Esophagitis—What Do We Know So Far? J Clin Med 2023; 12:jcm12062259. [PMID: 36983260 PMCID: PMC10051236 DOI: 10.3390/jcm12062259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023] Open
Abstract
Eosinophilic esophagitis is a Th-2 antigen-mediated disease in which there is an influx of eosinophils to all layers of the esophagus, triggering an inflammatory response. Chronic inflammatory process causes esophageal remodeling, leading to difficulties in swallowing. Food impaction, heartburn, and chest pain are other characteristic (but not pathognomonic) symptoms in adults. Although the disease has only been described since in the early 1970s, its incidence and prevalence are rapidly growing, especially in Western countries. According to the diagnostic guidelines, there should be at least 15 eosinophils visible per high-power field in biopsies obtained from different sites in the esophagus upon endoscopy with relevant esophageal symptoms. Other diseases that can cause esophageal eosinophilia should be ruled out. Eosinophilic esophagitis treatment may be challenging; however, new methods of management have recently emerged. The currently used proton pump inhibitors, topical corticosteroids, and elimination diet are combined with biological treatment. New methods for disease diagnostics and clinical course assessment are also available. This review presents current knowledge about the disease, supported by the latest research data.
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9
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Eosinophilic esophagitis focusing on dysphagia. Dysphagia 2023. [DOI: 10.1016/b978-0-323-99865-9.00001-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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10
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Shiotani A, Kasugai K. Pharynx and esophagus: Esophageal benign diseases. Dig Endosc 2022; 34 Suppl 2:31-35. [PMID: 34486771 DOI: 10.1111/den.14109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/09/2021] [Accepted: 08/18/2021] [Indexed: 02/08/2023]
Affiliation(s)
- Akiko Shiotani
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Kunio Kasugai
- Division of Gastroenterology, Department of Internal Medicine, Aichi Medical University School of Medicine, Aichi, Japan
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11
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Suzuki Y, Iizuka T, Hosoi A, Kikuchi D, Okamura T, Ochiai Y, Hayasaka J, Dan N, Mitsunaga Y, Tanaka M, Odagiri H, Nomura K, Yamashita S, Matsui A, Hoteya S. Clinicopathological Differences between Eosinophilic Esophagitis and Asymptomatic Esophageal Eosinophilia. Intern Med 2022; 61:1319-1327. [PMID: 34670895 PMCID: PMC9152855 DOI: 10.2169/internalmedicine.8241-21] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective According to consensus guidelines, eosinophilic esophagitis (EoE) is defined as a clinicopathological entity whose symptoms and histology must always be considered together. However, endoscopic findings typical of EoE are often seen in asymptomatic esophageal eosinophilia (aEE). We aimed to clarify the clinicopathological features of aEE. Methods We retrospectively compared cases of aEE and those of symptomatic EoE. Materials We reviewed 146 patients who underwent upper gastrointestinal endoscopy and were confirmed histopathologically to have esophageal eosinophil infiltration of at least 15 eosinophils per high-power field. They were divided into the aEE group (n=75) and the EoE group (n=71). Patients' clinicopathological findings were then collected and examined. Results The EoE group experienced dysphagia (47.9%), heartburn (40.8%), food impaction (40.8%), chest pain (16.9%), and other symptoms (8.5%). There was no significant difference between the two groups with regard to age, sex, current smoking status, or alcohol consumption. The aEE group had a significantly higher body mass index (p<0.01) and significantly lower frequency of concurrent allergic diseases (p<0.01) than the EoE group. No significant differences were found between the two groups with regard to the mean peripheral blood eosinophil count, non-specific immunoglobulin E concentration, peak eosinophil infiltration in the biopsy specimens, EoE histology scoring system, phenotype and location of typical endoscopic findings of EoE, or thickness of the esophagus wall or the mucosal and submucosal layer as measured by endoscopic ultrasonography. Two patients in the aEE group who were followed up without treatment subsequently developed esophageal symptoms. Conclusion aEE and EoE may have the same clinicopathological features.
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Affiliation(s)
- Yugo Suzuki
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Toshiro Iizuka
- Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hopital, Japan
| | - Atsuko Hosoi
- Department of Pathology, Toranomon Hospital, Japan
| | | | | | | | | | - Nobuhiro Dan
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Masami Tanaka
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Kosuke Nomura
- Department of Gastroenterology, Toranomon Hospital, Japan
| | | | - Akira Matsui
- Department of Gastroenterology, Toranomon Hospital, Japan
| | - Shu Hoteya
- Department of Gastroenterology, Toranomon Hospital, Japan
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12
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Nagahara A, Shiotani A, Iijima K, Kamada T, Fujiwara Y, Kasugai K, Kato M, Higuchi K. The role of advanced endoscopy in the management of inflammatory digestive diseases (upper gastrointestinal tract). Dig Endosc 2022; 34:63-72. [PMID: 33772880 DOI: 10.1111/den.13982] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The Japan Gastroenterological Endoscopy Society held four serial symposia between 2019 and 2020 on the state-of-the-art of issues related to upper GI inflammatory diseases. This review discusses some of the topics addressed in these symposia. The papers regarding nonerosive reflux disease, recent improvements in intraesophageal pH-impedance monitoring and endoscopic diagnosis using image-enhanced endoscopy have been published. Many publications have addressed its usefulness in endoscopic treatment of gastroesophageal reflux disease such as anti-reflux mucosectomy. In the management of eosinophilic esophagitis, since the symptoms are subjective, objective indicators have been sought, and ultrasonography and high-resolution manometry may be useful tools for evaluation. The natural course of this condition, especially of asymptomatic cases, is not well clarified. Some newly developed anti-acid or anti-inflammatory medicines are now under investigation. With regard to autoimmune gastritis, because of widespread medical examinations, diagnosis of asymptomatic cases has been increasing. Recently, its endoscopic characteristics have become clear and the natural history of these conditions is being elucidated. The Kyoto Classification of Gastritis has been reported to be useful not only for Helicobacter pylori diagnosis but also for identification of risks of gastric cancer. Its usefulness is now recognized in Asia and Europe.
