Sample records for eosinophilic esophagitis clinical

  1. Eosinophilic esophagitis

    Anand R Gupte; Peter V Draganov


    Eosinophilic esophagitis is increasingly recognized in adults. The diagnosis is based on the presence of both typical symptoms and pathologic findings on esophageal biopsy. Patients usually present with dysphagia, food impaction and/or reflux-like symptoms, and biopsy of the esophagus shows more than 15 eosinophils per high-power field. In addition,it is essential to exclude the presence of known causes of tissue eosinophilia such as gastroesophageal reflux disease, infections, malignancy, collagen vascular diseases, hypersensitivity, and inflammatory bowel disease. There are no standardized protocols for the therapy of eosinophilic esophagitis. A variety of therapeutic approaches including acid suppression, dietary modi f icat ions, topical cor t icosteroids and endoscopic dilation can be used alone or in combination.

  2. Clinical Applications of the Eosinophilic Esophagitis Diagnostic Panel

    Ting Wen


    Full Text Available Eosinophilic esophagitis (EoE is a recently recognized upper gastrointestinal allergic disorder characterized by esophageal dysfunction (e.g., dysphagia and esophageal eosinophilia of ≥15 eosinophils/high-power field in patients who have persistent esophagitis even on proton pump inhibitor (PPI therapy. The histologic method is the gold standard of EoE diagnosis. However, EoE clinical symptoms do not always correlate with histology, and the histologic method has sensitivity and specificity issues due to the patchiness of EoE and the subjective nature of the method. The “EoE transcriptome” was initially discovered in 2006, which led to the invention of the EoE diagnostic panel (EDP. In addition to providing a definitive EoE diagnosis with high accuracy, the EDP has been useful in elucidating several key elements about the disease including the efficacy of specific drugs such as swallowed glucocorticoids and anti-IL-13 humanized antibody therapy, the relationship between EoE and PPI-responsive esophageal eosinophilia, and predicting the disease course and responsiveness to therapy. The EDP’s long-term potential arises from its plasticity to incorporate new genes and uncover novel disease pathogenesis. We expect that the EDP will be increasingly helpful for personalized medicine approaches and improved diagnostics and disease monitoring.

  3. Eosinophilic Esophagitis: Clinical Features, Endoscopic Findings and Response to Treatment

    Robert Enns


    Full Text Available Eosinophilic esophagitis (EE is a motility disorder of the esophagus that typically presents with dysphagia. The objective of the present study was to explore patient characteristics, clinical and endoscopic features, and response to treatment of patients with EE. Patients were selected retrospectively based on a review of biopsy results from previous endoscopies performed between 2004 and 2008. A total of 54 patients (41 men and 13 women with biopsy-proven EE were included in the study. Further information regarding the patients’ clinical and endoscopic features, and response to treatment were obtained through chart reviews and patient telephone interviews. The mean age of the patients at symptom onset was 30 years. All patients complained of dysphagia, 81% had a history of bolus obstruction, 43% had a history of asthma and 70% had a history of environmental allergies. Thirty-three per cent had a family history of asthma, while 52% had a family history of food or seasonal allergies. The most common endoscopic findings were rings and/or corrugations, which were found in 63% of patients. Swallowed fluticasone therapy resulted in symptom resolution in 74% of patients; however, 79% of these patients relapsed after discontinuing fluticasone therapy and required repeat treatments. Esophageal dilation was complication free and resulted in improvement in 80% of patients. However, 83% of those reporting improvement relapsed within one year. The clinical and endoscopic findings were similar to those found in the literature, with most patients requiring ongoing, repeated therapies. Further studies are needed to assess the safety and efficacy of treatment modalities ideally suited to patients with EE.

  4. [Eosinophilic esophagitis--pathogenesis, clinical presentation and therapeutic management].

    von Arnim, U; Mönkemüller, K; Malfertheiner, P; Straumann, A


    Eosinophilic esophagitis (EE) is a relatively new, chronic, TH 2-type allergic inflammation of the esophagus. EE occurs more frequently in men. Allergic diseases such as asthma or atopic dermatitis are present in 50-70 % of patients or their relatives. In adults, the most common presenting symptom of EE is dysphagia, with or without food bolus impaction. Endoscopic findings of EE include mucosal furrows, corrugated or concentric rings or ridges in the esophagus ("feline esophagus"), with or without tiny whitish exudates. The diagnosis is confirmed by the observation of high counts of eosinophils in the esophageal epithelium (at least 24 /HPF). The cornerstones of medical therapy are either topical or systemic corticosteroids. Additional therapies included leukotriene receptor antagonists (montelukast) and IL-5 blockers (Mepolizumab). Complications of EE such as esophageal strictures should be carefully dilated using either bougies or a balloon. Currently it is still not known whether the late complications of EE can be prevented by the use of anti-inflammatory agents and this can only be demonstrated through further long-term follow-up studies.

  5. Eosinophilic esophagitis: A newly established cause of dysphagia

    Yan, Brian M; Shaffer, Eldon A.


    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also atta...

  6. Similarities and differences among eosinophilic esophagitis, proton-pump inhibitor-responsive esophageal eosinophilia, and reflux esophagitis: comparisons of clinical, endoscopic, and histopathological findings in Japanese patients.

    Jiao, Dijin; Ishimura, Norihisa; Maruyama, Riruke; Ishikawa, Noriyoshi; Nagase, Mamiko; Oshima, Naoki; Aimi, Masahito; Okimoto, Eiko; Mikami, Hironobu; Izumi, Daisuke; Okada, Mayumi; Ishihara, Shunji; Kinoshita, Yoshikazu


    Esophageal eosinophilia is classified as either eosinophilic esophagitis (EoE) or proton-pump inhibitor-responsive esophageal eosinophilia (PPI-REE), depending on the response to PPI treatment. The aim of this study was to compare the clinical, endoscopic, and histopathological findings of EoE and PPI-REE in Japanese patients. In addition, the characteristics of these cases were compared with those of reflux esophagitis (RE) cases. Eleven patients diagnosed with EoE, 16 with PPI-REE, and 39 with RE, who were all consecutively examined from 2005 to 2015 at Shimane University Hospital, were enrolled. Clinical, endoscopic, and histopathological esophageal findings in these groups were retrospectively examined and compared. The differences in the clinical characteristics of EoE and PPI-REE were not remarkable, though patients with EoE and PPI-REE were younger, presented a higher prevalence of allergic comorbidities, and complained of symptoms of dysphagia more frequently than those with RE. The only noteworthy differences between EoE and PPI-REE were more frequent reports of asthma (36.4 vs. 2.6 %) and food allergy (27.3 vs. 0 %) by patients with EoE (P eosinophilia is difficult and requires further investigation.

  7. Activity assessment of eosinophilic esophagitis.

    Schoepfer, Alain; Safroneeva, Ekaterina


    The activity of eosinophilic esophagitis (EoE) can be assessed with patient-reported outcomes and biologic measures. Patient-reported outcomes include symptoms and quality of life, whereas biologic measures refer to endoscopic, histologic, and biochemical activity (e.g. blood biomarkers). So far, a validated tool to assess EoE activity in the above-mentioned dimensions is lacking. Given the lack of a standardized way to assess EoE activity in the various dimensions, the results of different clinical trials may be difficult to compare. For symptom assessment in adult patients, the symptom 'dysphagia' should be evaluated according to different standardized food consistencies. Furthermore, symptom assessment should take into account the following items: avoidance of specific food categories, food modification, and time to eat a regular meal. A distinct symptom recall period (e.g. 2 weeks) has to be defined for symptom assessment. Performing an 'esophageal stress test' with ingestion of a standardized meal to measure symptom severity bears the potential risk of acute food bolus impaction and should therefore be avoided. The description of endoscopic findings in EoE has meanwhile been standardized. Histologic evaluation of EoE activity should report either the size of the high-power field used or count the eosinophils per mm(2). There is a current lack of blood biomarkers demonstrating a good correlation with histologic activity in esophageal biopsies. The development and validation of an adult and pediatric EoE activity index is urgently needed not only for clinical trials and observational studies, but also for daily practice.

  8. Eosinophilic esophagitis: From pathophysiology to treatment.

    D'Alessandro, Alessandra; Esposito, Dario; Pesce, Marcella; Cuomo, Rosario; De Palma, Giovanni Domenico; Sarnelli, Giovanni


    Eosinophilic esophagitis (EoE) is a chronic immune disease, characterized by a dense eosinophilic infiltrate in the esophagus, leading to bolus impaction and reflux-like symptoms. Traditionally considered a pediatric disease, the number of adult patients with EoE is continuously increasing, with a relatively higher incidence in western countries. Dysphagia and food impaction represent the main symptoms complained by patients, but gastroesophageal reflux-like symptoms may also be present. Esophageal biopsies are mandatory for the diagnosis of EoE, though clinical manifestations and proton pump inhibitors responsiveness must be taken into consideration. The higher prevalence of EoE in patients suffering from atopic diseases suggests a common background with allergy, however both the etiology and pathophysiology are not completely understood. Elimination diets are considered the first-line therapy in children, but this approach appears less effective in adults patients, who often require steroids; despite medical treatments, EoE is complicated in some cases by esophageal stricture and stenosis, that require additional endoscopic treatments. This review summarizes the evidence on EoE pathophysiology and illustrates the safety and efficacy of the most recent medical and endoscopic treatments.

  9. Clinical experience using the tethered capsule-based spectrally encoded confocal microendoscopy for diagnosis of eosinophilic esophagitis (Conference Presentation)

    Do, Dukho; Alali, Sanaz; Kang, DongKyun; Tabatabaie, Nima; Lu, Weina; Grant, Catriona N.; Soomro, Amna R.; Nishioka, Norman S.; Rosenberg, Mireille; Hesterberg, Paul E.; Yuan, Qian; Garber, John J.; Katz, Aubrey J.; Shreffler, Wayne G.; Tearney, Guillermo J.


    Eosinophilic Esophagitis (EoE) is caused by food allergies, and defined by histological presence of eosinophil cells in the esophagus. The current gold standard for EoE diagnosis is endoscopy with pinch biopsy to detect more than 15 eosinophils/ High power field (HPF). Biopsy examinations are expensive, time consuming and are difficult to tolerate for patients. Spectrally encoded confocal microscopy (SECM) is a high-speed reflectance confocal microscopy technology capable of imaging individual eosinophils as highly scattering cells (diameter between 8 µm to 15 µm) in the epithelium. Our lab has developed a tethered SECM capsule that can be swallowed by unsedated patients. The capsule acquires large area confocal images, equivalent to more than 30,000 HPFs, as it traverses through the esophagus. In this paper, we present the outcome of a clinical study using the tethered SECM capsule for diagnosing EoE. To date, 32 subjects have been enrolled in this study. 88% of the subjects swallowed the capsules without difficulty and of those who swallowed the capsule, 95% preferred the tethered capsule imaging procedure to sedated endoscopic biopsy. Each imaging session took about 12 ± 2.4 minutes during which 8 images each spanning of 24 ± 5 cm2 of the esophagus were acquired. SECM images acquired from EoE patients showed abundant eosinophils as highly scattering cells in squamous epithelium. Results from this study suggest that the SECM capsule has the potential to become a less-invasive, cost-effective tool for diagnosing EoE and monitoring the response of this disease to therapy.

  10. Eosinophilic esophagitis: A newly established cause of dysphagia

    Brian M Yan; Eldon A Shaffer


    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment,and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/105 in children and 2.5/105 in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline"or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimai contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (>20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors,or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign,albeit inconvenient, course. With increasing recognition,this entity is taking its place as an established cause of solid food dysphagia.

  11. Eosinophilic esophagitis: a newly established cause of dysphagia.

    Yan, Brian-M; Shaffer, Eldon-A


    Eosinophilic esophagitis has rapidly become a recognized entity causing dysphagia in young adults. This review summarizes the current knowledge of eosinophilic esophagitis including the epidemiology, clinical presentation, diagnostic criteria, pathophysiology, treatment, and prognosis. An extensive search of PubMed/Medline (1966-December 2005) for available English literature in humans for eosinophilic esophagitis was completed. Appropriate articles listed in the bibliographies were also attained. The estimated incidence is 43/10(5) in children and 2.5/10(5) in adults. Clinically, patients have a long history of intermittent solid food dysphagia or food impaction. Some have a history of atopy. Subtle endoscopic features may be easily overlooked, including a "feline" or corrugated esophagus with fine rings, a diffusely narrowed esophagus that may have proximal strictures, the presence of linear furrows, adherent white plaques, or a friable (crepe paper) mucosa, prone to tearing with minimal contact. Although no pathologic consensus has been established, a histologic diagnosis is critical. The accepted criteria are a dense eosinophilic infiltrate (>20/high power field) within the superficial esophageal mucosa. In contrast, the esophagitis associated with acid reflux disease can also possess eosinophils but they are fewer in number. Once the diagnosis is established, treatment options may include specific food avoidance, topical corticosteroids, systemic corticosteroids, leukotriene inhibitors, or biologic treatment. The long-term prognosis of EE is uncertain; however available data suggests a benign, albeit inconvenient, course. With increasing recognition, this entity is taking its place as an established cause of solid food dysphagia.

  12. Pediatric eosinophilic esophagitis: radiologic findings with pathologic correlation

    Binkovitz, Larry A. [Nationwide Children' s Hospital, Columbus, OH (United States); Mayo Clinic, Division of Pediatric Radiology, E-2, Rochester, MN (United States); Lorenz, Emily A. [Nationwide Children' s Hospital, Columbus, OH (United States); Di Lorenzo, Carlo [Nationwide Children' s Hospital, Department of Gastroenterology, Columbus, OH (United States); Kahwash, Samir [Nationwide Children' s Hospital, Department of Pathology, Columbus, OH (United States)


    Eosinophilic esophagitis is increasingly recognized as a cause of dysphagia or food impaction in pediatric patients. It has a high male predominance and is often associated with a history of allergy or asthma. To correlate fluoroscopic findings in eosinophilic esophagitis with the endoscopic and histologic findings. We retrospectively reviewed the upper gastrointestinal (UGI) findings of eosinophilic esophagitis and correlated them with the clinical, endoscopic and histologic findings in a series of 17 children (12 boys, 5 girls). UGI findings were normal in 12 children, including 4 who had a normal UGI exam after endoscopic disimpaction for an obstructing food bolus. Five children had strictures identified on UGI: one was demonstrated with endoscopy. This suggests that the impactions and strictures were due to an esophageal dysmotility rather than a fixed anatomic abnormality. Because the UGI findings are frequently normal in eosinophilic esophagitis, radiologists need to have a high index of suspicion for this disease. In children with a strong clinical history, especially impaction in the absence of an esophageal stricture, endoscopy and biopsy are indicated for further evaluation. (orig.)

