Abstract
Eosinophilic esophagitis (EoE) is diagnosed by microscopic findings of eosinophilic infiltration into the squamous epithelium. In contrast, another disease concept termed “eosinophilic esophageal myositis (EoEM)” has been proposed, whereby there is eosinophilic infiltration into the muscularis propria instead. A 60-year-old man was referred to our hospital for chest pain, dysphagia, and several episodes of esophageal food impaction. Although EoE was suspected based on clinical features, biopsy specimens showed no mucosal eosinophilic infiltration. Endoscopic ultrasound (EUS) showed thickening of the muscularis propria layer and subsequent EUS-guided fine-needle aspiration biopsy (EUS-FNA) revealed eosinophilic infiltration into the muscularis propria. Although the patient’s symptoms gradually improved after steroid administration, complete remission was not achieved after 1 year of treatment. This case may reflect a disorder distinct from typical EoE based on eosinophilic infiltration of the muscularis propria but not the squamous epithelium, and we, therefore, diagnosed it as EoEM using the EUS-FNA findings as reference.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ali MA, Lam-Himlin D, Voltaggio L. Eosinophilic esophagitis: a clinical, endoscopic, and histopathologic review. Gastrointest Endosc. 2012;76(6):1224–37.
Sato H, Takeuchi M, Takahashi K. Eosinophilic infiltration of the muscularis propria in a patient with jackhammer esophagus treated with per-oral endoscopic myotomy. Clin Gastroenterol Hepatol. 2015;13(4):e33–4.
Sato H, Takeuchi M, Takahashi K, et al. Nutcracker and jackhammer esophagus treatment: a three-case survey, including two novel cases of eosinophilic infiltration into the muscularis propia. Endoscopy. 2015;47(9):855–7.
Dellon ES, Gonsalves N, Hiran I, et al. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EOE). Am J Gastroenterol. 2013;108(5):679–92.
Kinoshita Y, Furuta K, Ishimaura N, et al. Clinical characteristics of Japanese patients with eosinophilic esophagitis and eosinophilic gastroenteritis. J Gastroenterol. 2013;48(3):333–9.
Tomomatsu Y, Yoshino J, Inui K, et al. Clinical features of eosinophilic esophagitis: ten Japanese cases. Dig Endosc. 2013;25(2):117–24.
Furuta K, Adachi K, Kowari K, et al. A Japanese case of eosinophilic esophagitis. J Gastroenterol. 2006;41(7):706–10.
Fox VL, Nurko S, Teitelbaum JE, et al. High-resolution EUS in children with eosinophilic “allergic” esophagitis. Gastrointest Endosc. 2003;57(1):30–6.
Yamabe A, Irisawa A, Shibukawa G, et al. Clinical effects of eosinophilic esophagitis observed using endoscopic ultrasound. Clin J Gastroenterol. 2014;7(4):305–9.
Moawad FJ, Maydonovitch CL, Veerappan GR, et al. Esophageal motor disorders in adults with eosinophilic esophagitis. Dig Dis Sci. 2011;56(5):1427–31.
Othman MO, Davis B, Saroseik I, et al. EUS-guided FNA biopsy of the muscularis propria of the antrum in patients with gastroparesis is feasible and safe. Gastrointest Endosc. 2016;83(2):327–33.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Ryo Igarashi, Atushi Irisawa, Goro Shibukawa, Akane Yamabe, Mariko Fujisawa, Ai Sato, Takumi Maki, Noriyuki Arakawa, Yoshitsugu Yoshida, Shogo Yamamoto, and Tsunehiko Ikeda declare that they have no conflict of interest.
Human rights
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent
Informed consent was obtained from all patients included in the study.
Rights and permissions
About this article
Cite this article
Igarashi, R., Irisawa, A., Shibukawa, G. et al. Eosinophilic esophageal myositis diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy: a case report. Clin J Gastroenterol 9, 285–288 (2016). https://doi.org/10.1007/s12328-016-0678-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12328-016-0678-z