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Affiliation(s)
- Akihito Nagahara
- Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan
| | - Akiko Shiotani
- Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Okayama, Japan
| | - Katsunori Iijima
- Department of Gastroenterology, Akita University School of Medicine, Akita, Japan
| | - Tomoari Kamada
- Department of Health Care Medicine, Kawasaki Medical School, Okayama, Japan
| | - Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kunio Kasugai
- Department of Gastroenterology, Aichi Medical University, Aichi, Japan
| | - Mototsugu Kato
- Department of Gastroenterology, National Hospital Organization Hakodate National Hospital, Hokkaido, Japan
| | - Kazuhide Higuchi
- Second Department of Internal Medicine, Osaka Medical College, Osaka, Japan
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Fujiwara Y, Tanaka F, Sawada A, Nadatani Y, Nagami Y, Taira K, Nakamura N, Watanabe T, Ohsawa M, Sakamoto H. A case series of sublingual immunotherapy-induced eosinophilic esophagitis: stop or spit. Clin J Gastroenterol 2021; 14:1607-1611. [PMID: 34536216 DOI: 10.1007/s12328-021-01520-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/12/2021] [Indexed: 01/10/2023]
Abstract
We experienced six cases with eosinophilic esophagitis (EoE). They complained of dysphagia, heartburn, or retrosternal discomfort. Endoscopy revealed typical findings of EoE and biopsy examination showed significant eosinophil infiltration in the esophageal epithelium. They received sublingual immunotherapy (SLIT) for allergic rhinitis. Discontinuation or spit method during SLIT resulted in improvement of symptoms, and endoscopic and histological remission. Previously six cases with SLIT-induced EoE has been reported. Our case series suggest that SLIT is clearly associated with the development of EoE by entering of aeroallergens from the luminal side of the esophagus and spit method during SLIT might be one of the therapeutic options for SLIT-induced EoE.
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Affiliation(s)
- Yasuhiro Fujiwara
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Fumio Tanaka
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Akinari Sawada
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Yuji Nadatani
- Department of Premier Preventive Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuaki Nagami
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Koichi Taira
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan
| | - Naohiro Nakamura
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Toshio Watanabe
- Department of Premier Preventive Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Sakamoto
- Department of Otolaryngology, Head and Neck Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Sarbinowska J, Wiatrak B, Waśko-Czopnik D. Searching for Noninvasive Predictors of the Diagnosis and Monitoring of Eosinophilic Esophagitis-The Importance of Biomarkers of the Inflammatory Reaction Involving Eosinophils. Biomolecules 2021; 11:biom11060890. [PMID: 34203871 PMCID: PMC8232675 DOI: 10.3390/biom11060890] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 01/07/2023] Open
Abstract
Background: Invasive and costly endoscopic diagnosis is obligatory for the diagnosis and monitoring of eosinophilic esophagitis (EoE). This study aims to evaluate the usefulness of serum biomarkers involved in eosinophil-mediated inflammation in the management of EoE. Methods: A prospective cohort study was conducted in 58 patients with dysphagia. Each participant completed a health questionnaire, underwent esophagogastroduodenoscopy with esophageal biopsy for histopathological examination and assessment of total, inflammatory and fibrostenotic Eosinophilic Esophagitis Reference Score (EREFS). Serum levels of interleukin 5 (IL-5), interleukin 13 (IL-13), transforming growth factor β1 (TGF-β1), major basic protein (MBP), and eotaxin 3 were determined by enzyme immunoassays. Total of 16 patients meeting the histological criteria for EoE were treated with proton pump inhibitors for 8 weeks, and then the same diagnostics was performed again. Results: Statistically significantly higher concentrations of MBP and TGF-β1 were demonstrated in the group of patients with EoE, while MBP and eotaxin 3 correlated with the peak eosinophil count (PEC). Baseline MBP levels and eotaxin 3 after treatment significantly positively correlated with EREFS. There was a negative correlation between IL-13 and fibrostenotic EREFS. Additionally, after treatment, a negative correlation TGF-β1 was noted with the inflammatory EREFS and a positive correlation with the fibrostenotic EREFS. Conclusions: The potential role of MBP in predicting the diagnosis of EoE, eotaxin 3 in predicting the advancement and correlation of IL-13 and TGF-β1 in differentiating the inflammatory and fibrotic course of the disease may facilitate the management and individualization of EoE therapy.
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Affiliation(s)
- Joanna Sarbinowska
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.S.); (D.W.-C.)
| | - Benita Wiatrak
- Department of Pharmacology, Wroclaw Medical University, Mikulicza-Radeckiego 2, 50-345 Wroclaw, Poland
- Correspondence: ; Tel.: +48-717-841-438
| | - Dorota Waśko-Czopnik
- Department of Gastroenterology and Hepatology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (J.S.); (D.W.-C.)
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