No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Watch it grow: Esophageal impaction with chia seeds
Abstract
Esophageal obstructions are a medical emergency, due to inability to control secretions and risk of perforation. Epidemiology of esophageal foreign-body impaction has evolved to include increasing incidence of non-meat food causes as well as increasing underlying prevalence of pathologies including eosinophilic esophagitis. Chia seeds, a staple known for health benefits, have an uncanny ability to absorb large quantities of water leading to a hydrated gel-like substance which can cause an obstruction. We report the first case of chia seed impaction in a patient with likely eosinophilic esophagitis.
... There exists also a review on health promoting properties and therapeutic applications of chia (Marcinek K., 2017). Simmelink et al. (2016) even warned about possible obstructions caused by chia. Furthermore, chia seeds are found to affect satiety and to be beneficial in the treatment of overweight and obese patients with type 2 diabetes (Vuksan et al., 2017a,b). ...
Background:
The outstanding nutritional and technological properties lead to innovative applications of chia (Salvia hispanica L.) in food products.
Scope and Approach:
The aim of this contribution is to give an overview of the various food application approaches for chia. The nutritional and technological properties of chia as well as its technological and innovative utilization are presented. Examples for the various applications in food products are given in five main topics: baked goods, dairy products, meat and fish products, gluten-free products and other products such as functional food, hydrocolloid and thickener.
Key findings and conclusions:
Besides the nutritional benefits of chia incorporation in food products the technological effects are emphasized very often. Summarized in five main topics, most authors conclude that chia is a valuable food ingredient for functional food development. The application of chia in baked goods for example is beneficial not only to improve the nutritional value but acting as hydrocolloid or substitute egg, fat or gluten. The increase of oil stability and applications as food thickener in novel food applications are of high importance too. As different chia fractions give various options for applications the utilization of chia for further food products will increase significantly in the future.
In many cultures, “food as medicine” has existed for centuries as the foundation of health. It is a practice built on the knowledge that food and diet play important roles in disease prevention and management. Foods possessing therapeutic properties are often referred to as functional foods. Many herbs and spices contain numerous nutritional and non‐nutritional components that can interact with pharmacologically relevant receptors, either directly or indirectly via their metabolites, to regulate cellular biochemical processes. Although opinions are changing, the concept of food as a therapeutic intervention goes against conventional Western medicine. To provide guidance to clinicians interested in using these products, members of the Food as Medicine working group of the Nutrition Committee for the North American Society for Pediatric Gastroenterology, Hepatology & Nutrition, as part of a two‐part review series, have identified frequently used foods, supplements, herbs, and spices that are utilized for therapeutic intent and have created summaries of commonly used indications, doses, and caveats. In this review, the focus is the use of select herbs and spices for medicinal purposes. Gaps in our knowledge in how to effectively use these agents in pediatric patients are discussed. Evidence supporting their use for management of gastrointestinal conditions, especially in the pediatric population, is provided when available. Circumstances in clinical settings and patient indications may require actions different from those recommended in this review and professional judgment should prevail.
Background:
The use of food supplements containing botanicals is increasing in European markets. Although intended to maintain the health status, several cases of adverse effects to Plant Food Supplements (PFS) have been described.
Objectives:
To describe the self-reported adverse effects collected during the European PlantLIBRA PFS Consumer Survey 2011-2012, with a critical evaluation of the plausibility of the symptomatology reported using data from the literature and from the PlantLIBRA Poisons Centers' survey.
Subjects/setting:
From the total sample of 2359 consumers involved in the consumers' survey, 82 subjects reported adverse effects due to a total of 87 PFS.
Results:
Cases were self-reported, therefore causality was not classified on the basis of clinical evidence, but by using the frequency/strength of adverse effects described in scientific papers: 52 out of 87 cases were defined as possible (59.8%) and 4 as probable (4.6%). Considering the most frequently cited botanicals, eight cases were due to Valeriana officinalis (garden valerian); seven to Camellia sinensis (tea); six to Ginkgo biloba (Maidenhair tree) and Paullinia cupana (guarana). Most adverse events related to the gastrointestinal tract, nervous and cardiovascular systems.
