Eosinophilic esophagitis

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Eosinophilic esophagitis

Presented by Chuleeporn Kongmeesook, MD,

2013

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Eosinophilic esophagitis

  1. 1. Eosinophilic Esophagitis CHULEEPORN KONGMEESOOK ,MD
  2. 2. Outline • Prevalence • Diagnosis • Clinical presentation • Endoscopic and Histologic finding • Management
  3. 3. Definition A chronic, immune/antigen-mediated esophageal disease characterized • Clinically by symptoms related to esophageal dysfunction • Histologically by eosinophil-predominant inflammation ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  4. 4. • Non-Hispanic • White • Atopic males (male/female ratio 3:1) • Onset in childhood or during the third or fourth decades of life • Incidence 0.7-10 per 100,000 per person-year • Prevalence 0.2-43 per 100,000 Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  5. 5. Diagnosis • Symptomatic patients after a biopsy that confirms 15 Eos/HPF • At least one esophageal level (eg, distal, proximal) • In whom acid reflux has been ruled out Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  6. 6. Eosinophil associated esophagitis ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  7. 7. Clinical Manifestation Mirna Chehade et al Aceves Current Opinion in Allergy and Clinical Immunology 2010;10:231-237
  8. 8. • Any pt with symptoms suggestive of EoE should undergo careful history focus on eating and swallowing habits • Children and adults with EoE often rapidly adapt eating habits to manage their impaired esophageal function ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  9. 9. Endoscopic Finding • Esophageal endoscopy with biopsy  reliable diagnostic test for EoE • Appropriate clinical setting + any endoscopic finding supports but not establish the Dx of EoE • 2-4 mucosal specimens of the proximal and distal esophagus should be obtain ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  10. 10. ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  11. 11. Radiography • Not a recommended routinely • Helpful in selected cases anatomic abnormalities difficult to endoscope esophageal strictures (length and diameter) ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  12. 12. Histologic Finding 1 • At least 15 Eos/hpf in the maximally affected esophageal tissue • Histopathologic features of esophageal mucosal biopsy must be interpreted in with the patient’s clinical information ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  13. 13. Histologic Finding 2 • EoE might be focal and not be present in all biopsy specimens • Peak number of Eos/hpf as average number • Site and number of biopsy  Affect Eos count ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  14. 14. ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  15. 15. • Esophageal pH monitoring (and pH impedance ) useful diagnostic test to evaluate for GERD in pts with esophageal eosinophilia • Peripheral eosinophil counts pts with EoE 40-50% having increased numbers of circulating Eos (>300-350 /mm3) • Total IgE inadequate data to support the utility of measuring total IgE level as a surrogate disease in pts with EoE ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  16. 16. Management Corticosteroid therapy • Increase eosinophil apoptosis • Downregulate eosinophil chemotaxis • Inhibit proinflammatory cytokines that promote eosinophil survival and activation Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  17. 17. Management Systemic oral corticosteroid • Induce remission of EoE symptoms and both gross and histologic features • Long-term steroid adverse effects and relapse after discontinuation Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  18. 18. Management Topical corticosteroid • Modulation of esophageal gene expression Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  19. 19. ChrisA. Liacouras et al J Allergy Clin Immunol 2011;128:3-20
  20. 20. Management Dietary therapy • Elemental dietary therapy • Targeted dietary elimination • Empiric dietary elimination Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  21. 21. Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  22. 22. Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  23. 23. Conclusions Matthew Greenhawat et al J Allergy Clin Immunol : In Practice 2013;1:332-40
  24. 24. THANK YOU

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