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Eosinophilic oesophagitis: clinical presentation and pathogenesis.

Bystrom J, O'Shea NR - Postgrad Med J (2014)

Bottom Line: An allergic predisposition is common in the EoE population, which appears to be primarily food antigen driven in children and aeroallergen driven in adults.Allergen elimination and anti-inflammatory therapy with corticosteroids are currently the mainstay of treatment; however, an increasing number of studies are now focused on targeting different stages in the disease pathogenesis.A greater understanding of the underlying mechanisms resulting in EoE will allow us to improve the therapeutic options available.

View Article: PubMed Central - PubMed

Affiliation: Bone and Joint Research Unit, William Harvey Research Institute, Barts & the London, Queen Mary University of London, , London, UK.

ABSTRACT
Eosinophilic oesophagitis (EoE) is an inflammatory disorder of the oesophagus which has become increasingly recognised over recent years, although it remains underdiagnosed in many centres. It is characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field), and clinically with features of oesophageal dysfunction such a dysphagia, food impaction, and proton pump inhibitor (PPI) resistant dyspepsia. Fibrosis and oesophageal remodelling may occur and lead to oesophageal strictures. An allergic predisposition is common in the EoE population, which appears to be primarily food antigen driven in children and aeroallergen driven in adults. Evidence suggests that the pathogenesis of EoE is due to a dysregulated immunological response to an environmental allergen, resulting in a T helper type 2 (Th2) inflammatory disease and remodelling of the oesophagus in genetically susceptible individuals. Allergen elimination and anti-inflammatory therapy with corticosteroids are currently the mainstay of treatment; however, an increasing number of studies are now focused on targeting different stages in the disease pathogenesis. A greater understanding of the underlying mechanisms resulting in EoE will allow us to improve the therapeutic options available.

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Related in: MedlinePlus

Histology images of oesophageal epithelial eosinophilia. (A) Squamous mucosa showing basal cell hyperplasia, elongation of papillae, and numerous eosinophils in the epithelium (haematoxylin and eosin ×100). (B) Eosinophils in squamous epithelium (arrowhead, >30/high powered field). Detail upper right corner: eosinophilic micro abscess (arrow head, H&E ×400).
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POSTGRADMEDJ2012131403F1: Histology images of oesophageal epithelial eosinophilia. (A) Squamous mucosa showing basal cell hyperplasia, elongation of papillae, and numerous eosinophils in the epithelium (haematoxylin and eosin ×100). (B) Eosinophils in squamous epithelium (arrowhead, >30/high powered field). Detail upper right corner: eosinophilic micro abscess (arrow head, H&E ×400).

Mentions: Eosinophilic oesophagitis (EoE) is an inflammatory disorder of the oesophagus which has become increasingly recognised over recent years. The cardinal feature of this disease is a significant infiltration of eosinophils into the epithelial layer of the oesophagus (figure 1). The resulting oesophageal inflammation is accompanied by basal layer hyperplasia and dilated intracellular spaces with progression to lamina propria fibrosis over time, resulting in narrowing of the oesophagus and stricture formation (see companion article by Kumar et al)1. EoE is associated with considerable morbidity, and symptoms of dysphagia and food impaction are common. In rare cases rupture of the oesophagus may occur. Despite the significant impact on quality of life, EoE is not associated with an increased mortality and there is no evidence to suggest progression to oesophageal cancer.2 This paper will describe the epidemiology, clinical presentation, diagnosis, and pathophysiology of EoE. The article by Kumar et al1 will address the investigations and management of EoE.


Eosinophilic oesophagitis: clinical presentation and pathogenesis.

Bystrom J, O'Shea NR - Postgrad Med J (2014)

Histology images of oesophageal epithelial eosinophilia. (A) Squamous mucosa showing basal cell hyperplasia, elongation of papillae, and numerous eosinophils in the epithelium (haematoxylin and eosin ×100). (B) Eosinophils in squamous epithelium (arrowhead, >30/high powered field). Detail upper right corner: eosinophilic micro abscess (arrow head, H&E ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495666&req=5

POSTGRADMEDJ2012131403F1: Histology images of oesophageal epithelial eosinophilia. (A) Squamous mucosa showing basal cell hyperplasia, elongation of papillae, and numerous eosinophils in the epithelium (haematoxylin and eosin ×100). (B) Eosinophils in squamous epithelium (arrowhead, >30/high powered field). Detail upper right corner: eosinophilic micro abscess (arrow head, H&E ×400).
Mentions: Eosinophilic oesophagitis (EoE) is an inflammatory disorder of the oesophagus which has become increasingly recognised over recent years. The cardinal feature of this disease is a significant infiltration of eosinophils into the epithelial layer of the oesophagus (figure 1). The resulting oesophageal inflammation is accompanied by basal layer hyperplasia and dilated intracellular spaces with progression to lamina propria fibrosis over time, resulting in narrowing of the oesophagus and stricture formation (see companion article by Kumar et al)1. EoE is associated with considerable morbidity, and symptoms of dysphagia and food impaction are common. In rare cases rupture of the oesophagus may occur. Despite the significant impact on quality of life, EoE is not associated with an increased mortality and there is no evidence to suggest progression to oesophageal cancer.2 This paper will describe the epidemiology, clinical presentation, diagnosis, and pathophysiology of EoE. The article by Kumar et al1 will address the investigations and management of EoE.

Bottom Line: An allergic predisposition is common in the EoE population, which appears to be primarily food antigen driven in children and aeroallergen driven in adults.Allergen elimination and anti-inflammatory therapy with corticosteroids are currently the mainstay of treatment; however, an increasing number of studies are now focused on targeting different stages in the disease pathogenesis.A greater understanding of the underlying mechanisms resulting in EoE will allow us to improve the therapeutic options available.

View Article: PubMed Central - PubMed

Affiliation: Bone and Joint Research Unit, William Harvey Research Institute, Barts & the London, Queen Mary University of London, , London, UK.

ABSTRACT
Eosinophilic oesophagitis (EoE) is an inflammatory disorder of the oesophagus which has become increasingly recognised over recent years, although it remains underdiagnosed in many centres. It is characterised histologically by a significant eosinophilic infiltration of the oesophageal mucosa (>15 eosinophils per high powered field), and clinically with features of oesophageal dysfunction such a dysphagia, food impaction, and proton pump inhibitor (PPI) resistant dyspepsia. Fibrosis and oesophageal remodelling may occur and lead to oesophageal strictures. An allergic predisposition is common in the EoE population, which appears to be primarily food antigen driven in children and aeroallergen driven in adults. Evidence suggests that the pathogenesis of EoE is due to a dysregulated immunological response to an environmental allergen, resulting in a T helper type 2 (Th2) inflammatory disease and remodelling of the oesophagus in genetically susceptible individuals. Allergen elimination and anti-inflammatory therapy with corticosteroids are currently the mainstay of treatment; however, an increasing number of studies are now focused on targeting different stages in the disease pathogenesis. A greater understanding of the underlying mechanisms resulting in EoE will allow us to improve the therapeutic options available.

Show MeSH
Related in: MedlinePlus