  13. Eosinophilic esophagitis in Saudi children: Symptoms, histology and endoscopy results

    Mohammed Y Hasosah


    Full Text Available Background/Aim: Eosinophilic esophagitis (EE is a clinicopathologic entity characterized by esophageal symptoms in association with a dense eosinophilic infiltrate currently defined as >15 eosinophils per high power field in the appropriate clinical context. This is the first pediatric study in Saudi Arabia to give the experience with EE and examine its symptom, histology and endoscopy results. Materials and Methods: Retrospective chart review of all patients diagnosed with EE at National Guard Hospital, Jeddah Between 2007 and 2009. The authors identified EE on histologic criteria (≥15 eosinophils per high-power field together with their clinical context. The authors reviewed medical records for details of clinical presentation, laboratory data, radiologic, endoscopic, and histologic findings, and the results of treatment. Results: We identified 15 patients in our database in the last three years. 100% of the patients were males. The median age at presentation was 10 years (range, 3-17 years. The commonly reported symptoms were failure to thrive (86%, epigastric abdominal pain (53%, poor eating (40%, dysphagia with solid food (26%, food impaction (13%, and vomiting (20%. Asthma was reported in 46% and allergic rhinitis in 40%. Peripheral eosinophilia (>0.7 Χ 10/l was found in 66%. High serum IgE Level (>60 IU/ml was found in 60%. Upper endoscopic analysis revealed esophageal trachealization in 46%, esophageal erythema in 46%, white specks on the esophageal mucosa in 33%, esophageal narrowing in 13%, and normal endoscopy in 13%. The mean eosinophils per high-power field was 30.4 (range, 20-71. Histologic characteristics included degranulated eosinophils (86%, basal cell hyperplasia (93% and eosinophils clusters (micro-abscess in 73%. The treatment of EE revealed that they used swallowed corticosteroid in 50%, proton pump inhibitors in 66%, elemental diet/ food elimination in 13% and systemic corticosteroid in 13%. Conclusions: Failure to

  14. [Esophageal diseases: GERD, Barrett, achalasia and eosinophilic esophagitis].

    Calvet, Xavier; Villoria, Albert


    At Digestive Disease Week (DDW) 2014, developments in esophageal disease were presented. Highlights include: the usefulness of impedancemetry to diagnose reflux disease, or the effectiveness of PPIs for treating non-cardiac chest pain. Concerning Barrett's esophagus, its prevalence is identical in patients with and without reflux symptoms, Barrett segments less than 1cm probably do not require follow-up, and in older patients with long-segment Barrett, initial endoscopies overlooked up to 2% of significant lesions. Regarding achalasia, surgical myotomy is no more effective than endoscopic dilation and may even be less effective than peroral endoscopic myotomy (POEM). In terms of eosinophilic esophagitis, it is important to systematically take biopsies in patients with dysphagia so that cases of eosinophilic esophagitis are not overlooked. In addition, for this condition, routine endoscopic dilations not only do not seem useful in improving the course of the disease, but could also worsen the response to medical treatment.

  15. [Differencial diagnosis of gastroesophageal reflux disease -- eosinophilic esophagitis: case report].

    Franzius, M; Stolte, M; Porschen, R


    We report on a 22-year-old man with dysphagia and repeated bolus impaction in the esophagus for 10 years. Bolus impactions were frequently mobilised using an endoscope. At endoscopy, esophagitis IV degrees was described. After treatment with omeprazol there was no improvement. The patient was submitted to our hospital for fundoplication. pH-metry demonstrated an increased reflux. At endoscopy of the esophagus, we found red stripes which did not show the typical appearance of erosions. Manometry and X-ray films of the esophagus did not reveal any pathological findings. In combination with anamnesis, symptoms, and endoscopy, the diagnosis of eosinophilic esophagitis was documented by histology. After administration of oral corticosteroids a rapid improvement of the clinical symptoms was observed. The diagnosis of eosinophilic esophagitis should be kept in mind in patients with chronic symptoms of gastroesophageal reflux persisting despite medical therapy, pathological pH-metry and repeated bolus impactions.

  16. Eosinophilic esophagitis in adults: An update

    Monjur Ahmed


    Eosinophilic esophagitis is a worldwide chronic allergic disease of the esophagus.In the last decade,there is an epidemic of this entity in the western world.Mostly seen in children and young adults,patients present with dysphagia or food impaction in the emergency room.Characteristic endoscopic findings,esophageal eosinophilia and non-responsiveness to proton pump inhibitors help make the diagnosis.Avoidance of foodallergens,administration of steroidal anti-inflammatory medications and dilation of the esophagus are the mainstays of treatment.Investigations are ongoing for mucosal healing and optimum maintenance treatment.

  17. Seasonal variation in detection of esophageal eosinophilia and eosinophilic esophagitis

    Jensen, Elizabeth T.; Shah, Neil D.; Hoffman, Kate; Sonnenberg, Amnon; Genta, Robert M.; Dellon, Evan S.


    Summary Background Seasonal variation has been reported in diagnosis of eosinophilic esophagitis (EoE), but results are not consistent across studies and there are no national-level data in the United States. Aim To determine if there is seasonal variation in diagnosis of esophageal eosinophilia and EoE in the U.S., while accounting for factors such as climate zone and geographic variation. Methods This was a cross-sectional study using a U.S. national pathology database. Patients with esophageal eosinophilia (≥15 eosinophils per high-power field) comprised the primary case definition and were compared to those with normal esophageal biopsies. We calculated the crude and adjusted odds of esophageal eosinophilia by season, as well as by day of the year. Sensitivity analyses were performed using more restrictive case definitions of EoE, and after stratification by climate zone. Results 14,524 cases with esophageal eosinophilia and 90,459 normal controls were analyzed. The adjusted odds of esophageal eosinophilia were higher in the late spring and summer months, with the highest odds in July (aOR 1.13; 95%CI: 1.03–1.24). These findings persisted with increasing levels of esophageal eosinophilia, as well as across EoE case definitions. Seasonal variation was strongest in temperate and cold climates, and peak diagnosis varied by climate zone. Conclusions There is a mild but consistent seasonal variation in the diagnosis of esophageal eosinophilia and EoE, with cases more frequently diagnosed during summer months. These findings take into account climate and geographic differences, suggesting that aeroallergens may contribute to disease development or flare. PMID:26059636

  18. Eosinophilic esophagitis-endoscopic distinguishing findings

    Ana Célia Caetano; Raquel Gon(c)alves; Carla Rolanda


    Eosinophilic esophagitis (EE) is the most frequent condition found in a group of gastrointestinal disorders called eosinophilic gastrointestinal diseases.The hypothetical pathophysiological mechanism is related to a hypersensitivity reaction.Gastroesophageal reflux disease-like complaints not ameliorated by acid blockade or occasional symptoms of dysphagia or food impaction are likely presentations of EE.Due to its unclear pathogenesis and unspecific symptoms,it is difficult to diagnose EE without a strong suspicion.Although histological criteria are necessary to diagnosis EE,there are some characteristic endoscopic features.We present the case of a healthy 55-year-old woman with dysphagia and several episodes of esophageal food impaction over the last six months.This case report stresses the most distinguishing endoscopic findings-mucosa rings,white exudative plaques and linear furrows-that can help in the prompt recognition of this condition.

  19. Eosinophilic Esophagitis in Brazilian Pediatric Patients

    Pinheiro, Mayra Isabel Correia; de Góes Cavalcanti, Luciano Pamplona; Honório, Rodrigo Schuler; de Alencar Moreno, Luís Hélder; Fortes, Mayara Carvalho; da Silva, Carlos Antônio Bruno


    We examined 11 pediatric patients with eosinophilic esophagitis with a tardy diagnosis. The symptoms were initially thought to be related to other diseases, leading to the use of inadequate therapeutic approaches. The patients were between 3 and 17 years old (mean 7.8 ± 3.8 years), and 8 of the patients were male. Common symptoms included abdominal pain, regurgitation, difficulty in gaining weight, vomiting, dysphagia, and coughing. The mean age for the onset of symptoms was 4.3 ± 2.9 years. Endoscopic findings included normal mucosa in five (45%) patients, thickening of the mucosa with longitudinal grooves in three (27%), erosive esophagitis in two (18%), and a whitish stippling in one (9%) patient. Treatment included the use of a topical corticosteroid for 10 patients. In eight (73%) cases, the treatment made the symptoms disappear. Ten patients underwent histopathological management after treatment, with a decrease in the number of eosinophils. PMID:24106430

  20. Pathogenic role of mast cells in experimental eosinophilic esophagitis

    Niranjan, Rituraj; Mavi, Parm; Rayapudi, Madhavi; Dynda, Scott; Mishra, Anil


    Eosinophilic esophagitis (EoE) is a chronic allergic disease characterized by esophageal intraepithelial eosinophils, extracellular eosinophil granule deposition, induced mast cell accumulation, and epithelial cell hyperplasia. However, the processes involved in the development of a number of these characteristics are largely unknown. Herein, we tested the hypothesis whether induced mast cell accumulation in the esophagus has a role in promoting EoE pathogenesis. Accordingly, we induced exper...

  1. 2013 Update on Celiac Disease and Eosinophilic Esophagitis

    Marco Astegiano


    Full Text Available Celiac disease is a chronic, immune-mediated disorder, characterized by small intestinal inflammation and villous atrophy after the ingestion of gluten by genetically susceptible individuals. Several extraintestinal manifestations have been associated to celiac disease. Eosinophilic esophagitis is a primary disorder of the esophagus characterized by upper gastrointestinal symptoms, absence of gastroesophageal reflux disease and more than 15 eosinophils per high-power field in biopsy specimens. Both celiac disease and eosinophilic esophagitis are caused by aberrant, but distinct, immune responses to ingested antigens and can be responsive to restricted food intake. The aim of this review is to assess whether there is an association between these two pathologies. In the majority of the studies examined, including the studies in pediatric population, the prevalence of eosinophilic esophagitis in subjects with celiac disease was about 10-times that of the general population. We suggest searching for eosinophilic esophagitis in all children undergoing endoscopy for suspicious celiac disease.

  2. Eosinophilic esophagitis: manometric and pHmetric findings

    Monica Maria Cardoso Monnerat


    Full Text Available CONTEXT: Eosinophilic esophagitis is an entity characterized by an esophageal inflammatory infiltrate of eosinophils, manifested by dysphagia, intermittent food impactions and symptoms similar to gastroesophageal reflux disease (GERD, that predominantly affects young adults. There may be association of eosinophilic esophagitis with GERD, and motor abnormalities have been described. OBJECTIVE: The main objectives of this study are to describe the findings at esophageal manometry and pH monitoring in patients with eosinophilic esophagitis. METHODS: Cross-sectional study of 20 patients with a diagnosis of eosinophilic esophagitis, submitted to esophageal manometry and 24h pH monitoring. Were analysed the manometric changes and the presence of abnormal reflux on pH monitoring. RESULTS: Twenty patients (15 men, 5 women had a mean age of 29 years. Motility disorders were found in 25% (5/20 patients with ineffective esophageal motility being the most common finding. pH monitoring revealed abnormal reflux on 25%, without any relationship with manometric findings. CONCLUSIONS: Manometric abnormalities were observed in 25% of patients and abnormal reflux on pH monitoring also in 25%. This study showed no relationship between abnormal reflux and the presence of manometric changes.

  3. Eosinophilic esophagitis: New insights in pathogenesis and therapy

    Michele Pier Luca Guarino; Michele Cicala; Jose Behar


    Eosinophilic esophagitis(Eo E) is a clinico-pathological entity with esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus that may persist despite treatment with proton pump inhibitors. This eosinophilic infiltration is usually absent in the stomach, small intestine and colon, although there are a number of reports of patients with a multiorgan involvement. EoE is associated with abnormalities involving TH2-dependent immunity, with multiple environmental factors strongly contributing to disease expression. The layer of the esophagus affected by the eosinophilic infiltration causes the specific symptoms. Esophageal involvement results mostly in dysphagia for solids that can be severe enough to cause recurrent esophageal obstruction with typical endoscopic features suggesting esophageal remodeling and pathological changes of eosinophilic infiltration of the mucosa, sub-epithelial fibrosis and muscle hypertrophy. This disease is frequently associated with other allergic conditions such as allergic asthma, allergic dermatitis and eosinophilia. The treatment of patients with Eo E depends on the severity of the symptoms and of the inflammatory process as well as to their response to a gradual step-up treatment. The first line of treatment consists of steroid containing local inhalers. If unresponsive they are then treated with oral steroids. Intravenous interleukin blockers seem to have a consistent positive therapeutic effect.

  4. Eosinophilic esophagitis: clinical manifestations, diagnosis, and treatment Esofagitis eosinofílica: clínica, diagnóstico y tratamiento

    A. J. Lucendo Villarín


    Full Text Available Eosinophilic esophagitis (EE is a chronic inflammatory, immunoallergic disease of the esophagus that represents the most common eosinophilic gut disease. Understanding and diagnosis regarding this condition have greatly increased in recent years, particularly in Europe and North America, in parallel with other allergic disorders. It consists of dense esophageal infiltration with eosinophils in the absence of gastro-esophageal reflux (GER. It involves individuals at all ages, and is particularly common in males during childhood and up to the 5th decade of life. It manifests with chronic, intermittent esophageal symptoms that predominantly include dysphagia, food impaction episodes, and GER-attributable complaints that do not respond to antisecretory therapy. Endoscopically, EE is a polymorphous disease that presents with various changes in esophageal caliber, and subtle changes in mucosal appearance, which lead to biopsy collection as a key procedure for diagnosis. Management must be multidisciplinary, including gastroenterologists, pathologists, allergologists, and also nutrition specialists in pediatric cases. Regarding therapy, dietary food restrictions are especially useful in the management of pediatric EE, but effectiveness is lower in the adult, maybe because of a greater involvement of air allergens. Drug use is standard, particularly involving topical steroids, which may revert manifestations and histological lesions, even though recurrence following discontinuation is common.

