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Allergy–Asthma Practice
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Mark Holbreich, Pudupakkam K Vedanthan, PA Mahesh, Sitesh Roy
Eosinophilic esophagitis is a disease characterized most commonly by dysphagia in adults and chronic abdominal complaints in children. It was first recognized in 1986 and over the past 10 years the disease has been better defined. Although found throughout the world it is most prevalent in caucasian males living in developed countries. The treatment may consist of a diet or swallowed corticosteroids. It is a chronic and progressive disease.
Esophagogastroduodenoscopy and endoscopic retrograde cholangiopancreatography
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Colin G. DeLong, Afif N. Kulaylat, Eric M. Pauli, Robert E. Cilley
Removal of an irregular object, such as impacted food material, may be facilitated by the passage of a balloon catheter beyond the material or with the use of a specialized retrieval device (e.g. nets, basket), which is then withdrawn under direct vision while the airway is controlled by endotracheal intubation. Other techniques include the use of suction catheters to pull a soft food bolus back or a “push” technique where the object is gently pushed into the stomach. Food impactions in previously healthy children without known esophageal disease should prompt consideration of eosinophilic esophagitis.
The upper gastrointestinal tract, common conditions, and recommended treatments
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Increasingly recognised over the past 25 years and typically affecting children and young adults (male > female), eosinophilic oesophagitis is an immunologically mediated condition involving inflammation of the oesophagus in response to food and possibly, airborne allergens. Patients (who often also have hay fever or asthma) typically present with heartburn or difficulty swallowing, and food may become completely stuck in the oesophagus, requiring removal at endoscopy. Acid-suppressing medications are prescribed early as oesophageal acidification increases the severity of the inflammation. Dietary treatment is effective in many patients, with elimination of the foods causing the immune reaction using the six- or four-food elimination diet, although these can be difficult to follow. Alternatively, topical anti-inflammatory medication (steroids) can be applied to the oesophagus as a swallowed spray or paste. Occasionally, patients require a dilation (stretch) of the oesophagus, particularly if the condition has caused narrowing because of scarring. For more information about eosinophilic oesophagitis see [14].
Immunohistochemical markers for eosinophilic esophagitis
Published in Scandinavian Journal of Gastroenterology, 2020
Katarzyna Zdanowicz, Magdalena Kucharska, Joanna Reszec, Dariusz Marek Lebensztejn, Urszula Daniluk
The EoE diagnostic criteria have changed in recent years. According to previous guidelines, the diagnosis of EoE needed persistence of esophageal eosinophilia after two months of proton pump inhibitor (PPI) therapy. However, many patients with features of eosinophilic esophagitis have responded histologically to PPI. That was the reason for changing the guidelines and currently PPI is one of the therapeutic options, along with topical corticosteroids and an elimination diet [1]. Furthermore, IHC may be helpful in finding the reason why some patients do not respond to treatment. In this article, we have reviewed the current knowledge about EoE immunopathology, in particular the markers of inflammation and epithelial integrity, and their usefulness in disease monitoring and therapy. However, this method has some limitations that can be categorized asreaction bias (for example incorrect sample fixation, tissue processing) and interpretation bias (for example inappropriate antibody panel selection, sensitivity selected panel, selection of antibody types and clones, literature results and interpretation). The acquisition, handling, fixation, specimen delivery to the laboratory and antigen retrieval are important factors that may influence the final result [2].
Eosinophilic esophagitis in children: current knowledge to open new horizons
Published in Scandinavian Journal of Gastroenterology, 2019
Tommaso Alterio, Sabrina Cardile, Claire Trayers, Simona Valenti, Italia Loddo, Roxana Mardare, Antonella Mosca, Valerio Nobili
We carried out a review including the most pertinent manuscripts on “Pediatric Eosinophilic Esophagitis” present on PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) over the last 25 years (1993–2018); papers were selected from RCTs, case reports, reviews, systematic reviews, cohort and case–control studies, and observational studies. Researched terms were “pediatric eosinophilic esophagitis” [all fields]; “eosinophilic esophagitis” and “children” [all fields]; “pediatric eosinophilic esophagitis” and “management” [all fields]; “pediatric eosinophilic esophagitis” and “treatment” [all fields]; “pediatric eosinophilic esophagitis” and “therapy” [all fields]; “pediatric eosinophilic esophagitis” and “diet” [all fields]; “pediatric eosinophilic esophagitis” and “probiotics” [all fields]; “esophageal eosinophilia” [all fields]; “pediatric GERD” [all fields]; “gastroesophageal reflux” and “children” [all fields].
Effective treatment with omalizumab of a patient with spontaneous chronic urticaria and eosinophilic esophagitis
Published in Journal of Dermatological Treatment, 2018
Eugenio Provenzano, Pietro Morrone
Omalizumab is a humanized monoclonal antibody directed against E immunoglobulin (IgE), recommended for the treatment of allergic asthma and of chronic spontaneous urticaria (CSU) resistant to treatment with antihistamines (1). Urticaria is a series of skin conditions characterized by itching wheals, possibly associated with angioedema. Urticaria recurring for longer than 6 weeks is defined chronic, while acute urticaria usually lasts less than 3 weeks (2). Chronic urticaria heavily affects the quality of life of the patient and it is not easily managed. Eosinophilic esophagitis is a chronic inflammatory disease, characterized clinically by dysphagia and pathologically by eosinophilia of the esophagus. Diagnosis is made by 3 criteria: symptoms of esophageal dysfunction; presence of ≥15 eosinophils/high power field in at least 1 esophageal biopsy, with few exceptions; eosinophilia limited to the esophagus, with exclusion of other possible causes of esophageal eosinophilia, including proton pump inhibitors (PPI) responsive esophageal eosinophilia. It may be associated with allergy and epigastric pain, and symptoms do not respond to proton pump inhibitors (PPI) (3). This article reports the history of a patient affected by antihistamines-refractory CSU and eosinophilic esophagitis, who had remission of both diseases after therapy with omalizumab.