Abstract
Eosinophilic esophagitis is a clinicopathologic disease characterized by 1) persistent upper intestinal symptoms despite the patient’s use of gastric acid blockade and 2) large numbers of eosinophils in the squamous epithelium of the esophagus. This disease is increasing in frequency and the exact etiologic agent(s) remain elusive. The major importance of identifying eosinophilic esophagitis is that affected patients are receiving fundoplication for persistent symptoms when, in fact, corticosteroids or diet restriction is the treatment of choice.
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References and Recommended Reading
Attwood S, Smyrk T, Demeester T, Jones J: Esophageal eosinophilia with dysphagia. A distinct clinicopathologic syndrome. Dig Dis Sci 1993, 38:109–116.
Kelly K, Lazenby A, Rowe P, et al.: Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology 1995, 109:1503–1512.
Orenstein S, Shalaby T, Lorenzo CD, et al.: The spectrum of pediatric eosinophilic esophagitis beyond infancy: a clinical series of 30 children. Am J Gastroenterol 2000, 95:1422–1430. This is the most comprehensive clinical description of eosinophilic esophagitis in children. The authors carefully describe their collective experience and provide their insight into the observed clinical features.
Walsh S, Antonioli D, Goldman H, et al.: Allergic esophagitis in children-a clinicopathological entity. Am J Surg Pathol 1999, 23:390–396. The authors provide the first detailed description of the histopathologic features of eosinophilic esophagitis.
Shub MD, Ulshen MH, Hargrove CB, et al.: Esophagitis: a frequent consequence of gastroesophageal reflux in infancy. J Pediatr 1985, 107:881–884.
Biller JA, Winter HS, Grand RJ, Allred EN: Are endoscopic changes predictive of histologic esophagitis in children? J Pediatr 1983, 103:215–218.
Siafakas C, Ryan C, Brown M, Miller T: Multiple esophageal rings: an association with eosinophilic esophagitis. Case report and review of the literature. Am J Gastroenterol 2000, 95:1572–1575.
Furuta G: Clinicopathologic features of esophagitis in children. Gastroenterol Endoscop Clin North Am 2001, in press.
Gupta S, Fitzgerald J, Chong S, et al.: Vertical lines in distal esophageal mucosa (VLEM): a true manifestation of esophagitis in children. Gastrointest Endosc 1997, 45:485–489.
Lim JR, Gupta SK, Fitzgerald JF, et al.: White specks in esophageal mucosa: a true endoscopic manifestation of severe eosinophilic esophagitis in children? J Pediatr Gastroenterol Nutr 2001, 33:S411.
Teitelbaum J, Fox V, Nurko S, et al.: Fluticasone propionate treatment of eosinophilic esophagitis. J Pediatr Gastroenterol Nutr 2000, 31:S140.
Furuta G, Walsh S, Antonioli DA, et al.: Eosinophil major basic protein deposition occurs in eosinophilic esophagitis. Gastroenterology 1998, 114:G518.
Mishra A, Hogan S, Brandt E, Rothenberg M: An etiological role for aeroallergens and eosinophils in experimental esophagitis. J Clin Invest 2001, 107:83–90. This group has continued to define the murine models of noninfectious gastrointestinal eosinophilia. Here they define a model of antigen-driven eosinophilia and demonstrate its dependence on IL-5.
Mangano M, Antonioli D, Schnitt S, Wang H: Nature and significance of cells with irregular nuclear contours in esophageal mucosal biopsies. Mod Pathol 1992, 5:191–196.
Terris B, Potet F: Structure and role of Langerhan’s cells in the human oesophageal epithelium. Digestion 1995, 56:9–14.
Wang H, Mangano M, Antonioli D: Evaluation of T lymphocytes in esophageal mucosal biopsies. Mod Pathol 1994, 7:55–58.
Dvorak AM: Ultrastructural evidence for release of major basic protein-containing crystalline cores of eosinophil granules in vivo: cytotoxic potential in Crohn’s disease. J Immunol 1980, 125:460–462.
Dvorak AM, Monahan RA, Osage JE, Dickersin GR: Crohn’s disease: transmission electron microscopic studies-immunologic inflammatory response. Alterations of mast cells, basophils, eosinophils, and the microvasculature. Human Pathol 1980, 11:606–619.
Justinich C, Ricci A, Kalafus D, et al.: Activated eosinophils in esophagitis in children: a transmission electron microscopic study. J Pediatr Gastroenterol Nutr 1997, 25:194–198.
Kephart GM, McGovern TW, Carpenter HA, Gleich GJ: Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease. Gastroenterology 1992, 102:137.