  5. Gluten-free diet does not appear to induce endoscopic remission of eosinophilic esophagitis in children with coexistent celiac disease

    Abraham, Joseph R; Persad, Rabin; Turner, Justine M; Huynh, Hien Q


    BACKGROUND: Celiac disease and eosinophilic esophagitis are usually considered to be separate gastrointestinal diseases; however, it appears that they may coexist more often than would be expected. It is unknown whether eosinophilic esophagitis in patients with celiac disease responds to a gluten-free diet. OBJEVTIVES: To examine the clinical, endoscopic and histological features of children with both conditions to evaluate whether eosinophilic esophagitis responds to a gluten-free diet. METHODS: From January 1, 2009, to June 30, 2011, the medical records of children <18 years of age diagnosed with eosinophilic esophagitis and/or celiac disease were reviewed. Patients with clinical, endoscopic and histological diagnoses of both diseases were identified and included. These findings were analyzed, as were laboratory results, treatment and follow-up. RESULTS: During the study period, there were 206 celiac disease patients, 86 eosinophilic esophagitis patients and nine (4.4% of total celiac) patients with both diagnoses. Gluten-free diet was the primary treatment for both conditions in seven of nine (78%) cases. In six of these seven (86%) patients, no endoscopic or histological improvement of eosinophilic esophagitis was observed, while in one patient, histological remission of esophageal eosinophilia occurred while on a gluten-free diet. CONCLUSION: The prevalence of eosinophilic esophagitis in patients with celiac disease was 4.4%, confirming a higher than expected prevalence of eosinophilic esophagitis compared with the general population. In patients with celiac disease, a gluten-free diet did not appear to induce remission of coexistent endoscopic and histological features of eosinophilic esophagitis. PMID:22891176

  6. A Non-Frequently Considered Diagnosis of Dysphagia; Eosinophilic Esophagitis

    Mehmet Ağın


    Full Text Available Eosinophilic Esophagitis is infiltration of esophagus mucosa by eosinophil leucocyte. It is rarely observed in children and the symptoms are similar to gastroesophageal reflux. This case, which was applied esophagus balloon dilatation in the pediatric surgery due to dysphagia and diagnosed eosinophilic esophagitis, was presented in order to attract attention to the approach to the child with dysphagia. Total IgE=834 IU/mL and specific IgE (-, Fx5 (- was found negative. In the upper GIS endoscopy, it was observed that esophagus mucosa was pale, its structure was hard and its motility was disordered and a couple milimetric white lesions were observed as well. In the esophagus biopsy materials, it was observed that the eosinophil infiltration in the mucosa was 60%. With the diagnosis of Eosinophilic Esophagitis, the case was started on oral prednisolone 1 mg/kg/day. In the polyclinic control of the case after a week, it was observed that there was a significant decrease in the complaints about dysphagia and in the one-month control the complaints were all gone. In the symptoms similar to dysphagia and reflux, especially if the case is not responding to gastroesophageal reflux treatment, the diagnosis of Eosinophilic Esophagitis should absolutely be considered

  7. A Case of Eosinophilic Esophagitis Accompanying Familial Mediterranean Fever

    Pejman Rohani


    Full Text Available Background. Eosinophilic esophagitis is an inflammatory condition where there is a dense infiltration of eosinophils typically exceeding fifteen cells per high power field. Familial Mediterranean fever is an autosomal recessive disorder characterized by brief, acute, and self-limited episodes of fever and polyserositis that recur at irregular intervals. Case Presentation. A three-year-and-nine-month-old Iranian girl was admitted to our center. The patient’s parents complained of a history of abdominal pain, poor appetite, and poor weight gain from 1.5 years ago and episodes of food impaction after starting solid foods. Eosinophilic esophagitis was diagnosed based on histology. Because of continuing abdominal pain after treatment of eosinophilic esophagitis, the episodic nature of disease, and the presence of fever with pain, screening for familial Mediterranean fever mutation was performed and the patient was found to be heterozygote for Mediterranean fever. Conclusion. We have reported a case of eosinophilic esophagitis coexisting with familial Mediterranean fever which has not been described previously.

  8. A Case of Eosinophilic Esophagitis Accompanying Familial Mediterranean Fever.

    Rohani, Pejman; Najafi Sani, Mehri; Ahmadi, Mitra; Ziaee, Vahid


    Background. Eosinophilic esophagitis is an inflammatory condition where there is a dense infiltration of eosinophils typically exceeding fifteen cells per high power field. Familial Mediterranean fever is an autosomal recessive disorder characterized by brief, acute, and self-limited episodes of fever and polyserositis that recur at irregular intervals. Case Presentation. A three-year-and-nine-month-old Iranian girl was admitted to our center. The patient's parents complained of a history of abdominal pain, poor appetite, and poor weight gain from 1.5 years ago and episodes of food impaction after starting solid foods. Eosinophilic esophagitis was diagnosed based on histology. Because of continuing abdominal pain after treatment of eosinophilic esophagitis, the episodic nature of disease, and the presence of fever with pain, screening for familial Mediterranean fever mutation was performed and the patient was found to be heterozygote for Mediterranean fever. Conclusion. We have reported a case of eosinophilic esophagitis coexisting with familial Mediterranean fever which has not been described previously.

  9. A Case of Eosinophilic Esophagitis Accompanying Familial Mediterranean Fever

    Rohani, Pejman; Najafi Sani, Mehri; Ahmadi, Mitra


    Background. Eosinophilic esophagitis is an inflammatory condition where there is a dense infiltration of eosinophils typically exceeding fifteen cells per high power field. Familial Mediterranean fever is an autosomal recessive disorder characterized by brief, acute, and self-limited episodes of fever and polyserositis that recur at irregular intervals. Case Presentation. A three-year-and-nine-month-old Iranian girl was admitted to our center. The patient's parents complained of a history of abdominal pain, poor appetite, and poor weight gain from 1.5 years ago and episodes of food impaction after starting solid foods. Eosinophilic esophagitis was diagnosed based on histology. Because of continuing abdominal pain after treatment of eosinophilic esophagitis, the episodic nature of disease, and the presence of fever with pain, screening for familial Mediterranean fever mutation was performed and the patient was found to be heterozygote for Mediterranean fever. Conclusion. We have reported a case of eosinophilic esophagitis coexisting with familial Mediterranean fever which has not been described previously. PMID:28255474

  10. Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy.

    Jensen, Elizabeth T; Eluri, Swathi; Lebwohl, Benjamin; Genta, Robert M; Dellon, Evan S


    The possible association between eosinophilic esophagitis (EoE) and celiac disease is controversial because prior results have been contradictory. We aimed to determine the relationship between EoE and celiac disease among patients with concomitant esophageal and duodenal biopsies. We conducted a cross-sectional study in a U.S. national pathology database by using data from January 2009 through June 2012. Our primary case definition was defined by the presence of esophageal eosinophilia with ≥15 eosinophils per high-power field. The crude and adjusted (for age and sex) odds of esophageal eosinophilia for patients with active celiac disease were compared with those without celiac disease. Sensitivity analyses were performed by using more stringent case definitions and by estimating the associations between celiac disease and reflux esophagitis and celiac disease and Barrett's esophagus. Of 292,621 patients in the source population, 88,517 with both esophageal and duodenal biopsies were studied. Four thousand one hundred one (4.6%) met criteria for EoE, and 1203 (1.4%) met criteria for celiac disease. Odds of EoE were 26% higher in patients with celiac disease than in patients without celiac disease (adjusted odds ratio [aOR], 1.26; 95% confidence interval [CI], 0.98-1.60). The magnitude of association varied according to EoE case definition, but all definitions showed a weak positive association between the 2 conditions. There was no association between celiac disease and reflux esophagitis (aOR, 0.95; 95% CI, 0.85-1.07) or Barrett's esophagus (aOR, 0.89; 95% CI, 0.69-1.14) and celiac disease. There is a weak increase in EoE in patients with celiac disease. This association strengthened with increasingly stringent definitions of EoE and was not observed for other esophageal conditions. In patients with celiac disease, concomitant EoE should be considered in the correct clinical setting. Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights

  11. Eosinophilic esophagitis, celiac disease, and immunoglobulin E–mediated allergy in a 2-year-old child

    Sánchez-García, S.; Ibánez, M. D.; Martínez-Gómez, M. J.; Escudero, C.; Vereda, A.; Fernández-Rodríguez, M; P. Rodríguez del Río


    This communication was presented at XXVI National Congress of SEAIC, Spanish Society of Allergology and Clinical Immunology, Bilbao, Spain, 2008 Celiac disease, eosinophilic esophagitis, and urticaria are 3 manifestations of food allergy with different pathogenic mechanisms. We report the case of a 2-year-old child with digestive symptoms, slow growth, and severe asthma. The results of skin prick tests were positive to several foods. Endoscopy revealed eosinophilic esophagitis ...

  12. Eosinophilic esophagitis: A relevant entity for the otolaryngologist.

    Górriz-Gil, Carmen; Villarreal, Ithzel M; Álvarez-Montero, Óscar; Rodríguez-Valiente, Antonio; Magaz, Marta; García-Berrocal, José R


    Eosinophilic esophagitis (EE) is a recently recognised pathologic entity whose prevalence has risen significantly since it was first described. Its diagnosis represents a challenge for different medical specialties, among which ENT specialists play an important role. Clinical suspicion in a patient with recurrent food impaction or a child with eating disorders and history of hypersensitivity constitutes the first warning sign of a possible EE. The purpose of this review is to highlight EE as a possible differential diagnosis in patients with deglutition disorders and describe the possible clinical symptoms that should alert the ENT specialist to perform appropriate diagnostic tests and procedures. The transnasal esophagoscopy, performed in-office by the ENT, is ideal for reducing possible underdiagnosed cases. Given the fact that an ENT specialist will evaluate a great many patients with deglutition disorders, it is paramount for possible EE cases to be suspected and recognised so that a correct multidisciplinary approach involving not only ENT specialists but also paediatricians, gastroenterologists, allergologists and pathologists can be established. Identifying the dietary component responsible for the esophageal inflammation and removing that food from the patient's diet is the key in the treatment of this immune-mediated disease. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  13. Management guidelines of eosinophilic esophagitis in childhood

    Papadopoulou, A; Koletzko, S; Heuschkel, R


    (peak value) in ≥1 biopsy specimens are considered a minimum threshold for a diagnosis of EoE. The disease is restricted to the esophagus, and other causes of esophageal eosinophilia should be excluded, specifically proton pump inhibitor-responsive esophageal eosinophilia. This position paper aims...

  14. Eosinophilic esophagitis: current perspectives from diagnosis to management.

    Moawad, Fouad J; Cheng, Edaire; Schoepfer, Alain; Al-Haddad, Sahar; Bellizzi, Andrew M; Dawson, Heather; El-Zimaity, Hala; Guindi, Maha; Penagini, Roberto; Safrooneva, Ekaterina; Chehade, Mirna


    Eosinophilic esophagitis (EoE) is a chronic antigen-mediated immune disease of the esophagus characterized by symptoms related to esophageal dysfunction, as well as significant esophageal eosinophilia. Although dense eosinophilia is the hallmark of EoE, other characteristic histologic features have been described that may help distinguish EoE from other competing diagnoses, although none are specific to EoE. One or more foods and, at times, environmental allergens trigger EoE. Left untreated, esophageal inflammation in EoE may lead to esophageal remodeling and stricture formation. Symptoms in EoE vary with age, as they relate to the progression of the disease from an inflammatory to a fibrostenotic phenotype over time. There are currently no U.S. Food and Drug Administration-approved therapies for EoE. Current options include various dietary-restriction therapies, topical corticosteroids, and esophageal dilations. Several emerging therapies aiming at restoring the esophageal barrier function or targeting various inflammatory cells or their mediators are under investigation.

  15. Induction of Eosinophilic Esophagitis by Sublingual Pollen Immunotherapy

    Stephan Miehlke


    Full Text Available Sublingual immunotherapy (SLIT is increasingly investigated and utilized for the treatment of food and pollen allergies. Previous case reports suggested that eosinophilic esophagitis (EoE might develop as a long-term complication in children after completion of oral immunotherapy. Here, we describe a 44-year-old female with a medical history of pollinosis who for the first time in her life developed complete manifestation of EoE (peak eosinophils 164/high power field 4 weeks after initiation of SLIT using specific soluble allergens (hazelnut, birch, alder according to previous specific serum IgE testing. After discontinuation of SLIT, EoE resolved completely within 4 weeks without any other medical intervention. During a follow-up of 12 months the patient remained free of any esophageal symptoms. This is the first case report demonstrating a close and therefore likely causative association between pollen SLIT and EoE in an adult patient.

  16. Esophageal and Small Intestinal Mucosal Integrity in Eosinophilic Esophagitis and Response to an Elemental Diet.

    Warners, Marijn J; Vlieg-Boerstra, Berber J; Verheij, Joanne; van Hamersveld, Patricia H P; van Rhijn, Bram D; Van Ampting, Marleen T J; Harthoorn, Lucien F; de Jonge, Wouter J; Smout, Andreas J P M; Bredenoord, Albert J


    The esophageal mucosal integrity is impaired in eosinophilic esophagitis (EoE) and it has been suggested that the duodenal permeability is increased. The absence of food allergens may restore the integrity. The aims of this study were to assess duodenal permeability in EoE and to evaluate the effect of an elemental diet on the esophageal and duodenal integrity. In this prospective study 17 adult EoE patients and 8 healthy controls (HC) were included. Esophageal biopsy specimens were sampled before and after 4 weeks of elemental diet to measure eosinophil counts and gene expression of tight junction and barrier integrity proteins. Esophageal and duodenal impedance were measured by electrical tissue impedance spectroscopy and Ussing chambers were used to measure transepithelial resistance (TER) and transepithelial molecule flux. Small intestinal permeability was measured using a test, measuring lactulose/mannitol (L/M) ratios. In EoE patients, the esophageal but not the duodenal integrity was impaired, compared with HC. We observed no significant difference between L/M ratios of HC and EoE patients. After diet, eosinophil counts decreased significantly, which was paralleled by normalization of esophageal impedance and transepithelial molecule flux. The esophageal TER improved significantly, but did not reach values seen in HC. Esophageal expression of genes encoding for barrier integrity proteins filaggrin and desmoglein-1 was impaired at baseline and restored after diet. An elemental diet restores esophageal integrity, suggesting that it is at least partly secondary to allergen exposure. Duodenal integrity seems not to be affected in EoE, and possibly plays a minor role in its pathophysiology.

