Liacouras, C.A. et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J. Allergy Clin. Immunol. 128, 3-20

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


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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    • "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
    • "Not surprisingly, the exclusive use of prokinetic medications (such as metoclopramide) and anti-emetic medication (such as ondansetron or maropitant ) did not able resolve the clinical signs in one report (Mazzei et al., 2009). The use of immunosuppressive agents, such as anti-IL-5, anti-IL-3, and anti-eotaxin, has been recommended for people with eosinophilic esophagitis , but the beneficial effects of these treatments are still under scrutiny (Liacouras et al., 2011). "
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    ABSTRACT: Eosinophils play a crucial role in the inflammatory response in conjunction with both innate and adaptive immunity. Eosinophils have long been recognized as inflammatory leukocytes that are particularly important in patients with parasitic infestations. However, recent studies in veterinary medicine demonstrate a number of canine eosinophilic gastrointestinal (GI) disorders unrelated to a parasitic infestation. Although the underlying pathophysiology behind eosinophilic infiltration of the canine GI tract remains uncertain, medical intervention aiming to decrease the activation of eosinophils seems effective in reducing symptoms and preventing organ damage. This review focuses on the biology of eosinophils and their products. It describes, the composition of eosinophil granules, mechanisms of eosinophil activation, and eosinophil-related disease processes leading to organ damage. Even though the main clinical signs of canine eosinophilic gastroenteritis, vomiting and diarrhea, are similar to those of other types of gastroenteritis, the clinical response and prognosis are worse for this condition. The clinical signs and diagnostic approach for eosinophilic GI disorders are described and compared between canine and human patients for each region of GI tract, from the esophagus to the colon. Moreover, the current treatments for this syndrome in canine and human patients are summarized and paralleled. The comparative study of canine and human patients with eosinophilic gastroenteritis will advance the understanding of this syndrome in both species and may lead to the development of novel treatment strategies.
    Animal Health Research Reviews 05/2014; 17(01):1-11. DOI:10.1017/S1466252314000012
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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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