Conclusions:
Comparing the data from this study with those published in scientific papers and obtained by the PlantLIBRA Poisons Centers' survey, some important conclusions can be drawn: severe adverse effects to PFS are quite rare, although mild or moderate adverse symptoms can be present. Data reported in this paper can help health professionals (and in particular family doctors) to become aware of possible new problems associated with the increasing use of food supplements containing botanicals.
This study explores the mechanisms underlying the altered lipid metabolism in the heart of dyslipemic insulin-resistant (IR) rats fed a sucrose-rich diet (SRD) and investigates if chia seeds (rich in α-linolenic acid 18:3, n-3 ALA) improve/reverse cardiac lipotoxicity. Wistar rats received an SRD-diet for three months. Half of the animals continued with the SRD up to month 6. The other half was fed an SRD in which the fat source, corn oil (CO), was replaced by chia seeds from month 3 to 6 (SRD+chia). A reference group consumed a control diet (CD) all the time. Triglyceride, long-chain acyl CoA (LC ACoA) and diacylglycerol (DAG) contents, pyruvate dehydrogenase complex (PDHc) and muscle-type carnitine palmitoyltransferase 1 (M-CPT1) activities and protein mass levels of M-CPT1, membrane fatty acid transporter (FAT/CD36), peroxisome proliferator activated receptor α (PPARα) and uncoupling protein 2 (UCP2) were analyzed. Results show that: (a) the hearts of SRD-fed rats display lipotoxicity suggesting impaired myocardial lipid utilization; (b) Compared with the SRD group, dietary chia normalizes blood pressure; reverses/improves heart lipotoxicity, glucose oxidation, the increased protein mass level of FAT/CD36, and the impaired insulin stimulated FAT/CD36 translocation to the plasma membrane. The enhanced M-CPT1 activity is markedly reduced without similar changes in protein mass. PPARα slightly decreases, while the UCP2 protein level remains unchanged in all groups. Normalization of dyslipidemia and IR by chia reduces plasma fatty acids (FAs) availability, suggesting that a different milieu prevents the robust translocation of FAT/CD36. This could reduce the influx of FAs, decreasing the elevated M-CPT1 activity and lipid storage and improving glucose oxidation in cardiac muscles of SRD-fed rats.
The ancient grain is becoming enormously popular in modern food regimen in many countries; the higher proportion of α-linolenic acid makes chia the superb source of omega-3 fatty (about 65 % of the oil content). Omega-3 fatty acid has been associated with a large number of physiological functions in human body. Chia seed is a potential source of antioxidants with the presence of chlorogenic acid, caffeic acid, myricetin, quercetin, and kaempferol which are believed to have cardiac, hepatic protective effects, anti-ageing and anti-carcinogenic characteristics. It is also a great source of dietary fibre which is beneficial for the digestive system and controlling diabetes mellitus with higher concentration of beneficial unsaturated fatty acids, gluten free protein, vitamin, minerals and phenolic compounds. Therapeutic effects of chia in the control of diabetes, dyslipidaemia, hypertension, as anti-inflammatory, antioxidant, anti-blood clotting, laxative, antidepressant, antianxiety, analgesic, vision and immune improver is scientifically established.
In this chapter, a review is made on various aspects of chia seed in order to provide an overall, yet comprehensive view, about this important commodity with the aim of updating the current state of knowledge on its composition, possible nutraceutical properties, and potential benefits for human health. Based on this approach, the discussion includes some comments on the main historical aspects, morphology of the seed, its importance in the diet of humans and stresses the main results issued from investigations on its three main components; lipid, protein, and fiber. The chapter closes with a discussion on the potential benefits for human health, highlighting the contradictions that still exist in this area and the need for continued research in this direction and considerations on the role of chia seed as a functional food.
Chia (Salvia hispanica L.) constitutes a potential alternative raw material and ingredient in food industry applications due to its dietary fiber content. Gum can be extracted from its dietary fiber fractions for use as an additive to control viscosity, stability, texture, and consistency in food systems. The gum extracted from chia seeds was characterized to determine their quality and potential as functional food additives. The extracted chia gum contained 26.2% fat and a portion was submitted to fat extraction, producing two fractions: gum with fat (FCG) and gum partly defatted (PDCG). Proximal composition and physicochemical characterization showed these fractions to be different (
P
<
0.05
). The PDCG had higher protein, ash, and carbohydrates content than the FCG, in addition to higher water-holding (110.5 g water/g fiber) and water-binding capacities (0.84 g water/g fiber). The FCG had greater oil-holding capacity (25.7 g oil/g fiber) and water absorption capacity (44 g water/g fiber). In dispersion trials, the gums exhibited a non-Newtonian fluid behavior, specifically shear thinning or pseudoplastic type. PDCG had more viscosity than FCG. Chia seed is an excellent natural source of gum with good physicochemical and functional qualities, and is very promising for use in food industry.
