Evaluation of T-lymphocytes in esophageal mucosal biopsies.
ABSTRACT We previously demonstrated that in esophageal mucosal biopsies, intraepithelial cells with irregular nuclear contours (CINC) as well as mononuclear cells with round nuclei are T-lymphocytes and we suggested that they may be an independent marker of esophagitis. To investigate this hypothesis, we evaluated Hematoxylin and eosin-stained biopsy specimens from 201 consecutive patients (115 female, 86 male; mean age: 52 years) that showed either no accepted features of esophagitis (n = 122) or changes typical of esophageal reflux (n = 79). The number of intraepithelial CINC and mononuclear cells in the most densely populated high power field were counted. Twenty-two of these biopsies were also stained with UCHL-1 (T-lymphocyte marker) and L-26 (B-lymphocyte marker). All medical records were reviewed to determine clinical and endoscopic findings of esophagitis, which were then compared with the histologic results for correlations. The immunohistochemical results confirmed that the majority (> 95%) of CINC and mononuclear cells were T-lymphocytes, and the sum of CINC and mononuclear cells represents best the number of T-lymphocytes. The number of T-lymphocytes was significantly correlated with that of eosinophils (R = 0.24, P = 0.0008) but not with neutrophils (R = 0.069, P = 0.33). They were greater in number, although not significantly so, in the specimens with histologic evidence of esophagitis than those without (12.7 +/- 8.9 versus 11.3 +/- 7.7, P = 0.23).(ABSTRACT TRUNCATED AT 250 WORDS)
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ABSTRACT: The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the role of salivary stimulation and esophageal secretion of protective factors in prevention of adenocarcinoma sequelae in gastroesophageal reflux disease; the pediatric conditions associated with esophageal cancer; the relationship of achalasia and pseudoachalasia with esophageal cancer; the potential for malignant transformation in eosinophilic esophagitis and overlap syndromes; the role of lymphocytic esophagitis as an overlapping phenotype; the role of Barrett's esophagus as a premalignant condition; the indications and type of treatment of premalignant conditions of the esophagus; and the decision for use of endoscopical procedures in premalignant conditions of the esophagus.Annals of the New York Academy of Sciences 09/2014; 1325(1). DOI:10.1111/nyas.12534 · 4.31 Impact Factor
Article: Esofagitis eosinofílica[Show abstract] [Hide abstract]
ABSTRACT: La esofagitis eosinofílica se caracteriza por la infiltración del esófago por leucocitos eosinófilos. Representa una reacción local frente a alérgenos a los que el paciente muestra sensibilización previa, adquirida por vía digestiva, inhalatoria o incluso epicutánea. El esófago posee células residentes que participan en la captación, procesamiento y presentación de antígenos a los linfocitos T, que iniciarían una respuesta T helper 2 mediada por la interleucina 5. En la fisiopatología también participa un posible componente T helper 1 e inmunoglobulinas E de producción local, por lo que puede considerarse un trastorno inmunológico mixto. La identificación de los alérgenos causantes debe incluir la determinación de sensibilizaciones mediadas por inmunoglobulina E e hipersensibilidad retardada mediada por células.Los síntomas principales de la esofagitis eosinofílica son disfagia e impactaciones de alimento en el esófago por alteraciones endoscópicas y trastornos motores. La activación de los eosinófilos y mastocitos y la desgranulación de sus proteínas contra los alérgenos causales dañan el epitelio esofágico y alteran los componentes neuromusculares de la pared del esófago.Entre los tratamientos ensayados figuran el control de la exposición a antígenos, la dilatación de las estenosis endoscópicas y los fármacos con efecto antieosinofílico, entre los que destacan los glucocorticoides de aplicación tópica, que revierten la inflamación y restauran la histología y la motilidad esofágicas.Medicina Clínica 04/2007; 128(15):590-597. DOI:10.1157/13101616 · 1.25 Impact Factor
Article: What mucosal biopsies have to offer[Show abstract] [Hide abstract]
ABSTRACT: Biopsies are the current gold standard test for the diagnosis of all acute and chronic inflammatory diseases in the upper gastrointestinal tract, because changes associated with these diseases are not always visible on endoscopy. However, the correlation of inflammation with symptoms such as those that might suggest ulcers, erosions or non-ulcer dyspepsia is unclear. Terms such as erosions and mucosal breaks are often misinterpretations of endoscopic features frequently associated with some form of redness. However, redness often does not correlate with histological inflammation. In the stomach, it may be a marker of ingestion of nonsteroidal anti-inflammatory drugs (NSAIDs) or of other chemicals such as alcohol, or of duodeno-gastric reflux. Endoscopic findings should remain descriptive and attempts at interpretation should not be made unless the endoscopist is quite certain that the interpretation is correct. It makes little sense to base treatment and symptom-related improvement on these new paradigms, until there is evidence that such assumptions and correlations are justified.Histological changes indicative of gastro-oesophageal reflux disease are found on both sides of the squamo-columnar junction (Z-line). In the gastric cardia, inflammation is found in the absence of Helicobacter pylori or other known causes of gastritis (carditis); the squamous mucosa is most likely to show inflammatory changes such as neutrophils or eosinophils close to the Z-line, while traditional reactive changes in the squamous mucosa remain valid only in biopsies taken at least 3 cm above the Z-line. Endoscopic criteria of reflux disease have a morphological counterpart in capillary congestion and haemorrhage into the papillae, which have largely been ignored by pathologists as secondary to biopsy trauma. A biopsy protocol that maximizes the chances of detecting changes due to reflux disease is suggested.The traditional definition of Barrett's oesophagus as requiring 3 cm of glandular mucosa extending into the oesophagus is no longer tenable. It is suggested that Barrett's oesophagus is redefined as intestinal metaplasia in the lower oesophagus. It is currently unclear whether patients with such minimal Barrett's epithelium are at increased risk of adenocarcinoma, or require surveillance.Alimentary Pharmacology & Therapeutics 12/1997; 11(s2). DOI:10.1111/j.1365-2036.1997.tb00789.x · 4.55 Impact Factor