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Endoscopic images from a patient with esophageal food impaction. a Impaction of piece of meat on the middle esophagus. b Extraction of bolus with a network snare. c Aspect of esophageal mucosa after bolus extraction: Rings, longitudinal furrows, edema, whitish speckling, and mild stenosis are observed
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Background
Eosinophilic esophagitis (EoE) is the most common cause of dysphagia and esophageal food impaction (EFI) in the USA, Western Europe, and Australia. In Mexico, the uncomplicated form of this disease is infrequent, and prevalence in patients with EFI is unknown.
Aims
To determine the prevalence and causes of EFI, endoscopic and therapeu...
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Variable endoscopic and histological findings of esophageal lining are often detected in celiac disease, with unknown significance. We investigated the frequency and significance of such abnormalities in children. Macroscopic esophageal findings as reported by endoscopist and histological results by pathologist were compared between 316 celiac dise...
Citations
... Moreover, a Mexican study that included adult patients with esophageal food impaction reported low prevalence (11.7%) of biopsy-proven EoE, whereas peptic stenosis was identified as the most common etiology. 104 These data, despite the several methodological concerns, which confine interpretability (among others retrospective design, various bias or inability to rule-out GERD), are in contrast to previous reports of increasing prevalence rates and might reflect a leveling off of EoE prevalence. ...
Since its discovery, Helicobacter pylori (H. pylori) has attracted attention in the biomedical world with its numerous pathophysiologic implications, both gastrointestinal and systemic. Beyond its well‐established carcinogenic properties, emerging evidence also supports “harmful” proinflammatory and neurodegenerative roles of H. pylori. On the other hand, H. pylori infection has been proposed to be “protective” against several diseases, such as asthma and gastroesophageal reflux disease. Eosinophilic esophagitis (EoE) is a relatively new, allergen/immune–mediated disease, which has also been linked to these considerations. Main arguments are a postulated shift of immune responses by H. pylori from T helper 2 (TH2) to TH1 polarization, as well as a potential decline of the H. pylori burden with the dramatic parallel rise of ΕοΕ: a series of observational studies reported an inverse association. In this review, we counter these arguments by providing further epidemiological data, which point out that this generalization might be rather incomplete. We also discuss the limitations of the existing studies evaluating a possible association. Furthermore, we provide current evidence on common pathogenetic components, which share both entities. In summary, the claim that H. pylori is protective against EoE is rather incomplete, and further mechanistic studies are necessary to elucidate a possible association.
Introduction
Differences in EoE presentation and outcomes by ethnicity or race remain understudied. We aimed to determine whether EoE patients of Hispanic/Latinx ethnicity or non-White race have differences in presentation at diagnosis or response to topical corticosteroid (tCS) treatment.
Methods
This retrospective cohort study included subjects of any age with a new diagnosis of EoE and documentation of ethnicity or race. For those who had treatment with tCS and follow-up endoscopy/biopsy, we assessed histologic response (<15 eosinophils/hpf), global symptom response, and endoscopic responses. Hispanic EoE patients were compared to non-Hispanics at baseline, and before and after treatment. The same analyses were repeated for White vs non-Whites.
Results
Of 1026 EoE patients with ethnicity data, just 23 (2%) were Hispanic. Most clinical features at presentation were similar to non-Hispanic EoE patients but histologic response to tCS was numerically lower (38% vs 57%). Non-White EoE patients (13%) were younger at diagnosis, had less insurance, lower zip code-level income, shorter symptom duration, more vomiting, less dysphagia and food impaction, fewer typical endoscopic features, and less dilation. Of 475 patients with race data treated with tCS, non-Whites had a significantly lower histologic response rate (41% vs 59%; p=0.01), and odds of histologic response remained lower after controlling for potential confounders (aOR 0.40, 95%CI: 0.19-0.87).
Discussion
Few EoE patients at our center were Hispanic, and they had similar clinical presentations as non-Hispanics. The non-White EoE group was larger, and presentation was less dysphagia-specific. Non-White patients were also less than half as likely to respond to tCS.
Background:
The incidence of eosinophilic esophagitis (EoE) is increasing in some regions of the world. Retrospective studies have found an inverse association with Helicobacter pylori infection (H. pylori). A recent prospective study has questioned this relationship. We aimed to evaluate this relationship in Mexican patients.
Methods:
We evaluated adult patients without prior eradication of H. pylori. Cases were defined by the presence of esophageal symptoms and >15 eosinophils/high power field (HPF) in the esophageal biopsy. Controls were defined by the presence of <15 eosinophils/HPF in esophageal biopsy. H. pylori infection was defined by histology. Patients were matched by age and gender assigning 4 controls per case.