With increasing public health awareness worldwide, demand for functional food with multiple health benefits has also increased. The use of medicinal food from folk medicine to prevent diseases such as diabetes, obesity, and cardiovascular problems is now gaining momentum among the public. Seed from Salvia hispanica L. or more commonly known as chia is a traditional food in central and southern America. Currently, it is widely consumed for various health benefits especially in maintaining healthy serum lipid level. This effect is contributed by the presence of phenolic acid and omega 3/6 oil in the chia seed. Although the presence of active ingredients in chia seed warrants its health benefits, however, the safety and efficacy of this medicinal food or natural product need to be validated by scientific research. In vivo and clinical studies on the safety and efficacy of chia seed are still limited. This paper covers the up-to-date research on the identified active ingredients, methods for oil extraction, and in vivo and human trials on the health benefit of chia seed, and its current market potential.
Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. Although dense eosinophilia is the hallmark of EoE, other characteristic histologic features have been described that may help distinguish EoE from other competing diagnoses, although none are specific to EoE. One or more foods and, at times, environmental allergens trigger EoE. Left untreated, esophageal inflammation in EoE may lead to esophageal remodeling and stricture formation. Symptoms in EoE vary with age, as they relate to the progression of the disease from an inflammatory to a fibrostenotic phenotype over time. There are currently no U.S. Food and Drug Administration-approved therapies for EoE. Current options include various dietary-restriction therapies, topical corticosteroids, and esophageal dilations. Several emerging therapies aiming at restoring the esophageal barrier function or targeting various inflammatory cells or their mediators are under investigation.
Background: Esophageal food impaction is common, but incidence data are lacking and management is controversial. This is a survey of its epidemiology, endoscopic findings, and treatment. Methods: A retrospective study was conducted of 194 adults with 223 episodes of esophageal food impaction in a health maintenance organization. Of these, 192 (99%) patients were followed a median of 31 months (range 1-72) post-disimpaction. Results: The estimated annual incidence rate of episodes was 13.0 per 100,000, and the male:female ratio was 1.7:1.The rate increased with age, especially after the seventh decade.The bolus was meat in 189 (85%) episodes. Flexible esophagoscopy was performed initially in 222 (99.6%) episodes and permitted disimpaction in 218 (98%).The push technique was used alone or in combination with extraction in 186 (814%). Immediate dilation was performed in 172 (79%).There were no major complications. A final diagnosis was made in 171 (88%), including 151 (78%) with a Schatzki's ring or peptic stricture, and the diagnosis had changed during follow-up in 14(7%). A diagnosis of Schatzki's ring was associated with gender (p = 0.03) and decreased with increasing age (p = 0.003), especially among women. Conclusions: Esophageal food impaction is common and can nearly always be treated safely with flexible esophagoscopy, usually with the push technique.
Acknowledging that eosinophilic esophagitis (EoE) is a disease with variable involvement throughout the oesophagus, studies have suggested a minimum of five biopsies to diagnose EoE. Although it is accepted that furrows and exudates appear to represent areas of inflammation, no research to date has looked specifically at EoE endoscopic findings to see if eosinophilic infiltrate correlates with specific endoscopic findings.
To evaluate the distribution of eosinophils in EoE and determine whether endoscopic appearances predict the degree of eosinophilia at various locations of the oesophagus.
We performed a prospective cross sectional study of EoE (treated and untreated) patients to study the distribution of eosinophils according to endoscopic findings. The oesophagus of 10 EoE patients were biopsied up to 32 times in a circumferential manner. The mucosal changes were documented at the site of each biopsy. Histological determination of eosinophil counts and related histopathology of the oesophagus were then correlated with endoscopic findings. Similar biopsy assessments were made in treated (resolved) EoE patients (n = 6) to determine the permanence of specific endoscopic appearances.
