Eosinophilic Esophagitis Flashcards
Eosinophilic esophagitis (EoE) ………?
Eosinophilic esophagitis (EoE) is a chronic esophageal disorder characterized by esophageal dysfunction and infiltration of the esophageal epithelium by ≥15 eosinophils per high-power field.
Diagnostic criteria for Eosinophilic esophagitis………
The diagnosis of EoE should be considered in the
clinical presentation of esophageal dysfunction,
associated with esophageal epithelial infiltration of at least 15 eosinophils (eos) per high power field (hpf) or ~60 eos per mm2, and
after a careful evaluation of non-EoE disorders
Age of presentation of EoE…….
The mean age at diagnosis is 7 yr (range: 1-17 yr), and the duration of symptoms is 3 yr.
Many patients have other atopic diseases (or a positive family history) and associated food allergies;
laboratory abnormalities can include peripheral eosinophilia and elevated immunoglobulin E (IgE) levels
Pathogenesis of EoE……
The pathogenesis involves mainly T-helper type 2 cytokine-mediated (interleukin 5 and 13) pathways leading to production of a potent eosinophil chemoattractant, eotaxin-3, by esophageal epithelium
EREFS………..
The eosinophilic esophagitis endoscopic reference score (EREFS), based on commonly observed features of edema (E), rings (R), exudates (E), furrows (F), strictures (S), has utility in diagnosis and monitoring response to treatment
How to differentiate between GERD and EoE……
EoE is differentiated from gastroesophageal reflux disease by concurrent atopic diseases, its general lack of erosive esophagitis, its greater eosinophil density, and its normal esophageal pH-multichannel intraluminal impedance results
Role of PPI in EoE…..
A favorable response to proton pump inhibitor therapy should no longer be considered diagnostic of gastroesophageal reflux disease
Evaluation of EoE…….
Evaluation of EoE should include a search for food (aerodigestive) and environmental allergies via skin prick (IgE mediated) and patch (non–IgE mediated) tests to guide decisions regarding dietary elimination and future food challenges.
Dietary restrictions in case of EoE
dietary restrictions that take one of 3 forms: elimination diets guided by circumstantial evidence and food allergy test results; “6 food elimination diet” removing the major food allergens (milk, soy, wheat, egg, peanuts and tree nuts, seafood); and elemental diet composed exclusively of an amino acid-based formula.
Elimination diets are generally successful, with highest histologic response observed in nearly 91% on elemental diet and in 72% to empiric dietary elimination
Role of steroids in EoE……
Topically acting swallowed corticosteroids (fluticasone without spacer, viscous budesonide suspension) have been used successfully for those who refuse, fail to adhere, or have a poor response to restricted diets.
Histologic remission is observed in 65-77% children and adults treated with fluticasone for 3 mo
Therapies under investigation for EoE……
T herapies under investigation include anti-interleukin-5 antibodies (mepolizumab, reslizumab).
Infective esophagitis……
Candida is the leading cause of infective esophagitis in immunocompetent and immunocompromised children and presents with concurrent oropharyngeal infection in the majority of immunocompromised patients
PILL ESOPHAGITIS……….?
This acute injury is produced by contact with a damaging agent.
Drugs implicated in the pilli esophagitis …….?
Medications implicated in pill esophagitis include tetracycline, doxycycline, potassium chloride, ferrous sulfate, nonsteroidal antiinflammatory medications, cloxacillin, and alendronate
Risk for piili esophagitis……?
Most often the offending tablet is ingested at bedtime with inadequate water.
This practice often produces acute discomfort followed by progressive retrosternal pain, odynophagia, and dysphagia.
