Abstract
Eosinophilic esophagitis (EE) is an allergic inflammatory condition of the esophagus and is characterized by dense eosinophilic infiltration of the esophagus. There has been a dramatic increase in the diagnosis of EE in Western countries in recent years; however, in Japan, there are very few reports of EE. We present a rare case of EE in a 70-year-old Japanese woman, who had dysphasia for 2 years, but which worsened over a 6-month period. Laboratory examinations showed peripheral eosinophilia (1279/μl). Significant thickening of the esophageal wall was observed on computed tomography scan and many circular rings appeared when an esophagogastroduodenoscopy was carried out. From these circular rings, EE was suspected and a biopsy was then taken from the esophagus. As the histologic findings from the esophageal biopsy showed that >25 eosinophils existed per high-power field, the patient was diagnosed with EE. Oral corticosteroid (prednisolone 30 mg/day) therapy was administered and after 3 days of treatment her symptoms almost disappeared. EE needs to be considered as a differential diagnosis if patients with non-erosive reflux disease have dysphagia but do not respond to high-dose proton pump inhibitor therapy.
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References
Nielsen RG, Husby S. Eosinophilic oesophagitis: epidemiology, clinical aspects, and association to allergy. J Pediatr Gastroenterol Nutr. 2007;45:281–9.
Blanchard C, Rothenberg ME. Basic pathogenesis of eosinophilic esophagitis. Gastrointest Endosc Clin N Am. 2008;18:133–43.
Kelly JK, Lazenby AJ, Rowe PC, Yardley JH, Perman JA, Sampson HA, et al. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995;109:1503–12.
Furuta K, Adachi K, Kowari K, Mishima Y, Imaoka H, Kadota C, et al. A Japanese case of eosinophilic esophagitis. J Gastroenterol. 2006;41:706–10.
Kamimura K, Oosaki A, Sugahara S, Mori S, Morita T, Kimura K. Eosinophilic esophagitis: a case report. Effective treatment with systemic corticosteroids for the relapse of the disease. Clin J Gastroenterol. 2008;1:46–51.
Fujiwara H, Morita A, Kobayashi H, Hamano K, Fujiwara Y, Hirai K, et al. Infiltrating eosinophils and eotaxin: their association with idiopathic eosinophilic esophagitis. Ann Allergy Asthma Immunol. 2002;89:429–32.
Potter JW, Saeian K, Staff D, Massey BT, Komorowski RA, Shaker R, et al. Eosinophilic esophagitis in adults: an emerging problem with unique esophageal features. Gatrointest Endosc. 2004;59:355–61.
Arora AS, Yamazaki K. Eosinophilic esophagitis: asthma of the esophagus? Clin Gastroenterol Hepatol. 2004;2:523–30.
Straumann A, Beglinger C. Eosinophilic esophagitis: the endoscopist`s enigma. Gastrointest Endosc. 2006;63:13–5.
Landres RT, Kuster GGR, Strum WB. Eosinophilic esophagitis in a patient with vigorous achalasia. Gastroenterology. 1978;74:1298–301.
Teitelbaum JE, Fox VL, Twarog FJ, Nurko S, Antonioli D, Gleich G, et al. Eosinophilic esophagitis in children: immunopathological analysis and response to fluticasone propionate. Gastroenterology. 2002;122:1216–25.
Straumann A, Spichtin HP, Grize L, Bucher KA, Beglinger C, Simon HU. Natural history of primary eosinophilic esophagitis: a follow up of 30 adult patients for up to 11.5 years. Gastroenterology. 2003;125:1660–9.
Arora AS, Perrault J, Smyrk TC. Topical corticosteroid treatment of dysphagia due to eosinophilic esophagitis in adults. Mayo Clin Proc. 2003;78:830–5.
Croese J, Fairley SK, Massom JW, Chong AK, Whitaker DA, Kanowski PA, et al. Clinical and endoscopic features of eosinophilic esophagitis in adults. Gastrointest Endosc. 2003;58:516–22.
Spergel JM, Beausoleil JL, Mascarenhas M, Liacouras CA. The use of skin prick tests and patch tests to identify causative foods in eosinophilic esophagitis. J Allergy Clin Immunol. 2002;109:363–8.
Blanchard C, Wang N, Stringer KF, Mishra A, Fulkerson PC, Abonia JP, et al. Eotaxin-3 and a uniquely conserved gene expression profile in eosinophilic esophagitis. J Clin Invest. 2006;116:536–47.
Furuta GT, Liacouras CA, Collins MH, Gupta SK, Justinich C, Putnam PE, et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology. 2007;133:1342–63.
Gonsalves N, Policarpio-Nicolas M, Zhang Q, Rao MS, Hirano I. Histopathologic variability and endoscopic correlates in adults with eosinophilic esophagitis. Gastroint Endosc. 2006;64:313–9.
Zimmerman SL, Levine MS, Rubesin SE, Mitre MC, Furth EE, Laufer I, et al. Idiopathic eosinophilic esophagitis in adults: the ringed esophagus. Radiology. 2005;236:159–65.
Remedios M, Campbell C, Jones DM, Kerlin P. Eosinophilic esophagitis in adults: clinical, endoscopic, histologic findings, and response to treatment with fluticasone propionate. Gastrointest Endosc. 2006;63:3–12.
Martin LM, Vaquero CS, Prudencio SS, Perona JC, Gisbert JP, Otero RM. Eosinophilic esophagitis in the adult-clinical, endoscopic, pH-metric, and manometric findings. Rev Esp Enferm Dig. 2008;100:476–80.
Gupte AR, Draganov PV. Eosinophilic esophagitis. World J Gastroenterol. 2009;15:17–24.
Kagalwalla AF, Sentongo TA, Ritz S, Hess T, Nelson SP, Emerick KM, et al. Effect of six-food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4:1097–102.
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Sano, H., Iwakiri, K., Kawami, N. et al. Eosinophilic esophagitis: a case report with a review of the literature. Clin J Gastroenterol 3, 279–284 (2010). https://doi.org/10.1007/s12328-010-0172-y
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DOI: https://doi.org/10.1007/s12328-010-0172-y