  17. Elimination diets in the management of eosinophilic esophagitis

    Wechsler JB


    Full Text Available Joshua B Wechsler, Sally Schwartz, Katie Amsden, Amir F Kagalwalla Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, IL, USA Abstract: Eosinophilic esophagitis, an increasingly recognized chronic inflammatory disorder isolated to the esophagus, is triggered by an abnormal allergic response to dietary antigens. Current treatment includes swallowed topical steroids and dietary modification, which aim to resolve symptoms and prevent long-term complications such as formation of strictures. The dietary approach has become more widely accepted because long-term steroid therapy is associated with potential risks. Dietary treatment includes elemental and elimination diets. An exclusive elemental diet, which requires replacement of all intact protein with amino acid-based formula, offers the best response of all available therapies, with remission in up to 96% of subjects proving it to be superior to all other available therapies including topical steroids. However, compliance with this approach is challenging because of poor taste and monotony. The high cost of formula and the associated psychosocial problems are additional drawbacks of this approach. Empiric and allergy test-directed elimination diets have gained popularity given that elimination of a limited number of foods is much easier and as such is more readily acceptable. There is a growing body of literature supporting this type of therapy in both children and adults. This paper reviews the evidence for all types of dietary therapy in eosinophilic esophagitis. Keywords: eosinophilic esophagitis, dietary therapy, empiric elimination, elemental, allergy test-directed

  18. Molecular, genetic, and cellular bases for treating eosinophilic esophagitis.

    Rothenberg, Marc E


    Eosinophilic esophagitis (EoE) was historically distinguished from gastroesophageal reflux disease on the basis of histology and lack of responsiveness to acid suppressive therapy, but it is now appreciated that esophageal eosinophilia can respond to proton pump inhibitors. Genetic and environmental factors contribute to risk for EoE, particularly early-life events. Disease pathogenesis involves activation of epithelial inflammatory pathways (production of eotaxin-3 [encoded by CCL26]), impaired barrier function (mediated by loss of desmoglein-1), increased production and/or activity of transforming growth factor-β, and induction of allergic inflammation by eosinophils and mast cells. Susceptibility has been associated with variants at 5q22 (TSLP) and 2p23 (CAPN14), indicating roles for allergic sensitization and esophageal specific protease pathways. We propose that EoE is a unique disease characterized by food hypersensitivity; strong hereditability influenced by early-life exposures and esophageal-specific genetic risk variants; and allergic inflammation and that the disease is remitted by disrupting inflammatory and T-helper type 2 cytokine-mediated responses and through dietary elimination therapy.

  19. Do endoscopic features suggesting eosinophilic esophagitis represent histological eosinophilia?

    Hori, Kazutoshi; Watari, Jiro; Fukui, Hirokazu; Tanaka, Junji; Tomita, Toshihiko; Sakurai, Jun; Kondo, Takashi; Oshima, Tadayuki; Toyoshima, Fumihiko; Yamasaki, Takahisa; Okugawa, Takuya; Miwa, Hiroto


    Esophageal linear furrows, corrugated rings, and/or white exudates are often seen in patients with eosinophilic esophagitis (EoE); however, whether these are specific to EoE remains unclear. Endoscopic surveillance of these features was conducted to determine whether these represent esophageal eosinophilia, which is essential for the diagnosis of EoE. Two thousand seven hundred and sixty-three patients were enrolled consecutively. Target biopsy was carried out when the above features were seen. Histological eosinophilia was defined as 24 or more eosinophils per high-power field (HPF). Associations between features and eosinophilia were analyzed statistically. Two thousand five hundred and forty-five patients completed the study. Linear furrows, corrugated rings and white exudates were seen in 24, 15 and 45 patients, respectively. These findings somewhat overlapped. Among 58 biopsied patients withany of the above features, these features represented eosinophilia in 14% (3/21), 23% (3/13), and 5% (2/43), respectively. None of the 199 patients who received biopsy for other features had eosinophilia. Two of five eosinophilia patients were diagnosed with EoE. Multiple comparisons revealed that eosinophil counts in linear furrows and corrugated rings but not white exudates were significantly greater than those in other features (12, 9, 1, and eosinophilia and is non-specific for EoE, although it reminds endoscopists of the presence of EoE. The diagnostic utility of linear furrows or corrugated rings for esophageal eosinophilia is superior to that of white exudates. © 2013 The Authors. Digestive Endoscopy © 2013 Japan Gastroenterological Endoscopy Society.

  20. Recent discoveries and emerging therapeutics in eosinophilic esophagitis

    Aakash Goyal; Edaire Cheng


    Eosinophilic esophagitis(Eo E) is an allergy-mediated disease culminating in severe eosinophilic inflammation and dysfunction of the esophagus. This chronic disorder of the esophagus causes significant morbidity, poor quality of life, and complications involving fibrosis and esophageal remodeling. Overlapping features between EoE and gastroesophageal reflux disease(GERD) pose great challenges to differentiating the two conditions, although the two disorders are not mutually exclusive. Recent findings suggest that the confounding condition proton pump inhibitor- responsive esophageal eosinophilia(PPI-REE) is likely a subset of EoE. Since PPIs have therapeutic properties that can benefit EoE, PPIs should be considered as a therapeutic option for Eo E rather than a diagnostic screen to differentiate GERD, PPIREE, and EoE. Other current treatments include dietary therapy, corticosteroids, and dilation. Immunomodulators and biologic agents might have therapeutic value, and larger trials are needed to assess efficacy and safety. Understanding the pathophysiology of EoE is critical to the development of novel therapeutics.

  1. Beneficial effect of Lactococcus lactis NCC 2287 in a murine model of eosinophilic esophagitis.

    Holvoet, S; Doucet-Ladevèze, R; Perrot, M; Barretto, C; Nutten, S; Blanchard, C


    Eosinophilic esophagitis (EoE) is a severe inflammatory disease of the esophagus which is characterized histologically by an eosinophilic infiltration into the esophageal tissue. The efficacy of probiotics in the context of atopic diseases has been well investigated but, to date, there has been no study which has evaluated probiotic effects on EoE inflammation. This study sought to identify a probiotic which improves esophageal inflammation in experimental EoE. Two candidate probiotics, Lactococcus lactis NCC 2287 and Bifidobacterium lactis NCC 2818, were tested in a murine model of EoE elicited by epicutaneous sensitization with Aspergillus fumigatus protein extract. Administration of bacterial strains in drinking water was used, respectively, as a preventive or treatment measure, or continuously throughout the study. Inflammatory parameters were assessed in the esophagus, skin, and lungs after allergen challenge. In this EoE model, supplementation with L. lactis NCC 2287 significantly decreased esophageal and bronchoalveolar eosinophilia but only when given as a therapeutic treatment. No significant effect on eosinophilia was observed when NCC 2287 was given as a preventive or a continuous intervention. NCC 2287 supplementation had no significant effect on immunoglobulin levels, skin symptom scores, or on transepidermal water loss. Supplementation with another probiotic, B. lactis NCC 2818, had no significant effect on esophageal eosinophilia. We identified a L. lactis strain, able to attenuate esophageal eosinophilic inflammation in a preclinical model of EoE. This effect is strain specific and depends on the timing and duration of bacterial supplementation. Confirmation of these observations in human clinical trials is warranted. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. Esophageal Granular Cell Tumor and Eosinophilic Esophagitis: Two Interesting Entities Identified in the Same Patient

    Alfredo J. Lucendo


    Full Text Available We illustrate the case of a 41-year-old male with allergic manifestations since childhood. He sought medical attention for intermittent, progressive dysphagia from which he had been suffering for a number of years, having felt the sensation of a retrosternal lump and a self-limited obstruction to the passage of food. Endoscopy detected a submucosal tumor in the upper third of the esophagus, which was typified, via biopsy, as a granular cell tumor with benign characteristics and probably responsible for the symptoms. Two years later, the patient sought medical attention once again as these symptoms had not abated, hence digestive endoscopy was repeated. This revealed stenosis of the junction between the middle and lower thirds of the organ which had not been detected previously but was passable under gentle pressure. Eosinophilic esophagitis was detected after biopsies were taken. Esophageal manometry identified a motor disorder affecting the esophageal body. Following three months of treatment using fluticasone propionate applied topically, the symptoms went into remission, esophageal stenosis disappeared and the esophageal biopsies returned to normal. This is the first documented case of the link between granular cell tumors and Eosinophilic esophagitis, two different disorders which could cause dysphagia in young patients.

  3. Preferential Secretion of Thymic Stromal Lymphopoietin (TSLP by Terminally Differentiated Esophageal Epithelial Cells: Relevance to Eosinophilic Esophagitis (EoE.

    Prasanna M Chandramouleeswaran

    Full Text Available Eosinophilic esophagitis (EoE is a chronic Th2 and food antigen-mediated disease characterized by esophageal eosinophilic infiltration. Thymic stromal lymphopoetin (TSLP, an epithelial derived cytokine which bridges innate and Th2-type adaptive immune responses in other allergic conditions, is overexpressed in esophageal biopsies of EoE subjects. However, the triggers of TSLP expression in the esophageal epithelium are unknown. The objective of the current study was to characterize TSLP expression in human esophageal epithelium in EoE in vivo and to determine the role of food antigens upon epithelial TSLP expression in vitro. Using immunohistochemistry (IHC, we localized TSLP in esophageal biopsies of active EoE (≥15 eos/hpf, inactive EoE (<15 eos/hpf and non-EoE control subjects, and found that TSLP expression was restricted to the differentiated suprabasal layer of the epithelium in actively inflamed EoE biopsies. Consistent with these results in vivo, inducible TSLP protein secretion was higher in CaCl2 differentiated telomerase-immortalized esophageal epithelial cells (EPC2-hTERT compared to undifferentiated cells of the basal phenotype, following stimulation with the TLR3 ligand poly(I:C. To determine whether food antigens could directly induce epithelial TSLP secretion, differentiated and undifferentiated primary esophageal epithelial cells from EoE and non-EoE subjects were challenged with food antigens clinically relevant to EoE: Chicken egg ovalbumin (OVA, wheat, and milk proteins beta-lactoglobulin (blg and beta-casein. Food antigens failed to induce TSLP secretion by undifferentiated cells; in contrast, only OVA induced TSLP secretion in differentiated epithelial cells from both EoE and control cell lines, an effect abolished by budesonide and NF-κb inhibition. Together, our study shows that specific food antigens can trigger innate immune mediated esophageal TSLP secretion, suggesting that esophageal epithelial cells at the

  4. Eosinophilic Esophagitis: Another Atopy-Related Alopecia Areata Trigger?

    Ibrahim, Omer; Bergfeld, Wilma F; Piliang, Melissa


    Alopecia areata (AA) is associated with atopy in 10-22% of patients, twice the prevalence in the general population. Patients can present with concomitant atopic dermatitis, hay fever, asthma, and even allergies to dust mites. In many cases, severity and flares of these atopic diatheses correlate with severity of AA. Herein we present a patient with AA affected by contemporaneous eosinophilic esophagitis (EoE). EoE is a recently recognized allergic disorder, mediated by eosiniphils and histamine. It is characterized by esophageal dysfunction and intraepithelial microabscesses. We propose that EoE be considered as a condition falling within the realm of atopic diseases, and a potential trigger of AA in affected patients.

  5. Endoscopic findings in patients with Schatzki rings:Evidence for an association with eosinophilic esophagitis

    Michaela Müller; Alexander J Eckardt; Annette Fisseler-Eckhoff; Susanne Haas; Ines Gockel; Till Wehrmann


    AIM:To investigate endoscopic findings in patients with Schatzki rings (SRs) with a focus on evidence for eosinophilic esophagitis (EoE).METHODS:We consecutively approached all adult patients scheduled for elective outpatient upper endoscopy for a variety of indications at the German Diagnostic Clinic,Wiesbaden,Germany between July 2007 and July 2010.All patients with endoscopically diagnosed SRs,defined as thin,symmetrical,mucosal structures located at the esophagogastric junction,were prospectively registered.Additional endoscopic findings,clinical information and histopathological findings with a focus on esophageal eosinophilia (≥ 20 eosinophils/highpower field) were recorded.The criteria for active EoE were defined as:(1) eosinophilic tissue infiltration ≥20 eosinophils/hpf; (2) symptoms of esophageal dysfunction; and (3) exclusion of other causes of esophageal eosinophilia.Gastroesophageal reflux disease was excluded by proton pump inhibitor treatment prior to endoscopy.The presence of ≥ 20 eosinophils/hpf in esophageal biopsies in patients that did not fulfil the criteria of EoE was defined as esophageal hypereosinophilia.RESULTS:A SR was diagnosed in 171 (3.3%; 128males,43 females,mean age 66±12.9 years) of the 5163 patients that underwent upper gastrointestinalendoscopy.Twenty of the 116 patients (17%) from whom esophageal biopsies were obtained showed histological hypereosinophilia (≥ 20 eosinophils/hpf).Nine of these patients (8 males,1 female,mean age 49 ± 10 years) did not fulfill all diagnostic criteria of EoE,whereas in 11 (9%) patients with ≥ 20 eosinophils/hpf,a definite diagnosis of EoE was made.Three of the 11 patients (27%) with definite EoE had no suspicious endoscopic features of EoE.In contrast,in the 25 patients in whom EoE was suspected by endoscopic features,EoE was only confirmed in 7 (28%) patients.Patients with EoE were younger (mean age 41.5±6.5 vs 50.5± 11.5 years,P =0.012),were more likely to have a history of

  6. Circumferential mucosal dissection and esophageal perforation in a patient with eosinophilic esophagitis

    Gennaro Liguori; Maurizio Cortale; Fabrizio Cimino; Michele Sozzi


    A young man with a previous history of episodes of mild solid food dysphagia was admitted with a total dysphagia.The esophagogastroduodenoscopy (EGDS) showed an extensive disruption of mucosal layer with a cul-de-sac in the lower part of the esophagus.Soon after the procedure,the patient suffered from an acute chest pain and subsequent CT scan demonstrated an intramural circumferential dissection of thoracic esophagus,and a mediastinal emphysema.An emergency right thoracotomy was performed,followed by a total esophagectomy with esophagogastroplasty and jejunostomy.The histopathology confirmed that mucosal and submucosal layers were circumferentially detached from muscular wall and showed an eosinophilic infiltration of the whole organ with necrosis and erosions of mucosal,submucosal and muscular layers.The diagnosis was esophageal perforation in eosinophilic esophagitis.

