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Difference between revisions of "Eosinophilic esophagitis"
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| Caption = Eosinophilic esophagitis. [[H&E stain]]. | | Caption = Eosinophilic esophagitis. [[H&E stain]]. | ||
| Micro = mucosa with | | Micro = mucosa with abundant eosinophils (60 per mm*mm), [[basal cell hyperplasia]] (three cells thick ''or'' >15% of epithelial thickness), papillae elongated (reach into the top 1/3 of the epithelial layer) | ||
| Subtypes = | | Subtypes = | ||
| LMDDx = [[GERD]] | | LMDDx = [[GERD]] | ||
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| Assdx = atopy, [[celiac disease]] | | Assdx = atopy, [[celiac disease]] | ||
| Syndromes = | | Syndromes = | ||
| Clinicalhx = unresponsive to proton pump inhibitors (PPIs) | | Clinicalhx = may be unresponsive to proton pump inhibitors (PPIs) | ||
| Signs = | | Signs = | ||
| Symptoms = | | Symptoms = similar to [[GERD]] | ||
| Prevalence = uncommon | | Prevalence = uncommon | ||
| Bloodwork = | | Bloodwork = | ||
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==General== | ==General== | ||
Clinical: | Clinical: | ||
*Dysphagia<ref>URL: [http://www.medicinenet.com/eosinophilic_esophagitis/page2.htm#tocc http://www.medicinenet.com/eosinophilic_esophagitis/page2.htm#tocc]. Accessed on: 1 December 2009.</ref> - classic presentation. | *Dysphagia<ref>URL: [http://www.medicinenet.com/eosinophilic_esophagitis/page2.htm#tocc http://www.medicinenet.com/eosinophilic_esophagitis/page2.htm#tocc]. Accessed on: 1 December 2009.</ref> - classic presentation. | ||
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*Topical corticosteroids, e.g. fluticasone. | *Topical corticosteroids, e.g. fluticasone. | ||
Note: | Note on treatment: | ||
*The classic teaching was that EE does not respond to proton pump inhibitors; thinking on this has evolved.<ref name=pmid30009819/> | *The classic teaching was that EE does not respond to proton pump inhibitors; thinking on this has evolved.<ref name=pmid30009819/> | ||
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==Gross/endoscopic== | ==Gross/endoscopic== | ||
*'''Trachealization'''; | *'''Trachealization'''; esophagus looks like trachea.<ref name=pmid19636182>{{Cite journal | last1 = Al-Hussaini | first1 = AA. | last2 = Semaan | first2 = T. | last3 = El Hag | first3 = IA. | title = Esophageal trachealization: a feature of eosinophilic esophagitis. | journal = Saudi J Gastroenterol | volume = 15 | issue = 3 | pages = 193-5 | month = | year = | doi = 10.4103/1319-3767.54747 | PMID = 19636182 }} | ||
</ref> | </ref> | ||
**[[AKA]] ''feline esophagus''.<ref>URL: [http://www.ajronline.org/cgi/reprint/164/4/900.pdf http://www.ajronline.org/cgi/reprint/164/4/900.pdf]. Accessed on: 4 October 2010.</ref> | **[[AKA]] ''feline esophagus''.<ref>URL: [http://www.ajronline.org/cgi/reprint/164/4/900.pdf http://www.ajronline.org/cgi/reprint/164/4/900.pdf]. Accessed on: 4 October 2010.</ref> | ||
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==Microscopic== | ==Microscopic== | ||
Features:<ref name=Ref_GLP19>{{Ref GLP|19}}</ref> | Features:<ref name=Ref_GLP19>{{Ref GLP|19}}</ref> | ||
