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{{ Infobox diagnosis | |||
| Name = {{PAGENAME}} | |||
| Image = Eosinophilic_esophagitis_-_2_-_very_high_mag.jpg | |||
| Width = | |||
| Caption = Eosinophilic esophagitis. [[H&E stain]]. | |||
| 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 = | |||
| LMDDx = [[GERD]] | |||
| Stains = | |||
| IHC = | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[esophagus]] | |||
| Assdx = atopy, [[celiac disease]] | |||
| Syndromes = | |||
| Clinicalhx = may be unresponsive to proton pump inhibitors (PPIs) | |||
| Signs = | |||
| Symptoms = similar to [[GERD]] | |||
| Prevalence = uncommon | |||
| Bloodwork = | |||
| Rads = | |||
| Endoscopy = trachealization of esophagus ([[AKA]] feline esophagus) | |||
| Prognosis = | |||
| Other = | |||
| ClinDDx = [[GERD]] | |||
}} | |||
'''Eosinophilic esophagitis''', abbreviated '''EE''', is relatively uncommon pathology of the [[esophagus]] with some similarities to [[gastroesophageal reflux disease]] (GERD). | '''Eosinophilic esophagitis''', abbreviated '''EE''', is relatively uncommon pathology of the [[esophagus]] with some similarities to [[gastroesophageal reflux disease]] (GERD). | ||
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*Avoid exacerbating antigens. | *Avoid exacerbating antigens. | ||
*Topical corticosteroids, e.g. fluticasone. | *Topical corticosteroids, e.g. fluticasone. | ||
* | |||
Note on treatment: | |||
*The classic teaching was that EE does not respond to proton pump inhibitors; thinking on this has evolved.<ref name=pmid30009819/> | |||
Biopsies: | Biopsies: | ||
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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. | ||
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**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> | ||
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===Images=== | ===Images=== | ||
<gallery> | <gallery> | ||
Image: | Image:Eosinophilic esophagitis - intermed mag.jpg | Intermed. mag. (WC) | ||
Image: | Image:Eosinophilic esophagitis - high mag.jpg | High mag. (WC) | ||
Image:Eosinophilic esophagitis - very high mag.jpg | Very high mag. (WC) | |||
Image:Eosinophilic esophagitis - 2 - high mag.jpg | High mag. (WC) | |||
Image:Eosinophilic esophagitis - 2 - very high mag.jpg | Very high mag. (WC) | |||
</gallery> | </gallery> | ||
====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/> | ||
*[http://www.medunigraz.at/23798 Eosinophilic esophagitis - nice pictures (medunigraz.at)]. | |||
==Sign out== | ==Sign out== | ||
<pre> | |||
A. Distal Esophagus, Biopsy: | |||
- Squamous mucosa with basal cell hyperplasia, abundant intraepithelial | |||
eosinophils, edema, and papillary elongation, see comment. | |||
- NEGATIVE for columnar type epithelium. | |||
- NEGATIVE for dysplasia. | |||
B. Mid Esophagus, Biopsy: | |||
- Squamous mucosa with basal cell hyperplasia, abundant intraepithelial | |||
eosinophils, edema, and papillary elongation, see comment. | |||
- NEGATIVE for dysplasia. | |||
COMMENT: | |||
There are approximately 35 eosinophils per 0.2376 mm*mm (1 HPF) in | |||
both Part A and Part B. | |||
The above findings are suggestive of eosinophilic esophagitis in the proper | |||
clinical context. | |||
</pre> | |||
===Block letters=== | |||
<pre> | <pre> | ||
ESOPHAGUS, DISTAL, BIOPSY: | ESOPHAGUS, DISTAL, BIOPSY: | ||
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COMMENT: | COMMENT: | ||
There are approximately 65 eosinophils per 0.2376 mm*mm (1 HPF). | There are approximately 65 eosinophils per 0.2376 mm*mm (1 HPF). | ||
The above findings are suggestive of eosinophilic esophagitis in the proper | The above findings are suggestive of eosinophilic esophagitis in the proper | ||
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compatible with gastroesophageal reflux; however, eosinophilic esophagitis is also a | compatible with gastroesophageal reflux; however, eosinophilic esophagitis is also a | ||
consideration. Clinical correlation is required. | consideration. Clinical correlation is required. | ||
</pre> | </pre> | ||
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*[[Esophagus]]. | *[[Esophagus]]. | ||
*[[Eosinophilic colitis]]. | *[[Eosinophilic colitis]]. | ||
*[[ | *[[Eosinophilic gastritis]]. | ||
==References== | ==References== |
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