A total of 16 patients were biopsied (10 EoE, 6 treated EoE). A total of 432 biopsies were obtained in all with 294 biopsies from 10 EoE subjects. Eosinophil density was increased distally in the majority of EoE patients. Biopsies performed in areas of exudates and furrows demonstrated higher eosinophil counts. Lines and normal-appearing oesophagi in EoE subjects were not commonly associated with elevated eosinophil counts (>15 eos/HPF). Rings alone without associated furrows or plaques did not demonstrate elevated eosinophil counts and were seen in resolved EoE (Rx-EoE) as well as in active EoE patients.
Eosinophilic esophagitis remains a variable disease with some patients manifesting extensive disease throughout the oesophagus. Characteristics of furrows and exudates found during endoscopy are associated with higher peak eosinophil counts, requiring fewer biopsies to make a diagnosis. Lines and otherwise normal appearances of the oesophagus suggest a milder mucosal eosinophilia, requiring substantial biopsies to adequately identify fields with diagnostic eosinophil counts.
© 2015 John Wiley & Sons Ltd.
EoE is a newly recognised condition that is apparently increasing in prevalence, and the etiology is poorly understood. The role of aeroallergens in eosinophilic esophagitis (EoE) is controversial, given the success of dietary therapy. Massive aeroallergen exposure leading to food bolus obstruction events (FBOE) has been described, and the diagnosis of EoE by esophageal biopsy noted to be more common in the pollen season according to previous case series.
To determine if a seasonal variation and a geographical variation occurred in EoE presenting as FBO in adults, and to track the prevalence of FBOE and EoE over time.
A retrospective case control study analysis was performed from January 2002 to January 2012 to identify all food bolus obstruction events in adults presenting to 5 tertiary hospitals in Melbourne Australia. Endoscopy, histopathological reports, case notes and blood tests were examined, and post codes recorded. Records of pollen counts were obtained. Cases were defined according to esophageal biopsy and grouped based on month of diagnosis. All other causes of FBOE served as controls.
1132 food bolus obstruction events were identified. Biopsies were only performed in 278 of these cases, and 85 patients were found to have EoE after biopsy. Patients with EoE were younger (mean age 38 years, range 18-72 compared to those with alternative diagnosis (mean age 64.4 range 22-92). more likely to be male (M: F=4:1 compared to 1.68:1 ) and had a higher eosinophil count in venous blood. Overall no seasonality was demonstrated in FBOE secondary to any diagnosis, although the six cases of recurrent FBOE secondary to EoE mainly occurred in the grass pollen season in subsequent years. FBOE cases were evenly distributed throughout metropolitan Melbourne irrespective of population density. EoE as a percentage of FBOE increased over time.
Seasonal aeroallergens may be important for a subgroup of patients with EoE presenting as recurrent FBOE. Esophageal biopsies are performed in a minority of patients, representing a significant departure from ideal management and contributing to recurrent unnecessary FBOE. EoE is an increasingly important cause of FBOE.
This article is protected by copyright. All rights reserved.
Aims: The object of this review was to collect available data on 1) adverse effects observed in humans from the intake of plant food supplements (PFS) or botanical preparations; 2) the misidentification of poisonous plants; 3) interactions between PFS/botanicals and conventional drugs or nutrients.
Methods: PubMed/MEDLINE and Embase were searched from database inception to June 2014, using the terms “adverse effect/s”, “poisoning/s”, “plant food supplement/s”, “misidentification/s”, and “interaction/s” in combination with the relevant plant name. All papers were critically evaluated according to the WHO Guidelines for causality assessment.
Results: Data were obtained for 66 plants that are common ingredients of PFS; of the 488 papers selected, 398 (81.6%) dealt with adverse effects directly associated with the botanical and 89 (18.2%) concerned interactions with conventional drugs. Only 1 case was associated with misidentification. Adverse effects were reported for 39 out of the 66 botanical substances searched. Of the total references, 86.5% were associated with 14 plants, including Glycine max/soybean (19.3%), Glycyrrhiza glabra/liquorice (12.5%), Ginkgo biloba/ginkgo and Camellia sinensis/green tea (both 8.6%).
