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Endoscopic Features Before and After Treatment of Eosinophilic Esophagitis Pre-treatment Post-treatment p value
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Purpose:
The prevalence and incidence of eosinophilic esophagitis (EoE) are increasing worldwide. Despite increased understanding of inflammatory pathogenesis, changes in endoscopic features after treatment of EoE have not been clearly described. We aimed to investigate the reversibility of endoscopic features of EoE after treatment.
Materials an...
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Endoscopy and mucosal biopsies are essential to the diagnosis of EoE. Together they either confirm or exclude mucosal eosinophilia and provide a visual inspection of the esophagus that may be consistent with EoE or suggest other underlying etiologies. Endoscopy also plays an important therapeutic role in the management of EoE including the assessme...
Citations
... Previous studies reveal discernible differences in endoscopic findings between patients with EoE and NOD, as well as the potential for endoscopic reversibility in EoE when appropriate treatment is administered [27]. Moreover, recent studies emphasize the marked histological expression of IgG4 in individuals with EoE [11,28]. ...
... This underscores the importance of histological evaluation alongside endoscopic phenotype assessment. Moreover, significant differences in ∆EREFS were observed between the EoE phenotypes, consistent with previous studies showing reversibility in the inflammatory phenotype [27]. In this study, we compared the endoscopic clinical manifestations of patients with EoE, differentiating between those with and without TRC staining. ...
Background: Eosinophilic esophagitis (EoE) is a disease that has been subcategorized into two endoscopic phenotypes: inflammatory and fibrostenotic. Moreover, studies have shown a link between EoE and immunoglobulin G4 (IgG4), a subclass of the immunoglobulin G (IgG) antibody. In this study, we aimed to evaluate the relationship between histologic IgG4 expression and endoscopic phenotypes in patients with EoE. Methods: This case-control study included patients diagnosed with EoE (n = 19) and patients with non-obstructive dysphagia without abnormal findings as controls (NOD; n = 12). The EoE group was further divided into three subgroups based on endoscopic phenotype: inflammatory, fibrostenotic, or combined. Retrospective examination of endoscopic findings and pathological slides was performed to analyze IgG4 staining. Results: Histological analysis revealed a significant difference in IgG4 cell count (15.00 vs. 0.58, p = 0.003) and eosinophil cell count (84.67 vs. 0.08, p < 0.001) between the EoE and NOD groups. Symptom manifestation and blood test results were similar across all three endoscopic EoE phenotypes. However, histological analysis revealed a significant difference in IgG4 cell count between the inflammatory, fibrostenotic, and combined phenotypes (4.13 vs. 17.6 vs. 59.7, p = 0.030). Conclusions: IgG4 expression was higher in EoE patients than in those with NOD, the highest being in the combined phenotype subgroup. These findings emphasize the important role of endoscopic and histological examination in diagnosing EoE and the need for further research in this area.
... However, this all depends on the study, as another study showed that the total EREFS score is highly predictive of EoE, and the findings are highly responsive to treatment [64]. In yet another study, all inflammatory features (edema, exudates, and furrows) significantly improved after treatment; unfortunately, the fibrostenotic features did not [65]. Table 1 illustrates the differences in the EREFS results between two studies. ...
Eosinophilic esophagitis is a Th-2 antigen-mediated disease in which there is an influx of eosinophils to all layers of the esophagus, triggering an inflammatory response. Chronic inflammatory process causes esophageal remodeling, leading to difficulties in swallowing. Food impaction, heartburn, and chest pain are other characteristic (but not pathognomonic) symptoms in adults. Although the disease has only been described since in the early 1970s, its incidence and prevalence are rapidly growing, especially in Western countries. According to the diagnostic guidelines, there should be at least 15 eosinophils visible per high-power field in biopsies obtained from different sites in the esophagus upon endoscopy with relevant esophageal symptoms. Other diseases that can cause esophageal eosinophilia should be ruled out. Eosinophilic esophagitis treatment may be challenging; however, new methods of management have recently emerged. The currently used proton pump inhibitors, topical corticosteroids, and elimination diet are combined with biological treatment. New methods for disease diagnostics and clinical course assessment are also available. This review presents current knowledge about the disease, supported by the latest research data.
... [62]. Endoscopic healing, especially with regard to fibrotic features, is now included as an important target for any EoE treatment, despite an endoscopic remission criterion still needing to be agreed [63]. In the future, novel parameters of esophageal distensibility [64] and biomarkers of eosinophil activity or gene expression panels [65] may also be included as treatment outcomes. ...
