Eosinophilic esophagitis. N Engl J Med

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
New England Journal of Medicine (Impact Factor: 55.87). 09/2004; 351(9):940-1. DOI: 10.1056/NEJM200408263510924
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    • "A betegség leggyakrabban gyermekkorban vagy fi atal felnőttkorban jelentkezik [2]. Noel és mtsai 2000– 2003 között az ohiói gyermekpopulációban vizsgálva az EoE-prevalenciát 4/100 000, az EoE-incidenciát 0,9– 1,3/100 000-nek találták [3]. Egy 16 éven át tartó svájci tanulmány hasonló prevalenciát (2/100 000) és incidenciát (1,4/100 000) fi gyelt meg felnőtt betegek körében [4]. "
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    ABSTRACT: Eosinophilic esophagitis is considered to be a chronic antigen-driven disease whereby food and/or aeroallergens induce a chronic inflammatory infiltrate in the esophagus leading to pathological hyperplasia of the epithelial and muscular layers, fibrosis of the lamina propria and symptoms of dysphagia and food impaction. Eosinophilic esophagitis is often associated with other allergic diseases such as asthma or atopic dermatitis. Current first line treatments of the disease include strict dietary modification and topical anti-inflammatory steroids. In this review the authors summarize currently available treatment strategies of eosinophilic esophagitis. Orv. Hetil, 2015, 156(23), 927-932.
    Orvosi Hetilap 06/2015; 156(23):927-32. DOI:10.1556/650.2015.30164
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    • "Accumulating evidence has shown a strong familial association in EoE (15). Zink et al. (24) reported EoE to span over two generations in five out of seven families studied. "
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    ABSTRACT: Eosinophilic esophagitis (EoE) is an emerging disease characterized by esophageal eosinophilia (>15eos/hpf), lack of responsiveness to acid-suppressive medication and is managed by allergen elimination and anti-allergy therapy. Although the pathophysiology of EoE is currently unsubstantiated, evidence implicates food and aeroallergen hypersensitivity in genetically predisposed individuals as contributory factors. Genome-wide expression analyses have isolated a remarkably conserved gene-expression profile irrespective of age and gender, suggesting a genetic contribution. EoE has characteristics of mainly TH2 type immune responses but also some TH1 cytokines, which appear to strongly contribute to tissue fibrosis, with esophageal epithelial cells providing a hospitable environment for this inflammatory process. Eosinophil-degranulation products appear to play a central role in tissue remodeling in EoE. This remodeling and dysregulation predisposes to fibrosis. Mast-cell-derived molecules such as histamine may have an effect on enteric nerves and may also act in concert with transforming growth factor-β to interfere with esophageal musculature. Additionally, the esophageal epithelium may facilitate the inflammatory process under pathogenic contexts such as in EoE. This article aims to discuss the contributory factors in the pathophysiology of EoE.
    Frontiers in Pediatrics 05/2014; 2:41. DOI:10.3389/fped.2014.00041
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    • "An endoscopic esophageal biopsy is essential for establishing a diagnosis.4–7 The lack of knowledge regarding EoE-affected children and adults has delayed diagnosis and treatment. "
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    ABSTRACT: We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils.
    09/2013; 7:41-48. DOI:10.4137/CMPed.S12733
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