Korean J Gastroenterol.  2016 Apr;67(4):178-182. 10.4166/kjg.2016.67.4.178.

Proton Pump Inhibitor-responsive Esophageal Eosinophilia: An Overview of Cases from One University Hospital Center

• Ahn B
• Lee DH
• Lee CM
• Hwang JJ
• Yoon H
• Shin CM
• Park YS
• Kim N

• KMID: 2373422
• DOI: http://doi.org/10.4166/kjg.2016.67.4.178

Abstract

BACKGROUND/AIMS
Eosinophilic esophagitis (EoE) is a chronic, immune/antigen-mediated esophageal disease, with eosinophilic infiltration limited to the esophagus. A minority of EoE patients respond well to proton pump inhibitor (PPI) therapy alone, and that condition is labelled PPI-responsive esophageal eosinophilia (PPI-REE). The prevalence of PPI-REE among EoE cases is unknown. We aimed to identify clinical manifestations of PPI-REE, and the proportion of PPI-REE among all EoE cases.
METHODS
We reviewed pathology of the 4,075 patients who underwent esophageal biopsy at an institution from March 2003 to July 2015. EoE was diagnosed based on esophageal symptoms and eosinophilic infiltration limited to the esophagus, with ≥15 eosinophils per high-power field. We collected endoscopic and pathologic findings, and clinical features for these patients.
RESULTS
Thirteen (0.3%) patients were diagnosed with EoE. Clinical manifestations were dysphagia (30.8%), foreign body sensation (23.1%), regurgitation (23.1%), cough (15.4%), heartburn (15.4%), nausea (7.7%), dyspepsia (7.7%). The endoscopic findings noted were polypoid lesion (23.1%), whitish plaque or exudate (23.1%), linear furrow (7.7%), concentric ring (7.7%), nodularity (7.7%), erosion (7.7%), and normal (30.8%). Of these patients, five had a favorable course with PPI as monotherapy.
CONCLUSIONS
The proportion of EoE among all patients undergoing endoscopic biopsy was 0.3%. Of those, PPI-REE comprised 38%. Most of the endoscopic findings were atypical or normal when compared to the typical findings in EoE. In conclusion, patients who present with symptoms related to esophageal dysfunction need esophageal biopsy, regardless of the endoscopic findings. Moreover, patients diagnosed with EoE need to be treated first with PPI alone.

Keyword

Eosinophilic esophagitis; Proton pump inhibitors; Eosinophilia; Eosinophils; Esophagus

MeSH Terms

Adult
Aged
Endoscopy, Gastrointestinal
Eosinophilic Esophagitis/*diagnosis/etiology
Esophagus/pathology
Female
Gastroesophageal Reflux/drug therapy
Hospitals, University
Humans
Male
Middle Aged
Proton Pump Inhibitors/*adverse effects/therapeutic use
Retrospective Studies
Proton Pump Inhibitors

Figure

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  Fig. 1. Initial histologic finding (H&E, ×400) and endoscopic finding in No. 5 patient with proton pump inhibitor-responsive esophageal eosinophilia. (A) Biopsy of the esophageal mucosa showed infiltration of eosinophils (>100 eosinophils/high-power field). (B) Concentric rings in lower esophagus.

Reference

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