*Mucosa with | *Mucosa with abundant eosinophils - the consensus on eosinophils per area is 60/mm*mm.<ref name=pmid30009819>{{cite journal |authors=Dellon ES, Liacouras CA, Molina-Infante J, Furuta GT, Spergel JM, Zevit N, Spechler SJ, Attwood SE, Straumann A, Aceves SS, Alexander JA, Atkins D, Arva NC, Blanchard C, Bonis PA, Book WM, Capocelli KE, Chehade M, Cheng E, Collins MH, Davis CM, Dias JA, Di Lorenzo C, Dohil R, Dupont C, Falk GW, Ferreira CT, Fox A, Gonsalves NP, Gupta SK, Katzka DA, Kinoshita Y, Menard-Katcher C, Kodroff E, Metz DC, Miehlke S, Muir AB, Mukkada VA, Murch S, Nurko S, Ohtsuka Y, Orel R, Papadopoulou A, Peterson KA, Philpott H, Putnam PE, Richter JE, Rosen R, Rothenberg ME, Schoepfer A, Scott MM, Shah N, Sheikh J, Souza RF, Strobel MJ, Talley NJ, Vaezi MF, Vandenplas Y, Vieira MC, Walker MM, Wechsler JB, Wershil BK, Wen T, Yang GY, Hirano I, Bredenoord AJ |title=Updated International Consensus Diagnostic Criteria for Eosinophilic Esophagitis: Proceedings of the AGREE Conference |journal=Gastroenterology |volume=155 |issue=4 |pages=1022–1033.e10 |date=October 2018 |pmid=30009819 |pmc=6174113 |doi=10.1053/j.gastro.2018.07.009 |url=}}</ref> | ||
*[[Basal cell hyperplasia]]. | *[[Basal cell hyperplasia]]. | ||
**Three cells thick ''or'' >15% of epithelial thickness. | **Three cells thick ''or'' >15% of epithelial thickness. | ||
*Papillae elongated. | *Papillae elongated. | ||
**Papillae that reach into the top 1/3 of the epithelial layer - definition for GERD.<ref name=Ref_PBoD804>{{Ref PBoD|804}}</ref> | **Papillae that reach into the top 1/3 of the epithelial layer - definition for GERD.<ref name=Ref_PBoD804>{{Ref PBoD|804}}</ref> | ||
Note: | |||
*Many microscopes have an eye piece diameter of 22 mm. Thus, the field area (for a "HPF") with the 40x objective is ~0.2376 mm*mm. This works out to approximately 15 eosinophils/HPF. | |||
DDx:<ref name=Ref_Odze244>{{Ref Odze|244}}</ref> | DDx:<ref name=Ref_Odze244>{{Ref Odze|244}}</ref> | ||
*[[Gastroesophageal reflux disease]] - no mid and proximal involvement. | *[[Gastroesophageal reflux disease]] - no mid and proximal involvement. | ||
*[[Infectious esophagitis]]. | *[[Infectious esophagitis]], e.g. [[Herpes esophagitis]]. | ||
*Eosinophilic gastroenteritis. | *Eosinophilic gastroenteritis. | ||
*Hypereosinophilic syndrome. | *Hypereosinophilic syndrome. | ||
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====www==== | ====www==== | ||
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841420/figure/F0003/ Eosinophilic esophagitis (nih.gov)]. | *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2841420/figure/F0003/ Eosinophilic esophagitis (nih.gov)]. | ||
*[http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-134-6-815-f03&doi=10.1043%2F1543-2165-134.6.815 EE versus GERD (archivesofpathology.org)].<ref name=pmid20524860/> | *[http://www.archivesofpathology.org/action/showFullPopup?id=i1543-2165-134-6-815-f03&doi=10.1043%2F1543-2165-134.6.815 EE versus GERD (archivesofpathology.org)].<ref name=pmid20524860>{{Cite journal | last1 = Genevay | first1 = M. | last2 = Rubbia-Brandt | first2 = L. | last3 = Rougemont | first3 = AL. | title = Do eosinophil numbers differentiate eosinophilic esophagitis from gastroesophageal reflux disease? | journal = Arch Pathol Lab Med | volume = 134 | issue = 6 | pages = 815-25 | month = Jun | year = 2010 | doi = 10.1043/1543-2165-134.6.815 | PMID = 20524860 | url = http://www.archivesofpathology.org/doi/full/10.1043/1543-2165-134.6.815 }}</ref> | ||
*[http://www.medunigraz.at/23798 Eosinophilic esophagitis - nice pictures (medunigraz.at)]. | *[http://www.medunigraz.at/23798 Eosinophilic esophagitis - nice pictures (medunigraz.at)]. | ||