  7. Eosinophilic esophagitis in cystic fibrosis: a case series and review of the literature.

    Goralski, Jennifer L; Lercher, Daniel M; Davis, Stephanie D; Dellon, Evan S


    Patients with cystic fibrosis (CF) frequently experience gastrointestinal symptoms including nausea, emesis, malnutrition and indigestion; diseases such as gastroesophageal reflux disease (GERD), distal intestinal obstructive syndrome, and cholelithiasis are commonly implicated. We have recently diagnosed eosinophilic esophagitis (EoE) in three patients with CF. EoE is a TH-2 driven, allergen-mediated disease which causes esophageal eosinophilia and presents with symptoms of nausea, feeding intolerance, regurgitation, and dysphagia. EoE is diagnosed when esophageal biopsies reveal greater than 15 eosinophils per high power field in the setting of the appropriate clinical scenario and after exclusion of other causes of esophageal eosinophilia. Although described with increasing frequently in the gastrointestinal literature, there have been no prior cases documenting the co-existence of EoE and CF. We speculate that this is related to lack of familiarity with EoE symptoms by CF providers. We present three patients with CF diagnosed with EoE and review the current literature regarding diagnosis and management, focusing on management issues in patients with CF. Copyright © 2012 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

  8. Brief Report: Eosinophilic Esophagitis as a Cause of Feeding Problems in Autistic Boy. The First Reported Case

    Jarocka-Cyrta, Elzbieta; Wasilewska, Jolanta; Kaczmarski, Maciej Gustaw


    Unrecognized gastrointestinal disorders may contribute to the behavioral problems in non-verbal patients, but they are often overlooked since the clinical symptoms are nonspecific. Eosinophilic esophagitis (EE) is a chronic inflammatory disorder manifesting itself predominantly in reflux-type symptoms that do not respond to standard anti-reflux…

  9. Management of proton pump inhibitor responsive-esophageal eosinophilia and eosinophilic esophagitis: controversies in treatment approaches.

    Kochar, Bharati; Dellon, Evan S


    Eosinophilic esophagitis (EoE) is a chronic immune-mediated clinicopathologic disease. The prevalence of EoE is approximately 1/2000 persons, EoE is now the most common cause of food impactions, with healthcare expenditures approaching US$ 1 billion annually. This article will discuss challenges related to proton pump inhibitor responsive esophageal eosinophilia, including distinguishing this condition from EoE and understanding the mechanisms behind the PPI response. For EoE, we will review multiple ongoing debates about treatment and monitoring strategies, including selecting treatment outcomes, optimizing medication formulations, approaching the steroid-refractory patient, conducting dietary elimination, prescribing long-term maintenance therapy and performing esophageal dilation.

  10. Disease activity in eosinophilic esophagitis is associated with impaired esophageal barrier integrity.

    Warners, Marijn J; van Rhijn, Bram D; Verheij, Joanne; Smout, Andreas J P M; Bredenoord, Albert J


    In eosinophilic esophagitis (EoE), the esophageal barrier integrity is impaired. Integrity can be assessed with different techniques. To assess the correlations between esophageal eosinophilia and various measures of mucosal integrity and to evaluate whether endoscopic impedance measurements can predict disease activity, endoscopies and mucosal integrity measurements were performed in adult EoE patients with active disease (≥15 eosinophils/high-power field) at baseline (n = 32) and after fluticasone (n = 15) and elemental dietary treatment (n = 14) and in controls (n = 19). Mucosal integrity was evaluated during endoscopy using electrical tissue spectroscopy (ETIS) measuring mucosal impedance and transepithelial electrical resistance (TER) and transepithelial molecule-flux through biopsy specimens in Ussing chambers. We included 61 measurements; 32 of patients at baseline and 29 after treatment, 3 patients dropped out. After treatment, 20 patients were in remission (≤15 eosinophils/high-power field) and these measurements were compared with 41 measurements of patients with active disease (at baseline or after failed treatment). All four mucosal integrity measures showed significant impairment in active EoE compared with remission. Eosinophilia was negatively correlated with ETIS and TER and positively with transepithelial molecule flux (P ≤ 0.001). The optimal ETIS cutoff to predict disease activity was 6,000 Ω·m with a sensitivity of 79% [95% confidence interval (CI) 54-94%], specificity of 84% (95% CI 69-94%), positive predictive values of 89% (95% CI 77-95%) and negative predictive values of 71% (95% CI 54-84%). In EoE patients, markers of mucosal integrity correlate with esophageal eosinophilia. Additionally, endoscopic mucosal impedance measurements can predict disease activity.NEW & NOTEWORTHY In adult patients with eosinophilic esophagitis (EoE), the mucosal integrity, measured by making use of four different parameters, correlates strongly with

  11. Eosinophilic Esophagitis in a Developing Country: Is It Different from Developed Countries?

    Abdulrahman Al-Hussaini


    Full Text Available Background and Objective. Despite the extensive reporting of eosinophilic esophagitis (EoE from industrialized developed countries, reports from developing countries are rare. The aim of our study was to determine the epidemiological, clinical, and endoscopic features of EoE and response to therapy in children and adults from a developing country, Saudi Arabia. Methods. We identified patients diagnosed with EoE in our center from 2004 to 2011. EoE was defined as esophageal mucosal infiltration with a peak eosinophil count ≥15 eosinophils/high-powered field. Results. Forty-five patients were diagnosed with EoE (37 children and 8 adults; 36 males; median age 10.5 years, range from 1–37 years. Feeding difficulty, vomiting/regurgitation, and failure to thrive predominated in young children, whereas dysphagia and food impactions predominated in older children and adults. Allergy testing revealed food sensitization in 12 of 15 patients (80%; 3 responded to elemental formula, while 8 failed to respond to dietary manipulation after the allergy testing. Thirty-nine patients achieved remission by swallowed inhaled fluticasone. The majority of patients experienced a recurrence of symptoms upon the discontinuation of fluticasone. Conclusion. Our data indicate that EoE is increasingly recognized in Saudi Arabia and show many similarities to data from North America and Europe.

  12. Milk-specific immunoglobulin free light chain secretion is increased in children with eosinophilic esophagitis

    Chehade, Mirna; Vos, Arjan P.; Kleinjan, Marije; Garssen, Johan; Redegeld, Frank A.


    Background: Eosinophilic esophagitis (EoE) is an esophageal inflammatory disease caused by multiple food triggers. The mechanism by which foods trigger EoE is unknown. Milk is by far the most common trigger. Standard allergy tests to milk (skin prick tests, atopy patch tests, and serum milk-specific

  13. You Are What You Eat: A Case of Nematode-Induced Eosinophilic Esophagitis

    Agarwal, Nikhil


    Human anisakiasis is acquired through eating raw or undercooked saltwater fish or squid. Infestation with living larvae caused by eating parasitized fish often times results in gastroenteritis. It mainly involves the stomach and small intestine with no reported cases of eosinophilic esophagitis caused by Anisakidea. A 41-year-old man presented for the evaluation of 1 year of dysphagia to solid foods and was found to have endoscopic findings consistent with eosinophilic esophagitis with pathology showing 100 eosinophils per high-power field. During endoscopy, a roundworm, later identified as Anisakidae species, was found. Patient was treated with a 6-week course of albendazole with symptomatic, endoscopic, and histologic improvement. PMID:28144618

  14. Reflectance confocal microscopy for the diagnosis of eosinophilic esophagitis: a pilot study conducted on biopsy specimens.

    Yoo, Hongki; Kang, DongKyun; Katz, Aubrey J; Lauwers, Gregory Y; Nishioka, Norman S; Yagi, Yukako; Tanpowpong, Pornthep; Namati, Jacqueline; Bouma, Brett E; Tearney, Guillermo J


    Diagnosis of eosinophilic esophagitis (EoE) currently requires endoscopic biopsy and histopathologic analysis of the biopsy specimens to count intraepithelial eosinophils. Reflectance confocal microscopy (RCM) is an endomicroscopy technology that is capable of obtaining high-resolution, optically sectioned images of esophageal mucosa without the administration of exogenous contrast. In this study, we investigated the capability of a high-speed form of RCM, termed spectrally encoded confocal microscopy (SECM), to count intraepithelial esophageal eosinophils and characterize other microscopic findings of EoE. A total of 43 biopsy samples from 35 pediatric patients and 8 biopsy samples from 8 adult patients undergoing EGD for EoE were imaged by SECM immediately after their removal and then processed for routine histopathology. Two SECM readers, trained on adult cases, prospectively counted intraepithelial eosinophils and detected the presence of abscess, degranulation, and basal cell hyperplasia on SECM images from the pediatric patients. A pathologist blinded to the SECM data analyzed the same from corresponding slides. The Gastrointestinal Unit, Massachusetts General Hospital. Eosinophils by SECM demonstrated a higher reflectance than the surrounding cells and other inflammatory cells. There was good correlation between SECM and histology maximum eosinophil counts/high-power field (R = 0.76, P biopsy samples. These findings suggest that RCM may be developed into a tool for assessing eosinophilic infiltration in the esophagus in vivo. Copyright © 2011 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.

  15. Gluten-Free Diet Does Not Appear to Induce Endoscopic Remission of Eosinophilic Esophagitis in Children with Coexistent Celiac Disease

    Joseph R Abraham


    Full Text Available BACKGROUND: Celiac disease and eosinophilic esophagitis are usually considered to be separate gastrointestinal diseases; however, it appears that they may coexist more often than would be expected. It is unknown whether eosinophilic esophagitis in patients with celiac disease responds to a gluten-free diet.

  16. Eosinophilic Esophagitis in Cystic Fibrosis: A Case Series and Review of the Literature

    Goralski, Jennifer L.; Lercher, Daniel M.; Davis, Stephanie D.; Dellon, Evan S.


    Patients with cystic fibrosis (CF) frequently experience gastrointestinal symptoms including nausea, emesis, malnutrition and indigestion; diseases such as gastroesophageal reflux disease (GERD), distal intestinal obstructive syndrome, and cholelithiasis are commonly implicated. We have recently diagnosed eosinophilic esophagitis (EoE) in three patients with CF. EoE is a TH-2 driven, allergen-mediated disease which causes esophageal eosinophilia and presents with symptoms of nausea, feeding i...

  17. Intrabolus pressure on high-resolution manometry distinguishes fibrostenotic and inflammatory phenotypes of eosinophilic esophagitis.

    Colizzo, J M; Clayton, S B; Richter, J E


    The aim of this investigation was to determine the motility patterns of inflammatory and fibrostenotic phenotypes of eosinophilic esophagitis (EoE) utilizing high-resolution manometry (HRM). Twenty-nine patients with a confirmed diagnosis of EoE according to clinicopathological criteria currently being managed at the Joy McCann Culverhouse Swallowing Center at the University of South Florida were included in the retrospective analysis. Only patients who completed HRM studies were included in the analysis. Patients were classified into inflammatory or fibrostenotic subtypes based on baseline endoscopic evidence. Their baseline HRM studies prior to therapy were analyzed. Manometric data including distal contractile integral, integrated relaxation pressure, and intrabolus pressure (IBP) values were recorded. HRM results were interpreted according to the Chicago Classification system. Statistical analysis was performed with SPSS software (Version 22, IBM Co., Armonk, NY, USA). Data were compared utilizing Student's t-test, χ(2) test, Pearson correlation, and Spearman correlation tests. Statistical significance was set at P < 0.05. A total of 29 patients with EoE were included into the retrospective analysis. The overall average age among patients was 40 years. Male patients comprised 62% of the overall population. Both groups were similar in age, gender, and overall clinical presentation. Seventeen patients (58%) had fibrostenotic disease, and 12 (42%) displayed inflammatory disease. The average IBP for the fibrostenotic and inflammatory groups were 18.6 ± 6.0 mmHg and 12.6 ± 3.5 mmHg, respectively (P < 0.05). Strictures were only seen in the fibrostenotic group. Of the fibrostenotic group, 6 (35%) demonstrated proximal esophageal strictures, 7 (41%) had distal strictures, 3 (18%) had mid-esophageal strictures, and 1 (6%) patient had pan-esophageal strictures. There was no statistically significant correlation between the level of esophageal stricture and degree

  18. Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies:A review of the literature

    Javier Molina-Infante; Lucia Ferrando-Lamana; Jose Maria Mateos-Rodriguez; Belén Péez-Gallardo; Ana Beatriz Prieto-Bermejo


    Eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have overlapping clinical,manometric,endoscopic and histopathologic features.The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field (eo/HPF) in esophageal biopsies.We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies,both of which became asyrnptomatic on proton pump inhibitor (PPI) therapy.The first patient also achieved a histologic response,while EE remained in the other patient after effective PPI treatment,as shown by 24-h esophageal pH monitoring.Topical steroid therapy combined with PPI led to complete remission in this latter patient.GERD and EE may be undistinguishable,even by histology,so diagnosis of EE should only be established after acareful correlation of clinical,endoscopic and pathologicdata obtained under vigorous acid suppression.Thesediagnostic difficulties are maximal when both diseases overlap.Limited data are available about this topic,and the interaction between EE and GERD is a matter of debate.In this setting,upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease.A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment,EE should be suggested.However,a clinical response to PPI may not rule out quiescent EE,as shown in this report.

  19. The TGFβ1 Promoter SNP C-509T and Food Sensitization Promote Esophageal Remodeling in Pediatric Eosinophilic Esophagitis.