Introduction:
Current treatments of eosinophilic esophagitis (EoE) induce symptomatic and histological remission in a proportion of patients. However, they do not fully meet patients' needs and limitations should be acknowledged. The growing epidemiology of EoE has generated a great interest for research into novel therapeutic approaches.
Areas covered:
This article discusses current therapies available for EoE, those under investigation and presents potential additional ones. Established anti-inflammatory treatments for EoE include dietary therapy, proton pump inhibitors, and swallowed topical corticosteroids, which are combined with endoscopic dilation in cases of strictures. Refractoriness, recurrence after treatment-cessation, and need for long-term therapies have encouraged investigation of novel, esophageal-targeted formulas of topical corticosteroids and of new therapeutic approaches directed at blocking the molecular pathways that lead to inflammation in EoE. These include monoclonal antibodies (including mepolizumab, reslizumab, benralizumab, dectrekumab, cendakimab, and dupilumab), JAK-STAT blockers and S1PR agonists, among others. Some have provided evidence of effectiveness and safeness in the short term use.
Expert opinion:
Therapies under investigation potentially can target multiple Th2-associated diseases that converge in EoE patients. Therapeutic strategies require a personalized and patient-centered approach to reduce the burden of the disease, and cost-effectiveness analysis to position their use in a complex therapeutic landscape.
Objetivo: Analisar as características da Esofagite Eosinofílica (EEo). Revisão bibliográfica: A EEo é uma doença inflamatória crônica, imunomediada, caracterizada por disfunção esofágica e infiltração transmural do esôfago por eosinófilos. A EEo é considerada o distúrbio gastrointestinal eosinofílico mais freqüente com incidência de aproximadamente 5 a 10 casos por 100.000 por ano e prevalência de aproximadamente 0,5 a 1 caso por 1.000. Sua etiologia exata é desconhecida, mas acredita-se que seja resultado das interações de ambiente, genética e sistema imunológicos do hospedeiro. Na EEo a inflamação causada por eosinófilos está confinada ao esôfago. O aumento da prevalência resulta da conscientização sobre a doença, melhor acesso à endoscopia, bem como aumento da incidência de alergias. Considerações finais: A EEo é uma doença inflamatória imunológica crônica, mediada por antígeno Th2, cuja incidência é crescente, principalmente nos países ocidentais. Seu diagnóstico é feito a partir da suspeição clínica (impactação alimentar, disfagia e história de atopia) confirmado com endoscopia digestiva alta com no mínimo 6 biópsias. O tratamento da EEo é feito primariamente com dieta e, posteriormente, com opções terapêuticas como os inibidores de bombas de prótons e corticóides tópicos deglutidos.
Background
Eosinophilic esophagitis (EoE) is a male predominant disease, typically presenting with dysphagia. Our goal was to investigate sex differences in clinical presentation and management of EoE.
Methods
We performed a retrospective cross-sectional review of 489 EoE patients seen at NewYork Presbyterian Weill Cornell from August 2015 to August 2019. Charts were queried for age at diagnosis, symptoms at presentation, endoscopic findings, need for dilations, and medical therapy. Student t and χ ² tests were implemented to compare outcome variables of the 2 independent groups (males vs females) and logistic regressions for invariable and multivariable analyses.
Results
489 EoE patients (226 Female [F] [46.2%], 263 Male [M] [53.8%]) were reviewed. Males were more likely to present with food impaction (92 [35.8%] vs 44 [19.7%], M vs F, P < .001), have a fibrostenotic phenotype on initial endoscopy (140 [54.1%] vs 98 [45.0%], M vs F, P = .043) and undergo dilation (odds ratio [OR] = 1.985, 95% confidence interval [CI] = 1.209-3.328, P < .01). Female patients were more likely to have atopic disease (153 [67.6%] vs 153 [58.8%], F vs M, P = .044) and a reported normal index endoscopy (79 [36.2%] vs 69 [26.6%], F vs M, P = .026).
Conclusion
This large retrospective review highlights clinically important differences in presentation between sexes. Increasing awareness of these differences, especially history of atopic disease, impaction, and the need for dilation, can help clinicians better identify EoE in female patients and therefore, guide initial therapy. The mechanistic underpinnings of these discrepancies are not evident from this data and will require future studies.
