Eosinophilic esophagitis: Updated consensus recommendations for children and adults

Center for Pediatric Eosinophilic Disorders, Division of Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
The Journal of allergy and clinical immunology (Impact Factor: 11.48). 04/2011; 128(1):3-20.e6; quiz 21-2. DOI: 10.1016/j.jaci.2011.02.040
Source: PubMed

ABSTRACT Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.

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Available from: Glenn T Furuta, Sep 29, 2015
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    • "These agents should provide stable contrast despite transient interference from bowel gas, enabling molecular imaging of normal and abnormal structures throughout the gastrointestinal (GI) tract (Mittal et al. 2005; Schwartz et al. 2001). Eosinophilic esophagitis (EoE) is an inflammatory condition of the esophagus caused by the infiltration and activation of eosinophils in the esophageal mucosa (Furuta et al. 2007; Liacouras et al. 2011; Straumann et al. 2003). Current diagnosis requires collection of multiple biopsies throughout the esophagus, which are evaluated for eosinophilic invasion (Dellon et al. 2013). "
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    ABSTRACT: Although traditional microbubble contrast agents are bright, the high contrast of gas bubbles and air-water interfaces in the upper gastrointestinal tract renders these agents less useful for diagnosing diseases such as eosinophilic esophagitis, a disease characterized by patchy infiltration of eosinophils into the esophagus. Here we report a first-in-class ultrasound contrast enhancement agent composed of echogenic insulin particles, which are labeled with molecular recognition elements to diagnose eosinophil-associated diseases. We prepared solid echogenic insulin particles, tethered antibodies to eosinophil granule major basic protein 1 (MBP-1) to their surfaces and experimentally evaluated binding of these agents to MBP-1 on ex vivo non-human primate esophagi. We found that insulin particles can be readily observed by ultrasound and bind to MBP-1-coated esophagi within minutes. Our results suggest the potential of this new class of solid contrast agents to image, diagnose and improve management of eosinophilic esophagitis. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.
    Ultrasound in Medicine & Biology 01/2015; 41(3). DOI:10.1016/j.ultrasmedbio.2014.09.017 · 2.21 Impact Factor
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    • "There is no clinical or histological finding known to be pathognomonic for EoE.1 Isolated esophageal eosinophilia meeting criteria for EoE may respond to proton pump inhibitor (PPI) treatment. This entity is termed proton pump inhibitor responsive esophageal eosinophilia (PPI-REE).1,3 GERD is thought to comprise a subgroup of patients with PPI-REE. "
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    ABSTRACT: Eosinophilic esophagitis (EoE) and gastroesophageal reflux disease are among the major causes of isolated esophageal eosinophilia. Isolated esophageal eosinophilia meeting criteria for EoE may respond to proton pump inhibitor (PPI) treatment. This entity is termed proton pumps inhibitor responsive esophageal eosinophilia (PPI-REE). Gastro-esophageal reflux is thought to comprise a subgroup of patients with PPI-REE. According to the latest guidelines, PPI responsiveness distinguishes people with PPI-REE from patients having EoE (non-responders). In this report, two unusual cases with findings belonging to both EoE and PPI-REE are discussed with known and unknown facts.
    Pediatric reports 05/2014; 6(2):5160. DOI:10.4081/pr.2014.5160
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    • "The presence of more than 15 eosinophils per high power field (HPF) is the gold standard for diagnosis [5]. EoE has been shown to be a T-helper-2 lymphocyte-driven disorder with upregulation of interleukins (IL) 4, 5 and 13 [5]. The number of mucosal mast-cells is also increased and migration of eosinophils to the oesophagus is controlled by three critical effector molecules: IL- 5, IL-13, eotaxin-3 [6]. "
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    ABSTRACT: Eosinophilic oesophagitis is an inflammatory condition characterized by a dense eosinophilic infiltrate. The migration of eosinophils into the oesophagus is influenced by cytokines such as IL-5, IL-13 and eotaxin-3. The aim of this study was to evaluate changes in the cytokine expression profiles (IL-5, IL-13 and eotaxin-3/CCL26) in children after topical steroid treatment. a prospective case-control study was performed in 23 paediatric patients (age 5-16 years) with a histological diagnosis of eosinophilic oesophagitis. Histological evaluation and cytokine levels assay (IL-5, IL-13 and eotaxin-3/CCL26) in the proximal and distal oesophagus were performed before, and after 8 weeks of topical budesonide. Data were compared with a matched healthy control group. quantitative expression levels of IL-5, IL-13 and eotaxin-3 were significantly higher in the eosinophilic oesophagitis group both compared to healthy subjects (p<0.0001). A significant reduction of the eosinophil infiltrate as well as of IL-5, IL-13 and eotaxin-3 mucosal profiles was observed after steroid treatment both at the proximal and distal oesophagus (p<0.0001). IL-5, IL-13 and eotaxin-3/CCL26 are significantly over-expressed in the oesophageal epithelium of children with eosinophilic oesophagitis. Topical steroid treatment (inhaled and swallowed budesonide) can induce clinical response with partial mucosal remission.
    Digestive and Liver Disease 04/2014; 46(7). DOI:10.1016/j.dld.2014.03.003 · 2.96 Impact Factor
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