    Renee Rawson

    Full Text Available Eosinophilic esophagitis (EoE is a chronic antigen mediated disease associated with substantial esophageal remodeling and fibrosis. The functional TGFβ1 promoter SNP C-509 associates with renal fibrosis and asthma. The effect of TGFβ1 genotype and EoE severity or potential gene-environment interactions have not been previously reported in EoE.Genotype at TGFβ1 C-509T and remodeling was analyzed in 144 subjects with EoE. The severity of remodeling and inflammation was analyzed in the context of IgE sensitization to food antigens and C-509T genotype.The TGFβ1 promoter C-509 genotypes CC, CT, and TT were 35%, 52%, and 13%, respectively. Sixty-six percent of subjects were sensitized to foods by positive skin prick test (SPT or serum specific IgE. TT genotype subjects had significantly more TGFβ1 (CC subjects = 1300 per mm2; TT = 2250 per mm2 (p<0.05 and tryptase (CC subjects = 145 per mm2: TT = 307 per mm2 (p<0.05 positive cells and higher epithelial remodeling scores (2.4 vs 3.7, p<0.001 than CC subjects. The differences in TGFβ1 and tryptase positive cells as well as fibrosis were significantly increased when there was concurrent food sensitization. Food sensitization alone did not associate with any parameters of inflammation or remodeling.Our data support a gene-environment interaction between food and genotype at C-509 that modulates disease severity in EoE. Since EoE subjects often continue to consume foods to which they are sensitized, these findings may have clinical relevance for disease management.

  20. A Case Report of Eosinophilic Esophagitis Accompanying Hypereosinophilic Syndrome

    Mahreema Jawairia


    Full Text Available Hypereosinophilic syndrome is a blood disorder characterized by the overproduction of eosinophils in the bone marrow with persistent peripheral eosinophilia, associated with organ damage by the release of eosinophilic mediators. Although HES can involve multiple organ systems, GI tract involvement is very rare. Few cases of HES presenting with gastritis or enteritis have been reported worldwide. To date, HES presenting with esophagus involvement has only been reported once. Here, we present a 39-year-old Hispanic female patient with history of HES presenting with complaints of dysphagia and generalized pruritus.

  1. Omeprazole Blocks STAT6 Binding to the Eotaxin-3 Promoter in Eosinophilic Esophagitis Cells

    Zhang, Xi; Cheng, Edaire; Huo, Xiaofang; Yu, Chunhua; Zhang, Qiuyang; Pham, Thai H.; Wang, David H.; Spechler, Stuart J.; Souza, Rhonda F.


    Background Patients who have esophageal eosinophilia without gastroesophageal reflux disease (GERD) nevertheless can respond to proton pump inhibitors (PPIs), which can have anti-inflammatory actions independent of effects on gastric acid secretion. In esophageal cell cultures, omeprazole has been reported to inhibit Th2 cytokine-stimulated expression of eotaxin-3, an eosinophil chemoattractant contributing to esophageal eosinophilia in eosinophilic esophagitis (EoE). The objective of this study was to elucidate molecular mechanisms underlying PPI inhibition of IL-4-stimulated eotaxin-3 production by esophageal cells. Methods/Findings Telomerase-immortalized and primary cultures of esophageal squamous cells from EoE patients were treated with IL-4 in the presence or absence of acid-activated omeprazole or lansoprazole. We measured eotaxin-3 protein secretion by ELISA, mRNA expression by PCR, STAT6 phosphorylation and nuclear translocation by Western blotting, eotaxin-3 promoter activation by an exogenous reporter construct, and STAT6, RNA polymerase II, and trimethylated H3K4 binding to the endogenous eotaxin-3 promoter by ChIP assay. Omeprazole in concentrations ≥5 µM significantly decreased IL-4-stimulated eotaxin-3 protein secretion and mRNA expression. Lansoprazole also blocked eotaxin-3 protein secretion. Omeprazole had no effect on eotaxin-3 mRNA stability or on STAT6 phosphorylation and STAT6 nuclear translocation. Rather, omeprazole blocked binding of IL-4-stimulated STAT6, RNA polymerase II, and trimethylated H3K4 to the eotaxin-3 promoter. Conclusions/Significance PPIs, in concentrations achieved in blood with conventional dosing, significantly inhibit IL-4-stimulated eotaxin-3 expression in EoE esophageal cells and block STAT6 binding to the promoter. These findings elucidate molecular mechanisms whereby patients with Th2 cytokine-driven esophageal eosinophilia can respond to PPIs, independent of effects on gastric acid secretion. PMID:23185525

  2. Increased acid responsiveness in vagal sensory neurons in a guinea pig model of eosinophilic esophagitis.

    Hu, Youtian; Liu, Zhenyu; Yu, Xiaoyun; Pasricha, Pankaj J; Undem, Bradley J; Yu, Shaoyong


    Eosinophilic esophagitis (EoE) is characterized with eosinophils and mast cells predominated allergic inflammation in the esophagus and present with esophageal dysfunctions such as dysphagia, food impaction, and heartburn. However, the underlying mechanism of esophageal dysfunctions is unclear. This study aims to determine whether neurons in the vagal sensory ganglia are modulated in a guinea pig model of EoE. Animals were actively sensitized by ovalbumin (OVA) and then challenged with aerosol OVA inhalation for 2 wk. This results in a mild esophagitis with increases in mast cells and eosinophils in the esophageal wall. Vagal nodose and jugular neurons were disassociated, and their responses to acid, capsaicin, and transient receptor potential vanilloid type 1 (TRPV1) antagonist AMG-9810 were studied by calcium imaging and whole cell patch-clamp recording. Compared with naïve animals, antigen challenge significantly increased acid responsiveness in both nodose and jugular neurons. Their responses to capsaicin were also increased after antigen challenge. AMG-9810, at a concentration that blocked capsaicin-evoked calcium influx, abolished the increase in acid-induced activation in both nodose and jugular neurons. Vagotomy strongly attenuated those increased responses of nodose and jugular neurons to both acid and capsaicin induced by antigen challenge. These data for the first time demonstrated that prolonged antigen challenge significantly increases acid responsiveness in vagal nodose and jugular ganglia neurons. This sensitization effect is mediated largely through TRPV1 and initiated at sensory nerve endings in the peripheral tissues. Allergen-induced enhancement of responsiveness to noxious stimulation by acid in sensory nerve may contribute to the development of esophageal dysfunctions such as heartburn in EoE.

  3. How to improve the diagnosis of eosinophilic esophagitis: Experience from a case series in Mexico.

    Soto-Solís, R; Santana-de Anda, K; González-Uribe, N; Gallegos, C; Romo-Aguirre, C; Remes-Troche, J M; Ballesteros-Amozurrutia, M A

    Eosinophilic esophagitis (EoE) is a chronic, immune disorder mediated largely by food antigens. It shares nonspecific symptoms with gastroesophageal reflux disease (GERD). EoE is rarely reported in Mexico, perhaps due to the racial characteristics of the population or because of insufficient diagnostic suspicion. Our aim was to describe a Mexican cohort with EoE and evaluate the usefulness of the clinical history and endoscopy in the EoE diagnosis, in comparison with GERD patients. A retrospective study was carried out on the clinical characteristics and endoscopic and histopathologic findings in patients with EoE, along with a case-control study on patients with GERD. The endoscopic images obtained were interpreted in a blind and randomized manner by 4 gastroenterologists, before and after providing them with information on the characteristic alterations of EoE. The esophageal biopsies were also blinded to 2 pathologists that evaluated their diagnostic correlation. The Fisher's exact test and Mann-Whitney U test were used in the statistical analysis. Fourteen patients with EoE were included in the study. Ten (71%) of them were men and the mean age of the patients was 35 years. There were more subjects with a personal history of asthma (p=0.0023) and food impaction (p=0.04) in the EoE group. The initial evaluation of the endoscopic findings showed 53% correct EoE interpretations and rose to 96% in the second revision (sensitivity 100%, specificity 71%, PPV 65%, NPV 100%). Mexican patients with EoE have similar characteristics to those of patients in western case series. Clinical awareness of the disorder increases endoscopic diagnosis in up to 40% of cases. Copyright © 2016 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  4. 认识嗜酸细胞性食管炎——从基因学、免疫学到临床诊治%An overview of eosinophilic esophagitis: from genetics, immunology to clinical presentation and management

    邵洁; 张自力


    在欧美国家中,嗜酸细胞性食管炎已成为一种常见的以严重嗜酸性粒细胞浸润为主的消化道疾病.其发病和食物过敏、支气管哮喘、特应性皮炎及其他过敏性疾病密切相关.Th2细胞在疾病的慢性炎症中起到了至关重要的作用.文章拟综述嗜酸细胞性食管炎的基础研究进展及临床治疗.%In Europe and the United States, eosinophilic esophagitis (EoE) has become a common gastrointestinal disease characterized by severe eosinophil infiltration in the esophagus. It is strongly associated with food allergy, asthma, atopic dermatitis, and other allergic diseases. T lymphocytes, especially Th2 cells, play an instrumental role in the development of allergic inflammation. In this review, the current understanding of EoE and its treatment options will be discussed.

  5. Eosinophilic Esophagitis (EoE: an emerging disease in childhood - Review of diagnostic and management strategies

    Jorge Amil Dias


    Full Text Available Eosinophilic esophagitis (EoE is a chronic immune/antigen mediated inflammatory disease of the esophagus. It comprises a separate entity of increasing incidence and prevalence in children and adults. The disease is characterized by histological evidence of dense esophageal tissue eosinophilia in the presence of a variety of upper GI symptoms including vomiting, dysphagia, food impaction and odynophagia. Cornerstone of treatment is dietary intervention and/or the off-label use of swallowed topical corticosteroids. New drug therapies are under investigation. In this review we focus on the diagnostic approach and the currently available treatment strategies. Keywords: Eosinophilic esophagitis, oral viscous budesonide, fluticasone propionate, oral steroids, amino acid-based formula, empiric elimination diet, targeted elimination dietKey points:1.A trial with antisecretory medication is necessary to exclude GERD and PPI-responsive esophageal eosinophilia and to fulfil the diagnostic criteria of EoE. 2.Elimination diet and/or off-label use of topical corticosteroids are effective measures for treating EoE. 3.Elimination diet is the first line treatment in atopic children. 4.Systemic corticosteroids are reserved for patients with severe disease requiring immediate relief, or when other treatments have failed. 5.Cromolyn sodium (sodium cromoglycate and leukotriene receptor antagonists, are not currently recommended for treating EoE, due to lack of solid evidence of benefit.6.Immunosuppressive drugs and biologics have shown some value but effect has been limited and therefore not yet recommended as standard therapy.

  6. 2015 David Y. Graham Lecture: The First Two Decades Of Eosinophilic Esophagitis-From Acid Reflux To Food Allergy.

    Hirano, Ikuo


    Collaborative efforts by pediatric and adult gastroenterologists, allergists, dieticians, and pathologists have brought about marked progress in the recognition, understanding, and management of eosinophilic esophagitis (EoE) over the past two decades. Once an esoteric diagnosis, EoE is now increasingly identified as a major cause of morbidity, afflicting both children and adults. The detection of mucosal eosinophils has evolved from a diagnostic feature of acid reflux to a biomarker of food sensitization of the esophagus. Translational studies and murine models have elucidated Th-2 immune pathways in EoE, inspiring the development of targeted biologic therapeutics. At the same time, validation of patient-reported outcomes and endoscopic end points has facilitated the implementation of clinical trials of novel therapeutics. Ongoing investigations have elucidated the importance of "looking beneath the surface" of the epithelium, focusing greater attention on the impact of esophageal remodeling in the clinical consequences of EoE. Elimination diets continue to gain popularity as an intriguing, highly effective, and non-pharmacologic therapy that lends credence to the concept that EoE is a food-driven, immunologic disorder.

  7. Eosinophilic gastroenteritis: Clinical experience with 15 patients

    Ming-Jen Chen; Cheng-Hsin Chu; Shee-Chan Lin; Shou-Chuan Shih; Tsang-En Wang


    AIM: To evaluate the clinic features of eosinophilicgastroenteritis and to examine the diagnosis, treatment,long-term outcome of this disease.METHODS: Charts with a diagnosis of eosinophilicgastroenteritis from 1984 to 2002 at Mackay Memorial Hospital were reviewed retrospectively. There were 15 patients diagnosed with eosinophilic gastroenteritis. The diagnosis was established in 13 by histologic evaluation of endoscopic biopsy or operative specimen and in 2 by radiologic imaging and the presence of eosinophilic ascites.RESULTS: All the patients had gastrointestinal symptoms and 12 (80 %) had hypereosinophilia (absolute eosinophil count 1 008 to 31 360/cm3). The most common symptoms were abdominal pain and diarrhea. Five of the 15 patients had a history of allergy. Seven patients had involvement of the mucosa, 2 of muscularis, and 6 of subserosa. One with a history of seafood allergy was successfully treated with an elimination diet. Another patient improved spontaneously after fasted for several days. The remaining 13 patients were treated with oral prednisolone, 10 to 40 mg/day initially,which was then tapered. The symptoms in all the patients subsided within two weeks. Eleven of the 15 patients were followed up for more than 12 months (12 to 104 months,mean 48.7), of whom 5 had relapses after discontinuing steroids (13 episodes). Two of these patients required longterm maintenance oral prednisolone (5 to 10 mg/day).CONCLUSION: Eosinophilic gastroenteritis is a rare condition of unclear etiology characterized by relapses and remissions. Short courses of corticosteroids are the mainstay of treatment, although some patients with relapsing disease require long-term low-dose steroids.

  8. Eosinophilic colitis

    Nnenna Okpara; Bassam Aswad; Gyorgy Baffy


    Eosinophilic colitis (EC) is a rare form of primary eosinophilic gastrointestinal disease with a bimodal peak of prevalence in neonates and young adults. EC remains a little understood condition in contrast to the increasingly recognized eosinophilic esophagitis. Clinical presentation of EC is highly variable according to mucosal, transmural, or serosal predominance of inflammation. EC has a broad differential diagnosis because colon tissue eosinophilia often occurs in parasitic infection, drug-induced allergic reactions,inflammatory bowel disease, and various connective tissue disorders, which require thorough searching for secondary causes that may be specifically treated with antibiotics or dietary and drug elimination.Like eosinophilic gastrointestinal disease involving other segments of the gastrointestinal tract, EC responds very well to steroids that may be spared by using antihistamines, leukotriene inhibitors and biologics.

  9. Tethered SECM endoscopic capsule for the diagnosis of eosinophilic esophagitis (Conference Presentation)

    Do, Dukho; Kang, DongKyun; Tabatabaei, Nima; Grant, Catriona N.; Nishioka, Norman S.; Rosenberg, Mireille; Hesterberg, Paul E.; Yuan, Qian; Garber, John J.; Katz, Aubrey J.; Shreffler, Wayne G.; Tearney, Guillermo J.


