Clinical Implications of Endoscopically Suspected Eosinophilic Esophagitis

Keun Man Lee; Hyun Chul Lim; Jie-Hyun Kim; Young Hoon Yoon; Hyojin Park; Sang In Lee

doi:10.4166/kjg.2010.56.5.285

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Lee, Lim, Kim, Yoon, Park, and Lee: Clinical Implications of Endoscopically Suspected Eosinophilic Esophagitis

Original Article

Korean J Gastroenterol 2010;56(5):285-292.

Published online: 21 February 2010

DOI: https://doi.org/10.4166/kjg.2010.56.5.285

Clinical Implications of Endoscopically Suspected Eosinophilic Esophagitis

Keun Man Lee, M.D., Hyun Chul Lim, M.D., Jie-Hyun Kim, M.D., Young Hoon Yoon, M.D., Hyojin Park, M.D., Sang In Lee, M.D.

Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Hyojin Park, M.D. Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, 146-92, Dogok- dong, Gangnam-gu, Seoul 135-720, Korea Tel: +82-2-2019-3318, Fax: +82-2-3463-3882 E-mail: HJPARK21@yuhs.ac

Received 3 March 2010 Accepted 15 September 2010

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’, ‘≥2 endoscopic findings’ are more suggestive of EoE in ESEoE patients.

Keywords: Eosinophilic esophagitis, Dysphagia

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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.

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.

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.

Table 1.

List of Patients with Eosinophilic Esophagitis

No.	Sex	Age	Date	Indication of endoscopy	Esophageal endoscopic findings	Allergy history	Treatment & Follow-up
1^∗	M	67	2002.2.	Food impaction	Nodules	Food allergy	Follow-up loss
				Globus sensation		B. asthma
				Rt. Chest pain		B. asthma
2^†	M	70	2005.9.	Esophgeal nodules	Nodules		Follow-up loss
3	M	48	2006.6.	Dysphagia	Ring		Follow-up loss
					Furrow
					Whitish discoloration
4	F	54	2007.4.	Dysphagia	Ring	SPT(−)	PPI & Steroid inhaler
4	F	54	2007.4.	Food impaction	Furrow	SPT(−)	PPI & Steroid inhaler
5	F	68	2007.10.	Dysphagia	Linear shearing (friability)		PPI
5	F	68	2007.10.	Sore throat	Exudate		Follow-up loss
6	M	36	2008.11.	Check-up	Ring	SPT(＋)	PPI
				Odynophagia & Dysphagia	Furrow
				Odynophagia & Dysphagia	Nodules
7	M	46	2009.3.	Check-up	Ring	Allergic history(＋),	PPI
7	M	46	2009.3.	Check-up	Furrow	SPT(＋)	PPI

M, male; F, female; SPT, skin prick test; PPI, proton pump inhibitor; ESEoE, Endoscopically suspected eosinophlic esophagitis.

^∗ This case was the first eosinophilic esophagitis case of our institute and not included in ESEoE.

^† The patient was diagnosed as eosinophilic esophagitis retrospectively by reviewing endoscopic biopsy slides and not included in ESEoE.

Table 2.

Clinical Features & Endoscopic Findings of Endoscopically Suspected Eosinophilic Esophagitis Patients

		EoE＋ (n=7)		EoE− (n=12)		p-value
Sex			%		%
	Male	5	71.4	6	50.0
	Female	2	28.6	6	50.0
Mean age (yr)		56.0	(36-70)	51.0	(36-68)
Presenting symptom
	Dysphagia	5	71.4	1	8.3	＜0.05^∗
	Food impaction	3	42.9	5	41.7
	Heartburn	1	14.3	4	33.3
	Chest pain	1	14.3	2	16.7
	Foreign body sensation	2	28.6	2	16.7
Allergic history		2	28.6	3	25.0
Endoscopic findings
	Furrow	6	85.7	7	58.3
	Ring	5	71.4	10	83.3
	Exudates/Nodules	3	42.9	0	0	＜0.05^∗
	Friability	1	14.3	0	0	＜0.05^∗
	≥2 Endoscopic findings	6	85.7	6	50.0	＜0.05^∗

Fisher's Exact Test.

EoE, eosinophilic esophagitis; EoE＋, histologically diagnosed as EoE cases; EoE−, histologically not diagnosed as EoE cases.

^∗ p＜0.05, statistically significant.

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