Results:
We included 190 patients: 38 cases and 152 controls. Cases had higher frequency of atopy, dysphagia, food impaction, peripheral eosinophilia, and endoscopic EoE abnormalities. The overall prevalence of H. pylori was 63.6%. Cases had significantly lower prevalence of H. pylori than controls (36.8% vs 70.4%, OR 0.21 95% CI 0.08-0.69, p=0.001). Atopic patients had lower prevalence of H. pylori than non-atopic: 13.1% vs 50.5% (OR 0.20, 95% CI 0.06-0.69, p<0.001), particularly allergic rhinitis and food allergy.
Conclusions:
We observed an inverse relationship between H. pylori and EoE as well as atopy. Studies in experimental models of EoE that clarify the role of H. pylori in this interaction are required, as well as robust studies that include other factors (socioeconomic, cultural, microbiota etc.) in order to clarify this relationship.
Background
Foreign body impaction is a frequent indication of urgent endoscopy. One of the reasons for impaction is eosinophilic oesophagitis (EE). To analyze characteristics of oesophageal foreign body impactions and their relationship with eosinophilic oesophagitis.
Methods
In this retrospective study, urgent endoscopies in a tertiary care centre were analyzed. We included all urgent endoscopies due to bolus and foreign body impactions performed between September 1st 2018 and September 1st 2020. We reviewed clinical data of all patients who were diagnosed with EE and compared it to impactions that were due to other motives. The mean follow-up time was 18.7 months.
Results
693 urgent endoscopy procedures were performed. 239 (34%) of these were due to foreign body ingestion. Mean age of the patients was 63 years old and 135 (63%) were men. EE was diagnosed in 36 (17%) patients. The factors associated with EE were age, to be younger than 50 years (OR, 7.3; 95% CI, 1.1–48.4; p = 0.04), asthma/rhinitis/atopic dermatitis (OR, 8.9; 95% CI, 2.3–35.3; p = 0.002), findings in the endoscopy as trachealization (OR, 9.7; 95% CI, 1.3–70.9; p = 0.03) and psychotropic/calcium channel blocker drugs (OR, 0.09; 95% CI, 0.009–0.9; p = 0.04). 15 (7%) patients died. In 6 of them death was impaction-related. None patients with EE died.
Conclusions
Foreign body impaction in the upper gastrointestinal tract due to EE is a frequent cause of urgent endoscopy. Being under 50 years of age, having asthma/rhinitis/atopic dermatitis, trachealization on the oesophagus and not taking psychotropic/calcium channel blocker drugs are factors associated with the diagnosis of EE. Mortality in the follow-up of patients without EE is important.
Resumen
Background: La impactación por cuerpos extraños es una indicación frecuente de endoscopia urgente. Una de las causas de impactación es la esofagitis eosinofílica (EE). Nuestro objetivo es analizar las características de las impactaciones por cuerpos extraños en el esófago y su relación con la esofagitis eosinofílica.
Methods: En este estudio retrospectivo, se analizan todas las endoscopias urgentes realizadas por impactación de alimentos y cuerpos extraños en un hospital terciario entre el 1 de septiembre de 2018 y el 1 de septiembre de 2019. Se analizan características clínicas de los pacientes diagnosticados de esofagitis eosinofilica y se comparan con las impactaciones debidas a otros motivos. El seguimiento medio es de 18,7 meses.
Results: Se realizaron 693 procedimientos de endoscopia urgentes, de ellos 239 (34%) fueron por impactación por cuerpos extraños. La edad media fue de 63 años y 135 (63%) eran hombres. 36 (17%) de todos los pacientes con impactación fueron diagnosticados de EE. Los factores asociados con la EE son la edad, ser menor de 50 años (OR, 7.3; 95% CI, 1.1-48.4; P=0.04), asma, rinitis y dermatitis atópica (OR, 8.9; 95% CI, 2.3-35.3; P= 0.002), hallazgos endoscópicos como traquealización (OR, 9.7; 95% CI, 1.3-70.9; P= 0.03) y el consumo de fármacos psicotrópicos o antagonistas del calcio (OR, 0.09; 95% CI, 0.009-0.9; P= 0.04). Fallecieron 15 (7%) pacientes, todos sin EE y en 6 fue relacionado con las impactaciones.
Discussion: La impactación por cuerpos extraños en el tubo digestivo por EE es una patología frecuente en los servicios de endoscopia de urgencia. Tener menos de 50 años, asma, rinitis, dermatitis atópica, traquealización del esófago y no consumir fármacos psicotrópicos o antagonistas del calcio son factores asociados al diagnóstico de EE. La mortalidad en el seguimiento de los pacientes sin EE es importante.