Conclusions: Considering the length of time examined and the number of plants included in the review, it is remarkable that: 1) the adverse effects due to botanical ingredients were relatively infrequent, if assessed for causality; 2) the number of severe clinical reactions was very limited, but some fatal cases have been described.
Data presented in this review were assessed for quality in order to make the results maximally useful for clinicians in identifying or excluding deleterious effects of botanicals.
BACKGROUND
Hamburger is a meat-based food that is easy to prepare and is widely consumed. It can be enriched using different ingredients, such as chia's by-product, which is rich in omega-3. Chemometrics is a very interesting tool to assess the influence of ingredients in the composition of foods. A complete factorial design 22 (two factors in two levels) with duplicate was performed to investigate the influence of the factors (1) concentration of textured soy proteins (TSP) and (2) concentration of chia flour partially defatted (CFPD) as a partial replacement for the bovine meat and porcine fat mix in hamburgers.RESULTSThe results of proximal composition, lipid oxidation, fatty acids sums, ratios, and nutritional indexes were used to propose statistical models. The factors TSP and CFPD were significant, and the increased values contributed to improve the composition in fatty acids, crude protein, and ash. Principal components analysis distinguished the samples with a higher content of chia. In desirability analysis, the highest level of TSP and CFPD was described as the optimal region, and it was not necessary to make another experimental point.CONCLUSION
The addition of chia's by-product is an alternative to increase the α-linolenic contents and to obtain nutritionally balanced food. © 2014 Society of Chemical Industry
Microstructural, physical and functional properties of thin films (90–110 μm) made from blends of the mucilage of Salvia hispanica (MC) and whey protein concentrate (WPC) were studied. Two proportions of MC:WPC were used (1:3; 1:4) at pH 7 and 10 in distilled water using glycerol as plasticizer. The effects of MC:WPC ratio and pH on colour, solubility, water vapor permeability, mechanical properties and microstructure were investigated. Transmission and scanning electron microscopy were used to investigate the microstructure of aggregates and films. Films produced at pH 10 and MC:WPC ratio of 1:3 has superior mechanical properties than the other films, with higher resistance and flexibility. Also, films produced at pH 10 demonstrated better water vapour barrier (0.620 ± 0.08 g mm/kPa h m2) than films at pH 7. The pH and higher proportion of polysaccharide had a positive influence on mechanical and barrier properties achieving the highest value at pH 10 and higher proportion of polysaccharide.
Physical properties of Salvia hispanica L. seeds were investigated and their application was also discussed. Physical properties were assessed for white and dark seed separately, except for the angle of repose and static coefficient of friction, which were determined for the seed mixture. The mean moisture content was 7.0% (dry basis). The average for the three characteristic dimensions, length, width and thickness was 2.11, 1.32 and 0.81 mm for dark seeds and 2.15, 1.40 and 0.83 mm for white seeds, respectively. The bulk density, true density and the porosity were between 0.667 and 0.722 g cm−3, 0.931 and 1.075 g cm−3, and 22.9 and 35.9%, respectively. The equivalent diameter ranged from 1.32 to 1.39 mm. The volume of single grain and sphericity ranged between 1.19 and 1.42 mm3, and 62.2 and 66.0%, respectively. The geometric mean diameter ranged between 1.31 and 1.36 mm for dark and white chia seeds, respectively. This parameter could be used for the theoretical determination of seed volume and sphericity. One thousand seed mass averaged 1.323 g for dark seeds, and 1.301 g for white seed. The angle of repose varied between 16° and 18° whereas the value of static coefficient of friction was 0.28 on galvanized sheet and 0.31 on mild steel sheet.
Objectives:
The aim of this overview of systematic reviews (SRs) is to evaluate critically the evidence regarding interactions between herbal medicinal products (HMPs) and synthetic drugs.
Methods:
Four electronic databases were searched to identify relevant SRs.
Results:
Forty-six SRs of 46 different HMPs met our inclusion criteria. The vast majority of SRs were of poor methodological quality. The majority of these HMPs were not associated with severe herb-drug interactions. Serious herb-drug interactions were noted for Hypericum perforatum and Viscum album. The most severe interactions resulted in transplant rejection, delayed emergence from anaesthesia, cardiovascular collapse, renal and liver toxicity, cardiotoxicity, bradycardia, hypovolaemic shock, inflammatory reactions with organ fibrosis and death. Moderately severe interactions were noted for Ginkgo biloba, Panax ginseng, Piper methysticum, Serenoa repens and Camellia sinensis. The most commonly interacting drugs were antiplatelet agents and anticoagulants.
