ABSTRACT
Eosinophilic esophagitis (EE) is a chronic inflammatory, immunoallergic disease of the esophagus that represents the most common eosinophilic gut disease. Understanding and diagnosis regarding this condition have greatly increased in recent years, particularly in Europe and North America, in parallel with other allergic disorders. It consists of dense esophageal infiltration with eosinophils in the absence of gastro-esophageal reflux (GER). It involves individuals at all ages, and is particularly common in males during childhood and up to the 5th decade of life. It manifests with chronic, intermittent esophageal symptoms that predominantly include dysphagia, food impaction episodes, and GER-attributable complaints that do not respond to antisecretory therapy. Endoscopically, EE is a polymorphous disease that presents with various changes in esophageal caliber, and subtle changes in mucosal appearance, which lead to biopsy collection as a key procedure for diagnosis. Management must be multidisciplinary, including gastroenterologists, pathologists, allergologists, and also nutrition specialists in pediatric cases. Regarding therapy, dietary food restrictions are especially useful in the management of pediatric EE, but effectiveness is lower in the adult, maybe because of a greater involvement of air allergens. Drug use is standard, particularly involving topical steroids, which may revert manifestations and histological lesions, even though recurrence following discontinuation is common.
Subject(s)
Eosinophilia/diagnosis , Eosinophilia/therapy , Esophagitis/diagnosis , Esophagitis/therapy , HumansABSTRACT
Eosinophilic esophagitis (EE) is a chronic inflammatory, immunoallergicdisease of the esophagus that represents the mostcommon eosinophilic gut disease. Understanding and diagnosisregarding this condition have greatly increased in recent years,particularly in Europe and North America, in parallel with otherallergic disorders. It consists of dense esophageal infiltrationwith eosinophils in the absence of gastro-esophageal reflux(GER). It involves individuals at all ages, and is particularly commonin males during childhood and up to the 5th decade of life.It manifests with chronic, intermittent esophageal symptomsthat predominantly include dysphagia, food impactionepisodes, and GER-attributable complaints that do not respondto antisecretory therapy.Endoscopically, EE is a polymorphous disease that presentswith various changes in esophageal caliber, and subtle changesin mucosal appearance, which lead to biopsy collection as a keyprocedure for diagnosis. Management must be multidisciplinary,including gastroenterologists, pathologists, allergologists,and also nutrition specialists in pediatric cases.Regarding therapy, dietary food restrictions are especiallyuseful in the management of pediatric EE, but effectiveness islower in the adult, maybe because of a greater involvement ofair allergens. Drug use is standard, particularly involving topicalsteroids, which may revert manifestations and histological lesions,even though recurrence following discontinuation is common(AU)
Subject(s)
Humans , Male , Female , Esophagitis/diagnosis , Esophagitis/therapy , Endoscopy , Esophagitis/pathology , Steroids/therapeutic use , Esophagitis/diet therapy , Esophagitis/physiopathology , Endoscopes/trends , Esophagitis/etiologyABSTRACT
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Subject(s)
Female , Adult , Humans , Celiac Disease/diagnosis , Celiac Disease/therapy , Biopsy/methods , Diagnosis, Differential , Dyspepsia/complications , Hypocalcemia/complications , Hypocalcemia/diagnosis , Polymyalgia Rheumatica/complications , Hyperamylasemia/complications , Celiac Disease/epidemiology , Celiac Disease/physiopathologyABSTRACT
La esofagitis eosinofílica consiste en una inflamacióncrónica del esófago con una rica infiltración eosinófila.Durante años se ha considerado una patologíapoco frecuente causante de disfagia en el niño.Sin embargo, un incremento reciente en el diagnósticode esta enfermedad ha provocado que susciteun novedoso interés y a la vez que se reconsidereel papel inmunológico del esófago. Este artículoes una revisión de las características conocidasde esta enfermedad la cual implica aspectos clínicos,nutricionales, histológicos, endoscópicos, manométricos,e inmunológicos
Eosinophilic esophagitis is a disease characterizedby a marked eosinophilic chronic inflammationof the esophagus. For years it has been considereda rare cause of dysphagia in children but an increaseof its diagnosis in the last years provoked a newinterest and also a revaluation of the immunologicalpaper of the esophagus. This paper is a review ofthe known features of this disease (including clinical,nutritional, histological, endoscopic, manometric andimmunological aspects)
Subject(s)
Child , Humans , Esophagitis/diagnosis , Eosinophilia/diagnosis , Esophagitis/etiology , Eosinophilia/etiology , Esophagitis/therapy , Eosinophilia/therapy , Chronic DiseaseABSTRACT
Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC) after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.