Lavo B, Knutson L, Loof L, et al.: Challenge with gliadin induces eosinophil and mast cell activation in the jejunum of patients with celiac disease. Am J Med 1989, 87:655–660.
Levy AM, Gleich GJ, Sandborn WJ, et al.: Increased eosinophil granule proteins in gut lavage fluid from patients with inflammatory bowel disease. Mayo Clin Proc 1997, 72:117–123.
Makiyama K, Kanzaki S, Yamasaki K, et al.: Activation of eosinophils in the pathophysiology of ulcerative colitis. J Gastroenterol 1995, 30:64–69.
Rabb Y, Fredens K, Gerdin B, Hallgren R: Eosinophil activation in ulcerative colitis: studies on mucosal release and localization of eosinophil granule constituents. Dig Dis Sci 1998, 43:1061–1070.
Talley NJ, Kephart GM, McGovern TW, et al.: Deposition of eosinophil granule major basic protein in eosinophilic gastroenteritis and celiac disease. Gastroenterology 1992, 102:137–145.
Torpier G, Colombel JF, Mathieu-Chandelier C, et al.: Eosinophilic gastroenteritis: ultrastructural evidence for a selective release of eosinophil major basic protein. Clin Exp Immunol 1988, 74:404–408.
Flavahan NA, Slifman NR, Gleich GJ, Vanhoutte PM: Human eosinophil major basic protein causes hyperactivity of respiratory smooth muscle. Role of the epithelium. Am Rev Respir Dis 1988, 138:685–688.
Furuta GT, Ackerman SJ, Lu L, et al.: Stem cell factor influences mast cell mediator release in response to eosinophil derived granule major basic protein. Blood 1998, 92:1055–1061.
Furuta G, Ackerman SJ, Varga J, et al.: Eosinophil granulederived major basic protein induces IL-8 expression in human intestinal myofibroblasts. Clin Exp Immunol 2000, 122:35–40.
Haskell MD, Moy JN, Gleich GJ, Thomas LL: Analysis of signaling events associated with activation of neutrophil superoxide anion production by eosinophil granule major basic protein. Blood 1995, 86:4627–4637.
Kita H, Abu-Ghazaleh RI, Sur S, Gleich GJ: Eosinophil major basic protein induces degranulation and IL-8 production by human eosinophils. J Immunol 1995, 154:4749–4758.
Rochester CL, Ackerman SJ, Zheng T, Elias JA: Eosinophil-fibroblast interactions: granule major basic protein interacts with IL-1 and transforming growth factor-b in the stimulation of lung fibroblasts IL-6-type cytokine production. J Immunol 1996, 156:4449–4456.
Thomas LL, Zheutlin LM, Gleich GJ: Pharmacological control of human basophil histamine release stimulated by eosinophil granule major basic protein. Immunology 1989, 66:611–615.
Uchida DA, Ackerman SJ, Coyle AJ, et al.: The effect of human eosinophil granule major basic protein on airway responsiveness in the rat in vivo. Am Rev Respir Dis 1993, 147:982–988.
White SR, Ohno S, Munoz NM, et al.: Epithelium-dependent contraction of airway smooth muscle caused by eosinophil MBP. Am J Physiol Lung Cell Mol Physiol 1990, 259:L294–303.
Zheutlin LM, Ackerman SJ, Gleich GJ: Stimulation of basophil and rat mast cell histamine release by eosinophil granulederived cationic proteins. J Immunol 1984, 133:2180–2185.
Hogan S, Mishra A, Brandt E, et al.: A critical role for eotaxin in experimental oral antigen-induced eosinophilic gastrointestinal allergy. Proc Natl Acad Sci U S A 2000, 97:6681–6686.
Liacouras C, Wenner W, Brown K, Ruchelli E: Primary eosinophilic esophagitis in children: successful treatment with oral corticosteroids. J Pediatr Gastroenterol Nutr 1998, 26:380–385.
Faubion W, Perrault J, Burgart L, et al.: Treatment of eosinophilic esophagitis with inhaled corticosteroids. J Pediatr Gastroenterol Nutr 1998, 27:90–93. These investigators demonstrated the impact of the novel use of swallowed, not inhaled, metered dose units of fluticasone propionate and betamethasone in the treatment of eosinophilic esophagitis.
Neustrom M, Friesen C: Treatment of eosinophilic gastroenteritis with montelukast. J Allergy Clin Immunol 1999, 104:506.
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Furuta, G.T. Eosinophilic esophagitis: An emerging clinicopathologic entity. Curr Allergy Asthma Rep 2, 67–72 (2002). https://doi.org/10.1007/s11882-002-0042-x
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DOI: https://doi.org/10.1007/s11882-002-0042-x