Conclusion:
The majority of the HMPs evaluated in SRs were not associated with drug interactions with serious consequences. However, the poor quality and the scarcity of the primary data prevent firm conclusions.
This study determined the overall acceptability, sensory characteristics, functional properties, and nutrient content of cakes made using chia (Salvia hispanica L) gel as a replacement for oil or eggs. Chia gel was used to replace 25%, 50%, and 75% of oil or eggs in a control cake formulation. Seventy-five untrained panelists participated in rating cakes on a seven-point hedonic scale. Analysis of variance conducted on the sensory characteristics and overall acceptability indicated a statistically significant effect when replacing oil or eggs for color, taste, texture, and overall acceptability (P<0.05). Post hoc analysis (using Fisher's least significant difference method) indicated that the 25% chia gel cakes were not significantly different from the control for color, taste, texture, and overall acceptability. The 50% oil substituted (with chia gel) cake, compared to control, had 36 fewer kilocalories and 4 g less fat per 100-g portion. Cake weight was not affected by chia gel in the formulation, although cake volume was lower as the percentage of substitution increased. Symmetry was generally not affected. This study demonstrates that chia gel can replace as much as 25% of oil or eggs in cakes while yielding a more nutritious product with acceptable sensory characteristics.
To evaluate the scientific evidence on chia (Salvia hispanica) including history, folkloric precedent, expert opinion, pharmacology, dosing, interactions, adverse effects, and toxicology. This review serves as a clinical support tool.
Electronic searches were conducted in ten databases, 20 additional journals (not indexed in common databases), and bibliographies from 50 selected secondary references. No restrictions were placed on language or quality of publications. All literature collected pertained to efficacy in humans, dosing, precautions, adverse effects, use in pregnancy/lactation, interactions, alteration of laboratory assays, and mechanisms of action. Standardized inclusion/exclusion criteria are utilized for selection. Grades were assigned using an evidence-based grading rationale.
The available human and non-human studies show possible effectiveness for allergies, angina, athletic performance enhancement, cancer, coronary heart disease (CHD), heart attack, hormonal/endocrine disorders, hyperlipidemia, hypertension, stroke, and vasodilatation. Some evidence also suggests possible anticoagulant, antioxidant, and antiviral effects of Salvia hispanica.
There is limited evidence supporting the efficacy of Salvia hispanica for any indication; thus far, only two clinical studies have examined the effects of Salvia hispanica on cardiovascular disease (CVD) risk factors (including body weight). One study showed some effects on some CVD risk factors, while the other did not. Neither study showed any effects of Salvia hispanica on weight loss. However, the historical use of Salvia hispanica suggests that it is safe for consumption by nonallergic individuals. Further rigorous examination is warranted pertaining to the use of Salvia hispanica as a dietary supplement, as well as in the treatment or prevention of human disease.
Esophageal food impaction is a common presentation of eosinophilic esophagitis. The prevalence of eosinophilic esophagitis among patients with food impaction is unknown. To address this, we evaluated clinicopathologic features of adults with food impaction.
For a 3-year period, patients from a single, adult, community-based gastroenterology practice with esophageal food impaction were evaluated. Histories were assessed and esophageal biopsy specimens were evaluated by routine and immunohistochemical techniques.
Thirty-one patients with food impaction were evaluated. Seventeen of 31 patients had >20 eosinophils/high power field (HPF) without gender predilection. Thirteen of these 17 patients had been treated with proton pump inhibitors at the time biopsy specimens were obtained. Patients with >20 eosinophils/HPF were significantly younger (mean age 42 +/- 4 years) than patients with <20 eosinophils/HPF (mean age 70 + 3 years). Superficial white exudates and eosinophilic microabscesses in the squamous epithelium were features observed only in patients with >20 eosinophils/HPF. Immunopathologic analysis demonstrated increased CD8 lymphocytes and major basic protein deposition in their squamous epithelium.
More than half of patients with esophageal food impaction in a primary gastroenterology practice have >20 eosinophils/HPF. Based on clinicopathologic features, a significant number likely have eosinophilic esophagitis.