Korean J Gastroenterol.  2010 Nov;56(5):285-292. 10.4166/kjg.2010.56.5.285.

Clinical Implications of Endoscopically Suspected Eosinophilic Esophagitis

• Lee KM
• Lim HC
• Kim JH
• Yoon YH
• Park H
• Lee SI

• KMID: 1718369
• DOI: http://doi.org/10.4166/kjg.2010.56.5.285

Abstract

BACKGROUND/AIMS
We aimed to determine the concordance rate and clinical predictors of eosinophilic esophagitis (EoE) in patients with endoscopically suspected eosinophilic esophagitis (ESEoE) findings.
METHODS
From June 2006 to December 2009 in Gangnam Severance Hospital, we prospectively enrolled the patients of "endoscopically suspected eosinophilic esophagitis (ESEoE)", and then we retrospectively reviewed and analyzed clinical features and endoscopic findings.
RESULTS
We found 17 patients of ESEoE, and 5 of them were finally confirmed as an EoE by histology (diagnostic concordance rate 29.4%). We added two more patients previously diagnosed as EoE and compared patients of EoE+ (n=7) with EoE- (n=12). Mean age was 56.0 (range 36-70) and 51.0 (range 36-68) years old, respectively. In EoE+ group, there were 5 males and 2 females and 6 males and 6 females in EoE- group. The symptoms of EoE+ patients were dysphagia (n=5), food impaction (n=3), foreign body sensation in esophagus (n=2), chest pain (n=1), and heartburn (n=1). EoE- patients complained food impaction (n=5), heartburn (n=4), chest pain (n=2), foreign body sensation in esophagus (n=2), and dysphagia (n=1). The endoscopic findings of EoE+ patients were furrows (n=6), rings (n=5), exudates or nodules (n=3), and friability (n=1). EoE- patients showed rings (n=10) and furrows(n=7). Univariative analysis showed that 'a symptom of dysphagia', 'presence of exudates or nodules', 'more than 2 suggestive endoscopic findings' were significantly different between two groups.
CONCLUSIONS
In ESEoE, diagnostic concordance rate was 29.4%. In addition, 'symptom of dysphagia', 'exudates or nodules', '> or =2 endoscopic findings' are more suggestive of EoE in ESEoE patients.

Keyword

Eosinophilic esophagitis; Dysphagia

Figure

• 

  Fig. 1. Endoscopic findings of eosinophilic esophagitis (EoE＋) cases. Typical endoscopic findings of eosinophilic esophagitis patients including (A) linear furrows (thin arrow), (EoE＋ No.3), (B) linear furrows (thin arrow) and circular rings (thick arrows), (EoE＋ No.6), (C) linear furrows (thin arrow) and several nodules (red circles), (EoE＋ No.1), (D) several linear shearings (thick arrows), (EoE＋ No.5). Patient number is listed in Table 1.

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  Fig. 2. Initial & follow-up endoscopic findings of eosinophilic esophagitis (EoE＋) patients after the treatment. (A) It showed longitudinal furrows (EoE＋ No.7) and his symptoms were relieved after proton pump inhibitor (PPI) treatment. (B) It showed endoscopically improved findings 3 months later. (C) It showed longitudinal furrows and circular rings (EoE＋ No.4). She had no response to 2 months PPI treatment, so we prescribed a flucati-sone inhaler (125 ug/puff, 1,000 ug/D) for 4 weeks. Symptoms were relieved after taking a PPI for 6 more weeks. (D) It showed slightly improved findings 2 years later. Patient number is listed in Table 1.

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  Fig. 3. Initial and follow-up histologic findings of eosinophilic esophagitis (EoE＋) patient. (A) Initial microscopic finding of EoE＋ No.4 patient. It showed massive infiltrations of eosinophilis on the esophageal mucosa. (B) Microscopic finding of EoE＋ No.4 patient 2 years after the treatment. It showed normal esophageal epithelium without eosinophils. Patient number is listed in Table 1.

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