    Eosinophilic Esophagitis (EoE) is an inflammatory disease caused by inhaled or ingested food allergies, and characterized by the infiltration of eosinophils in the esophagus. The gold standard for diagnosing EoE is to conduct endoscopy and obtain multiple biopsy specimens from different portions of the esophagus; an exam is considered positive if more than 15 eosinophils per high power field (HPF) in any of the biopsies. This method of diagnosis is problematic because endoscopic biopsy is expensive and poorly tolerated and the esophageal eosinophil burden needs to be monitored frequently during the course of the disease. Spectrally encoded confocal microscopy (SECM) is a high-speed confocal microscopy technology that can visualize individual eosinophils in large microscopic images of the human esophagus, equivalent to more than 30,000 HPF. Previously, we have demonstrated that tethered capsule SECM can be conducted in unsedated subjects with diagnosed EoE. However, speckle noise and the relatively low resolution in images obtained with the first capsule prototypes made it challenging to distinguish eosinophils from other cells. In this work, we present a next-generation tethered SECM capsule, which has been modified to significantly improve image quality. First, we substituted the single mode fiber with a dual-clad fiber to reduce speckle noise. A gradient-index multimode fiber was fusion spliced at the tip of the dual-clad fiber to increase the effective numerical aperture of the fiber from 0.09 to 0.15, expanding the beam more rapidly to increase the illumination aperture at the objective. These modifications enabled the new SECM capsule to achieve a lateral resolution of 1.8 µm and an axial resolution of 16.1 µm, which substantially improves the capacity of this probe to visualize cellular features in human tissue. The total size of the SECM capsule remained 6.75 mm in diameter and 31 mm in length. We are now in the process of testing this new SECM capsule in

  10. [Esophageal diseases: gastroesophageal reflux disease, Barrett's esophagus, achalasia and eosinophilic esophagitis].

    Calvet, Xavier; Villoria, Albert


    Important new advances were presented in esophageal disease in Digestive Disease Week 2013. A highlight was confirmation of the high efficacy of weight loss to treat symptoms of reflux and an interesting pilot study suggesting that a simple ligature with supra- and infracardial bands could be an effective technique in esophageal reflux. If the excellent results and safety and efficacy of this technique are confirmed in the long term, it could revolutionize the management of gastroesophageal reflux disease. Also of note this year was the presentation of multiple studies validating a new technique, peroral endoscopic myotomy (POEM) for the endoscopic treatment of achalasia. This technique seems to have excellent efficacy and safety.

  11. Alterations in junctional proteins, inflammatory mediators and extracellular matrix molecules in eosinophilic esophagitis.

    Abdulnour-Nakhoul, Solange M; Al-Tawil, Youhanna; Gyftopoulos, Alex A; Brown, Karen L; Hansen, Molly; Butcher, Kathy F; Eidelwein, Alexandra P; Noel, Robert A; Rabon, Edd; Posta, Allison; Nakhoul, Nazih L


    Eosinophilic esophagitis (EoE), an inflammatory atopic disease of the esophagus, causes massive eosinophil infiltration, basal cell hyperplasia, and sub-epithelial fibrosis. To elucidate cellular and molecular factors involved in esophageal tissue damage and remodeling, we examined pinch biopsies from EoE and normal pediatric patients. An inflammation gene array confirmed that eotaxin-3, its receptor CCR3 and interleukins IL-13 and IL-5 were upregulated. An extracellular matrix (ECM) gene array revealed upregulation of CD44 & CD54, and of ECM proteases (ADAMTS1 & MMP14). A cytokine antibody array showed a marked decrease in IL-1α and IL-1 receptor antagonist and an increase in eotaxin-2 and epidermal growth factor. Western analysis indicated reduced expression of intercellular junction proteins, E-cadherin and claudin-1 and increased expression of occludin and vimentin. We have identified a number of novel genes and proteins whose expression is altered in EoE. These findings provide new insights into the molecular mechanisms of the disease.

  12. Clinical characteristics of eosinophilic asthma exacerbations

    Bjerregaard, Asger; Laing, Ingrid A; Backer, Vibeke;


    BACKGROUND AND OBJECTIVE: Airway eosinophilia is associated with an increased risk of asthma exacerbations; however, the impact on the severity of exacerbations is largely unknown. We describe the sputum inflammatory phenotype during asthma exacerbation and correlate it with severity and treatment...... response. METHODS: Patients presenting to hospital with an asthma exacerbation were recruited during a 12-month period and followed up after 4 weeks. Induced sputum was collected at both visits. Patients underwent spirometry, arterial blood gas analysis, fractional exhaled nitric oxide analysis, white...... with a sensitivity of 86% and a specificity of 70%. CONCLUSION: Our findings suggest that eosinophilic asthma exacerbations may be clinically more severe than NEEs, supporting the identification of these higher risk patients for specific interventions....

  13. Eosinophilic Esophagitis

    ... an increase in a gene coding for a protein called eotaxin-3 in patients with EoE. Further support that there may be a genetic link is that some adults have a family history of allergic disorders and a family history of ...

  14. Comparison of different biopsy forceps models for tissue sampling in eosinophilic esophagitis.

    Bussmann, Christian; Schoepfer, Alain M; Safroneeva, Ekaterina; Haas, Nadine; Godat, Sébastien; Sempoux, Christine; Simon, Hans-Uwe; Straumann, Alex


    Background and aims: Eosinophilic esophagitis (EoE) is a mixed inflammatory and fibrostenotic disease. Unlike superficial inflammatory changes, subepithelial fibrosis is not routinely sampled in esophageal biopsies. This study aimed to evaluate the efficacy and safety of deep esophageal sampling with four different types of biopsy forceps. Patients and methods: In this cross-sectional study, esophageal biopsies were taken in 30 adult patients by one expert endoscopist. Biopsies sampled from distal esophagus using a static jaw forceps (Olympus, FB-11K-1) were compared with proximal biopsies sampled with static jaw (Olympus, FB-45Q-1), alligator jaw (Olympus, FB-210K), and large-capacity forceps (Boston Scientific, Radial Jaw 4). One pathologist calculated the surface area of epithelial and subepithelial layers in hematoxylin and eosin (H&E)-stained biopsies. Results: Subepithelial tissue was acquired in 97 % (static jaw FB-11K-1), 93 % (static jaw FB-45Q-1), 80 % (alligator jaw), and 55 % (large-capacity) of samples. Median (interquartile [IQR]) ratios of surface area of epithelial to subepithelial tissue were: static jaw FB-45Q-1, 1.07 (0.65 - 4.465); static jaw FB-11K-1, 1.184 (0.608 - 2.545); alligator jaw, 2.353 (1.312 - 4.465); and large-capacity, 2.71 (1.611 - 4.858). The static jaw models obtained a larger surface area of subepithelial tissue compared with the alligator jaw (P  90 % of biopsies and appear to be superior to alligator or large-capacity forceps in sampling larger amounts of subepithelial tissue. © Georg Thieme Verlag KG Stuttgart · New York.

  15. Esofagitis eosinofílica en el adulto: aspectos clínicos, endoscópicos, pH-métricos y manométricos Eosinophilic esophagitis in the adult: clinical, endoscopic, pH-metric, and manometric findings

    L. Martín Martín


    Full Text Available Objetivos: la esofagitis eosinofílica (EE es una entidad de interés creciente caracterizada en el adulto por disfagia y episodios de impactación alimentaria recurrentes. Nuestro objetivo fue estudiar las características clínicas, endoscópicas, manométricas y pH-métricas en los pacientes con EE, así como la relación que pudiera existir entre ellas. Pacientes y métodos: se estudiaron de forma prospectiva durante un año los pacientes adultos diagnosticados de EE. En todos se realizó endoscopia digestiva alta con toma de biopsias, manometría esofágica estacionaria y pH-metría ambulatoria. Se documentó además el tiempo de evolución clínica, los antecedentes de atopia, la presencia de eosinofilia periférica, la frecuencia de la disfagia y el número de desimpactaciones y complicaciones endoscópicas. Resultados: se estudiaron 11 pacientes (edad media 35 años. Todas las endoscopias presentaron hallazgos patológicos: traquealización en 5, alteraciones mucosas en 4, en 3 anillos esofágicos distales y en 2 estenosis esofágicas. Precisaron desimpactaciones endoscópicas 7 pacientes. Se produjeron desgarros de la mucosa esofágica durante la endoscopia en 2 pacientes. La manometría esofágica fue patológica en 6 pacientes, de estos, 5 fueron trastornos de hipomotilidad. La pH-metría fue patológica en 2 casos. Presentaron eosinofilia periférica 3 pacientes. Conclusión: aunque los hallazgos patológicos en la endoscopia son frecuentes, no siempre justifican los episodios de impactación alimentaria característicos de la EE. Los trastornos de motilidad en forma de peristalsis esofágica ineficaz son el hallazgo manométrico más frecuente, aunque tampoco se han podido relacionar con un mayor número de episodios de disfagia o de impactaciones.Objectives: eosinophilic esophagitis (EE is a condition characterized by dysphagia and frequent food impaction in young adults. The aim of our study was to evaluate the clinical aspects

  16. Eosinophilic Esophagitis with Dysphagia and Food Impaction in a Young Adult.

    Cochet, Anthony A; Cochet, Allyson E; Francis, James M


    Eosinophilic esophagitis (EoE) is an emerging esophageal disease associated with dysphagia and food impaction. Practice guidelines have only recently been developed. It affects 1/1000 individuals, predominantly young men. As this demographic represents a substantial portion of the military aviation population, aerospace medicine clinicians should be familiar with this diagnosis when evaluating dysphagia or impactions. A 23-yr-old Caucasian man, a U.S. Air Force air traffic controller, presented to Flight Medicine following an episode of food impaction requiring evaluation in the local emergency department. The patient reported a 5-yr history of recurrent episodes of food lodging in his throat, requiring fluid and body repositioning for resolution. Medical history was significant for eczema. Upper endoscopy revealed an abnormal esophagus with macroscopic features of EoE and biopsies were also consistent with EoE. After further work-up, the patient was diagnosed with EoE and treated. Significant symptom improvement was noted after 2 mo of therapy. This case outlines the evaluation of food impaction as well as the diagnostic criteria for EoE, which is a disease that affects patients with demographics common to the military aviation community. As the diagnostic and treatment guidelines for EoE are relatively new, it may easily be overlooked by the primary care physician, causing a delay in subspecialist consultation, thus delaying treatment. EoE is a condition with symptoms that pose high risk to the performance of aircrew duties; therefore, flight surgeons must be familiar with the aeromedical standards that accompany this diagnosis.

  17. Clinical Characteristics of Pediatric Esophagitis in Southern Iran; A Single-Center Experience

    Mozhgan Zahmatkeshan


    Full Text Available Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire. Results: We studied 125 children, comprising 61 (48.8% girls and 64 (51.2% boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60% patients, followed by fever in 35 (28%. Erythema (33.6%, esophageal ulcer (11.2%, and whitish patch (8.0% were the most common endoscopic findings, while reflux esophagitis (32.8%, chronic (6.4% and acute esophagitis (5.6%, and candida esophagitis (5.6% were the most common histological diagnoses. Only one (0.8% patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease. Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression.

  18. Eosinophils in Autoimmune Diseases

    Daniela Čiháková


    Full Text Available Eosinophils are multifunctional granulocytes that contribute to initiation and modulation of inflammation. Their role in asthma and parasitic infections has long been recognized. Growing evidence now reveals a role for eosinophils in autoimmune diseases. In this review, we summarize the function of eosinophils in inflammatory bowel diseases, neuromyelitis optica, bullous pemphigoid, autoimmune myocarditis, primary biliary cirrhosis, eosinophilic granulomatosis with polyangiitis, and other autoimmune diseases. Clinical studies, eosinophil-targeted therapies, and experimental models have contributed to our understanding of the regulation and function of eosinophils in these diseases. By examining the role of eosinophils in autoimmune diseases of different organs, we can identify common pathogenic mechanisms. These include degranulation of cytotoxic granule proteins, induction of antibody-dependent cell-mediated cytotoxicity, release of proteases degrading extracellular matrix, immune modulation through cytokines, antigen presentation, and prothrombotic functions. The association of eosinophilic diseases with autoimmune diseases is also examined, showing a possible increase in autoimmune diseases in patients with eosinophilic esophagitis, hypereosinophilic syndrome, and non-allergic asthma. Finally, we summarize key future research needs.

  19. Twin and family studies reveal strong environmental and weaker genetic cues explaining heritability of eosinophilic esophagitis.

    Alexander, Eileen S; Martin, Lisa J; Collins, Margaret H; Kottyan, Leah C; Sucharew, Heidi; He, Hua; Mukkada, Vincent A; Succop, Paul A; Abonia, J Pablo; Foote, Heather; Eby, Michael D; Grotjan, Tommie M; Greenler, Alexandria J; Dellon, Evan S; Demain, Jeffrey G; Furuta, Glenn T; Gurian, Larry E; Harley, John B; Hopp, Russell J; Kagalwalla, Amir; Kaul, Ajay; Nadeau, Kari C; Noel, Richard J; Putnam, Philip E; von Tiehl, Karl F; Rothenberg, Marc E


    Eosinophilic esophagitis (EoE) is a chronic antigen-driven allergic inflammatory disease, likely involving the interplay of genetic and environmental factors, yet their respective contributions to heritability are unknown. To quantify the risk associated with genes and environment on familial clustering of EoE. Family history was obtained from a hospital-based cohort of 914 EoE probands (n = 2192 first-degree "Nuclear-Family" relatives) and an international registry of monozygotic and dizygotic twins/triplets (n = 63 EoE "Twins" probands). Frequencies, recurrence risk ratios (RRRs), heritability, and twin concordance were estimated. Environmental exposures were preliminarily examined. Analysis of the Nuclear-Family-based cohort revealed that the rate of EoE, in first-degree relatives of a proband, was 1.8% (unadjusted) and 2.3% (sex-adjusted). RRRs ranged from 10 to 64, depending on the family relationship, and were higher in brothers (64.0; P = .04), fathers (42.9; P = .004), and males (50.7; P Twins cohort, genetic heritability was 14.5% ± 4.0% (P twins was 57.9% ± 9.5% compared with 36.4% ± 9.3% in dizygotic co-twins (P = .11). Greater birth weight difference between twins (P = .01), breast-feeding (P = .15), and fall birth season (P = .02) were associated with twin discordance in disease status. EoE RRRs are increased 10- to 64-fold compared with the general population. EoE in relatives is 1.8% to 2.4%, depending on relationship and sex. Nuclear-Family heritability appeared to be high (72.0%). However, the Twins cohort analysis revealed a powerful role for common environment (81.0%) compared with additive genetic heritability (14.5%). Copyright © 2014 American Academy of Allergy, Asthma & Immunology. All rights reserved.

