Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors - PubMed (original) (raw)

Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors

Akinari Sawada et al. Endosc Int Open. 2019 Apr.

Abstract

Background and study aims Endoscopic findings of esophageal eosinophilia sometimes localize to small areas of the esophagus. A previous study suggested that pathogenesis of localized-type eosinophilic esophagitis (LEoE) was associated with acid reflux. However, LEoE treatment outcomes have not been studied. We aimed to analyze the clinical and histologic significance of LEoE in comparison with diffuse-type eosinophilic esophagitis (DEoE). Patients and methods This study included 106 patients with esophageal eosinophilia. Esophageal eosinophilia was defined as a condition where the maximum number of intraepithelial eosinophils was ≥ 15 per high-power field. LEoE was defined as an endoscopic lesion confined to one-third of the esophagus: upper, middle, or lower. Esophageal eosinophilia encompassing more than two-thirds of the esophagus was defined as DEoE. We retrospectively compared LEoE and DEoE in terms of clinical characteristics, histologic findings, and proportion of proton pump inhibitor (PPI) responders. Results Of 106 patients, 12 were classified as having LEoE and 94 were classified as having DEoE. The proportion of asymptomatic patients was significantly higher in the LEoE group than the DEoE group (42 % vs 7 %, P < 0.01). In the LEoE group, 10 patients (84 %) had endoscopic lesions in the lower esophagus. The maximum number of eosinophils did not differ between the groups (54 [24 - 71] for LEoE, 40 [20 - 75] for DEoE, P = 0.65). The prevalence of PPI responders was significantly higher in the LEoE group than the DEoE group (100 % vs 63 %, P = 0.01). Conclusion LEoE can be a sign of good responsiveness to PPI therapy.

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Conflict of interest statement

Competing interests None

Figures

Fig. 1

Fig. 1

Endoscopic and histologic findings of eosinophilic esophagitis.aEndoscopic findings of DEoE. Rings, white exudates, and linear furrows were observed in the etire esophagus.bCase 1 of LEoE. White turbidity was observed along the entire circumference just above the EGJ. In addition, linear furrows (black arrows) and white exudates (arrowhead) were distributed on white turbidity.cCase 2 of LEoE. White exudates and subtle rings were located along only half of the circumference of the upper esophagus.dNormal esophageal mucosa was found from the EGJ to middle esophagus.e, fHistologic findings in Case 2.eEsophageal biopsy samples taken from the mucosa with endoscopic findings around imagecshowed > 15 eosinophils/hpf, other inflammatory cells, and dilated intracellular space in the esophageal epithelium.fIn contrast, a sample taken from the mucosa without endoscopic findings around imagedshowed no intraepithelial eosinophils. LEoE, localized-type eosinophilic esophagitis; DEoE, diffuse-type eosinophilic esophagitis; EGJ, esophagogastric junction.

Fig. 2

Fig. 2

Number of eosinophils in each esophageal biopsy sample with or without endoscopic findings in localized-type eosinophilic esophagitis. *P < 0.01.

Fig. 3

Fig. 3

Response rate to PPI therapy of each type of eosinophilic esophagitis. LEoE, localized-type eosinophilic esophagitis; DEoE, diffuse-type eosinophilic esophagitis. *P < 0.05.

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