Subject(s)
Esophageal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Heat Stroke/complications , Hematoma/etiology , Adult , Humans , MaleABSTRACT
Las alteraciones de la coagulación son una complicación frecuenteen el golpe de calor grave, y pueden ser causa de hemorragiadigestiva. Presentamos el caso de un varón de 26 años quefue admitido en nuestro hospital por un cuadro de hipertermia,asociado con encefalopatía y coagulación intravascular diseminadatras exposición solar prolongada. Presentó hematemesis por laque fue diagnosticado de múltiples hematomas esofágicos queocupaban los tercios superior e inferior del órgano, en ausenciade otras lesiones en estómago y duodeno. Tras el tratamiento desoporte y la resolución de la patología subyacente, desaparecieronlas lesiones endoscópicas, normalizándose la mucosa esofágica
Alterations in blood clotting are a frequent complication ofserious heatstroke and may result in gastrointestinal bleeding.We report the case of a 26-year-old man who was admitted toour hospital with symptoms of hyperthermia associated with encephalopathyand disseminated intravascular coagulation (DIC)after prolonged exposure to sunlight. He presented hematemesis,after which he was diagnosed with having a bruising of theesophagus that took up the upper and lower thirds, there beingno other lesions in the stomach or duodenum. After supportivetreatment and following the resolution of the underlying pathology,the endoscopy-revealed injuries healed with a completenormalization of the esophageal mucosa. Esophageal submucosalbruising is an exceptional cause of hematemesis in seriousheatstroke not previously described in the literature
Subject(s)
Male , Adult , Humans , Esophageal Diseases/etiology , Gastrointestinal Hemorrhage/etiology , Hematoma/etiology , Heat Wave (Meteorology)ABSTRACT
BACKGROUND: Eosinophilic esophagitis is a rare condition mainly affecting children, although the number of cases reported in adults is on the increase. It is characterized by intense infiltration of eosinophilic leukocytes in the esophageal mucosa, without involvement of other sections of the alimentary canal. MATERIAL AND METHODS: Over the past year, following the performance of endoscopies and biopsies, our service identified nine patients who were diagnosed with suffering from this disorder. Each patient sought medical help for episodes of long-term, self-limited dysphagia or food impaction in the alimentary canal. RESULTS: Endoscopy revealed esophageal stenosis in the form of simultaneous contraction rings or regular stenosis. In six cases, the manometric study showed a nonspecific motor disorder of severe intensity affecting the esophageal body, and another patient had a disorder characterized by the presence of simultaneous waves and secondary peristaltic waves in the three thirds of the organ. These disorders are presumably due to eosinophilic infiltration of the muscular layer or ganglionar cells of the esophagus, and account for symptoms in these patients. Although the etiopathogenesis of this illness is uncertain, it is clearly an immunoallergic manifestation. CONCLUSIONS: As the number of diagnosed cases is on the increase, eosinophilic esophagitis is in adults a specific entity within the differential diagnosis of dysphagia in young males with a history of allergies. Eosiniphilic esophagitis responds in a different number of ways to therapies used. We successfully used fluticasone propionate, a synthetic corticoid applied topically, which proved to be efficient in the treatment of this illness by acting on the pathophysiological basis of the process. It does not have any adverse effects, thus offering advantages over other therapies such as systematic corticoids or endoscopic dilations.
