Clinical Features of Esophageal Eosinophilia According to Endoscopic Phenotypes - PubMed (original) (raw)

Comparative Study

. 2020 Dec 1;59(23):2971-2979.

doi: 10.2169/internalmedicine.4447-20. Epub 2020 Aug 4.

Yasuhiko Abe 2 3, Yu Sasaki 1, Ryosuke Kikuchi 4, Shiho Uchiyama 4, Gen Kusaka 4, Takao Yaoita 1, Makoto Yagi 2, Masakuni Shoji 1, Yusuke Onozato 1, Naoko Mizumoto 1, Yoshiyuki Ueno 1

Affiliations

Comparative Study

Clinical Features of Esophageal Eosinophilia According to Endoscopic Phenotypes

Takashi Kon et al. Intern Med. 2020.

Abstract

Objective Esophageal eosinophilia (EE), a histological hallmark of eosinophilic esophagitis, is classified into two endoscopic phenotypes: localized and diffuse EE. Our aim was to determine the prevalence of EE localized in the lower esophagus and to describe its clinical features in comparison with diffuse EE. Methods Data from 81 consecutive patients with EE were retrospectively investigated. EE was histologically defined as ≥15 eosinophils per high-power field. Based on the endoscopic appearance with a histological assessment, EE was classified as either diffuse or localized type. We compared the clinical features, including the medical treatment and natural course, between the two types. Results Of the 81 patients, 52 (64.2%) had diffuse EE, and 29 (35.8%) had localized EE. Among men patients, localized EE was significantly more common than diffuse EE. In localized EE, dysphagia and food impaction were less prevalent, and the presence of rings was significantly less common than in diffuse EE. Acid-suppressive therapy was administered to only 3 of the 29 patients with localized EE. In asymptomatic patients, especially those with localized EE, endoscopic abnormalities did not worsen but rather improved in some findings, such as with regard to furrows or exudate, during the natural course of three years without medical treatment. Conclusion Localized EE has a strong predilection for men patients and accounted for more than one third of all cases of EE. This condition appears to be less symptomatic and necessitates milder medical treatment than diffuse EE and might not worsen progressively.

Keywords: diffuse esophageal eosinophilia; endoscopic phenotype; eosinophilic esophagitis; esophageal eosinophilia; localized esophageal eosinophilia.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.

Figure 1.

The representative endoscopic images of diffuse EE (a1, a2), localized EE (b1, b2), and patchy-type EE (c1, c2); The proximal esophagus (a1, b1, c1) and distal esophagus (a2, b2, c2) are shown. In patients with diffuse EE (a1, a2), furrows, rings, and exudate were found in almost all areas of the esophagus. In patients with localized EE (b1, b2), furrows, rings, and exudate were observed only in the lower end of the esophagus. In patients with patchy-type EE (c1, c2), edematous mucosa was interspersed with exudate, furrows, or both, with an appearance resembling skip lesions in the esophagus and intervening normal-appearing mucosa. (d) The proportions of these three endoscopic phenotypes. EE: esophageal eosinophilia

Figure 2.

Figure 2.

Chronological changes in the total endoscopic score between the first and last endoscopy session in asymptomatic patients who had a long-term follow-up of more than three years. After excluding from both groups a total of 6 PPI users at the last follow-up endoscopy session, the decreased total endoscopic score of the last endoscopy remained significant in the localized group but not in the diffuse group (p=0.0313, Wilcoxon’s signed rank test). PPI: proton pump inhibitor

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