  20. Transcultural adaptation and validation of the "Adult Eosinophilic Esophagitis Quality of Life Questionnaire" into Spanish

    Alfredo J. Lucendo


    Full Text Available Background: The "Adult Eosinophilic Esophagitis Quality of Life (EoE-QoL-A Questionnaire" was developed in English as a valid, reliable, and disease-specific health-related QoL measure. This research aims to adapt and validate this questionnaire for Spanish-speaking patients. Patients and methods: A multicenter, observational, prospective study was conducted at 8 Spanish hospitals. The cultural adaptation of the original EoE-QoL-A questionnaire was undertaken through a standardized 3-phase procedure: 1. Translation; 2. Retrotranslation; and 3. Pilot study. Patients completed the Hospital Anxiety and Depression Scale (HADS, the Short Form (SF-12, the Brief Illness Perception Questionnaire (BIPQ, and the adapted EoE-QoL-A, with a retest 3 months later. Statistical analysis included construct validity, internal consistency, criterion validity, and reproducibility. Results: One hundred and seventy adult EoE patients (73.5 % male; aged 33.5 ± 11.4-y were included in the study. With regard to internal validity, all Cronbach alpha values were > 0.75. A significant correlation between items assessed in the SF-12, BIPQ and EoE-QoL-A questionnaires (p < 0.001 was observed. Correlations with the HADS were stronger for anxiety than for depression levels. Anxiety related to disease diagnosis and choking were the most affected dimensions; less affected were the dimensions related to eating, social, and emotional development. Intraclass correlation coefficients between the test and retest assessments were acceptable for all questionnaires, with the highest values (0.73-0.84 calculated for the EoE-QoL-A Spanish version. Conclusion: The Spanish version of the EoE-QoL-A is a reliable, valid, and responsive questionnaire. Diagnosis and choking anxiety were the most affected dimensions in the health-related QoL in adult EoE patients.

  1. The Six-Food Elimination Diet for Eosinophilic Esophagitis Increases Grocery Shopping Cost and Complexity.

    Asher Wolf, W; Huang, Kevin Z; Durban, Raquel; Iqbal, Zahra J; Robey, Benjamin S; Khalid, Farah J; Dellon, Evan S


    The six-food elimination diet (SFED), where dairy, wheat, eggs, soy, nuts, and seafood are avoided, is an effective treatment for eosinophilic esophagitis (EoE). Patient-related costs of this approach, however, are unknown. We aimed to assess the cost of and ease of shopping for an SFED compared to an unrestricted diet. A dietitian with expertise in EoE generated menus meeting dietary requirements for a week's worth of meals for the SFED and an unrestricted diet. We compared prices and the number of missing items for both diets at standard and specialty grocery stores. The average weekly price of the SFED at a standard supermarket was $92.54 compared to $79.84 for an unrestricted diet (p = 0.0001). A patient shopping at a standard grocery store needed a higher proportion of items from a second store compared to an unrestricted diet (32 vs. 3 %, p = 0.0001). The prices of the SFED and unrestricted diet using a specialty supermarket were comparable ($106.47 vs. $105.96, p = 0.81), as was the percentage of items requiring a trip to a second store (6 vs. 2 % items, p = 0.03). Shopping at a specialty grocery store increased weekly grocery costs by $13.93 (p = 0.04) for the SFED and $26.12 (p = 0.03) for the unrestricted diet. In conclusion, for patients shopping at standard grocery stores, the cost of an SFED is higher, and an SFED requires more items from a second store. These differences disappear at specialty grocery stores, but costs were significantly higher. This cost and logistical burden can inform patients when selecting dietary therapy.

  2. Eosinophilic pneumonias. A clinical case of acute eosinophilic pneumonia associated with sertraline and literature review

    Roberto Serini


    Full Text Available Background: Acute eosinophilic pneumonia (AEP is one of the heterogeneous group of disorders termed eosinophilic lung diseases showing an abnormal accumulation of eosinophils in distal airways, air spaces, and the interstitial compartment of the lung. AEP is characterized by acute febrile respiratory failure, a typical radiographic pattern similar to that of acute pulmonary edema, eosinophilia in bronchoalveolar lavage (BAL, a dramatic response to corticosteroid therapy with no relapse when tapering or withdrawing treatment in the absence of infection. It can be idiopathic o secondary to known causes such as drugs, or fungal and parasitic infections. Clinical case: We report a case of a 76-year-old woman who developed symptoms, respiratory signs, and radiological and histological findings compatible with secondary AEP, we assessed as being associated with sertraline assumption (second case in literature. Discussion: The AEP we detected could be related to a secondary hypersensitivity syndrome to drug exposure (DRESS syndrome: Drug Rush with Eosinophilia and Systemic Symptoms characterized by 1 skin rush, 2 increased eosinophilia, and 3 systemic involvement. The presence of all three criteria confirmed our diagnosis.

  3. Manifestações clínicas, terapêutica e evolução de crianças e adolescentes com esofagite eosinofílica Clinical manifestations, treatment, and outcomes of children and adolescents with eosinophilic esophagitis

    Maraci Rodrigues


    treatment of pediatric patients with the classical form of eosinophilic esophagitis (EoE. METHODS: Study of clinical, laboratory, endoscopic, and histologic data and response to conventional treatment of 43 previously followed pediatric patients with the classical form of EoE. RESULTS: A total of 43 patients diagnosed with EoE were included in the study, of which 37 were males (86%, with a mean age of 8.4 years. The most common symptoms were: nausea, vomiting, and abdominal pain (100% in children younger than 7 years, and loss of appetite (60%, heartburn (52%, and food impaction (48% in children older than 7 years and adolescents. Regarding the endoscopic findings, 12 (28% patients had whitish plaques on the esophageal lining, 8 (18.5% had longitudinal grooves, 2 (4.5% had concentric rings, 3 (7% had longitudinal grooves and whitish plaques, and the remaining 18 (42% had esophageal mucosa with normal appearance. Despite the initial favorable response, 76.7% of patients required more than one course of corticosteroid therapy (systemic or aerosol and diet (exclusion or elimination of food or elementary allergens. Persistence of eosinophil infiltration was found in some patients despite favorable clinical response. CONCLUSIONS: The classic form of EoE typically shows different symptoms according age range. A significant number of patients required more than one treatment cycle to show clinical remission. Endoscopic and histologic improvement was observed; however, eosinophilic infiltration persisted in some patients.

  4. Twin and family studies reveal strong environmental and weaker genetic cues explaining heritability of eosinophilic esophagitis

    Alexander, Eileen S.; Martin, Lisa J.; Collins, Margaret H.; Kottyan, Leah; Sucharew, Heidi; He, Hua; Mukkada, Vincent A.; Succop, Paul A.; Abonia, J. Pablo; Foote, Heather; Eby, Michael D.; Grotjan, Tommie M.; Greenler, Alexandria J.; Dellon, Evan S.; Demain, Jeffrey G.; Furuta, Glenn T.; Gurian, Larry E.; Harley, John B.; Hopp, Russell J.; Kaul, Ajay; Nadeau, Kari C.; Noel, Richard J.; Putnam, Philip E.; von Tiehl, Karl F.; Rothenberg, Marc E.


    Background Eosinophilic esophagitis (EoE) is a chronic antigen-driven allergic inflammatory disease, likely involving the interplay of genetic and environmental factors, yet their respective contributions to heritability are unknown. Objective To quantify risk associated with genes and environment on familial clustering of EoE. Methods Family history was obtained from a hospital-based cohort of 914 EoE probands, (n=2192 first-degree “Nuclear-Family” relatives) and the new international registry of monozygotic and dizygotic twins/triplets (n=63 EoE “Twins” probands). Frequencies, recurrence risk ratios (RRRs), heritability and twin concordance were estimated. Environmental exposures were preliminarily examined. Results Analysis of the Nuclear-Family–based cohort revealed that the rate of EoE, in first-degree relatives of a proband, was 1.8% (unadjusted) and 2.3% (sex-adjusted). RRRs ranged from 10–64, depending on the family relationship, and were higher in brothers (64.0; p=0.04), fathers (42.9; p=0.004) and males (50.7; p<0.001) compared to sisters, mothers and females, respectively. Risk of EoE for other siblings was 2.4%. In the Nuclear-Families, combined gene and common environment heritability (hgc2) was 72.0±2.7% (p<0.001). In the Twins cohort, genetic heritability was 14.5±4.0% (p<0.001), and common family environment contributed 81.0±4% (p<0.001) to phenotypic variance. Proband-wise concordance in MZ co-twins was 57.9±9.5% compared to 36.4±9.3% in DZ (p=0.11). Greater birth-weight difference between twins (p=0.01), breastfeeding (p=0.15) and Fall birth season (p=0.02) were associated with twin discordance in disease status. Conclusions EoE recurrence risk ratios are increased 10–64-fold compared with the general population. EoE in relatives is 1.8–2.4%, depending upon relationship and sex. Nuclear-Family heritability appeared to be high (72.0%). However, Twins cohort analysis revealed a powerful role for common environment (81

  5. Eosinophilic/T-cell Chorionic Vasculitis: Histological and Clinical Correlations.

    Cheek, Bradley; Heinrich, Stephen; Ward, Kenneth; Craver, Randall


    Eosinophilic T-cell chorionic vasculitis (E/TCV) is composed of eosinophils and T-lymphocytes originating within chorionic vessels, radiating toward the intervillous space and away from the amnion in a fashion different from the fetal vascular response seen in amnionitis. Clinical significance and risk factors are not well established. We report four pregnancies (five infants, one triplet was spared) with E/TCV, gestational ranging from 23 weeks to term. All had concurrent acute chorioamnionitis, three had the typical acute fetal inflammatory response. One had placental fetal obstructive vasculopathy and an upper extremity reduction defect (radio-ulnar synostosis), the mother had pre-eclampsia. A second case involved 2 of 3 23 week previable triplets. Our third case had a metatarsus varus resistant to casting, the mother had gestational diabetes. The last case was a normal infant. We review the literature, discuss the clinical findings and present the histologic characteristics of this infrequently recognized lesion.

  6. TGF-Beta Gene Polymorphisms in Food Allergic versus Non-Food Allergic Eosinophilic Esophagitis


    in LP eosinophils, angiogenesis, or vascular activation by genotype in the presence or absence of food sensitization. Conclusions: Our data...found that these also had no differences by genotype in the absence or presence of food sensitization. 21 Discussion In this study we...that genotype TT at C-509T associates with increased numbers of TGFb1 expressing cells. This was not changed by the presence or absence of food

  7. Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

    Graeff-Teixeira, Carlos; da Silva, Ana Cristina Arámburu; Yoshimura, Kentaro


    Summary: Eosinophilic meningoencephalitis is caused by a variety of helminthic infections. These worm-specific infections are named after the causative worm genera, the most common being angiostrongyliasis, gnathostomiasis, toxocariasis, cysticercosis, schistosomiasis, baylisascariasis, and paragonimiasis. Worm parasites enter an organism through ingestion of contaminated water or an intermediate host and can eventually affect the central nervous system (CNS). These infections are potentially serious events leading to sequelae or death, and diagnosis depends on currently limited molecular methods. Identification of parasites in fluids and tissues is rarely possible, while images and clinical examinations do not lead to a definitive diagnosis. Treatment usually requires the concomitant administration of corticoids and anthelminthic drugs, yet new compounds and their extensive and detailed clinical evaluation are much needed. Eosinophilia in fluids may be detected in other infectious and noninfectious conditions, such as neoplastic disease, drug use, and prosthesis reactions. Thus, distinctive identification of eosinophils in fluids is a necessary component in the etiologic diagnosis of CNS infections. PMID:19366917

  8. Clinical and dosimetric factors of radiation-induced esophageal injury: Radiation-induced esophageal toxicity

    Wen-Bo Qiao; Yan-Hui Zhao; Yan-Bin Zhao; Rui-Zhi Wang


    AIM: To analyze the clinical and dosimetric predictive factors for radiation-induced esophageal injury in patients with non-small-cell lung cancer (NSCLC) during threedimensional conformal radiotherapy (3D-CRT). METHODS: We retrospectively analyzed 208 consecutive patients (146 men and 62 women) with NSCLC treated with 3D-CRT. The median age of the patients was 64 years (range 35-87 years). The clinical and treatment parameters including gender, age, performance status, sequential chemotherapy, concurrent chemotherapy, presence of carinal or subcarinal lymph nodes, pretreatment weight loss, mean dose to the entire esophagus, maximal point dose to the esophagus, and percentage of volume of esophagus receiving >55 Gy were studied. Clinical and dosimetric factors for radiation-induced acute and late grade 3-5 esophageal injury were analyzed according to Radiation Therapy Oncology Group (RTOG) criteria.RESULTS: Twenty-five (12%) of the two hundred and eight patients developed acute or late grade 3-5 esophageal injury. Among them, nine patients had both acute and late grade 3-5 esophageal injury, two died of late esophageal perforation. Concurrent chemotherapy and maximal point dose to the esophagus ≥60 Gy were significantly associated with the risk of grade 3-5 esophageal injury. Fifty-four (26%) of the two hundred and eight patients received concurrent chemotherapy. Among them, 25 (46%) developed grade 3-5 esophageal injury (P = 0.0001<0.01). However, nograde 3-5 esophageal injury occurred in patients who received a maximal point dose to the esophagus <60 Gy (P= 0.0001<0.01).CONCLUSION: Concurrent chemotherapy and the maximal esophageal point dose ≥60 Gy are significantly associated with the risk of grade 3-5 esophageal injury in patients with NSCLC treated with 3D-CRT.

  9. Incidencia y características de la esofagitis eosinofílica (EE en adultos Incidence and characteristics of eosinophilic esophagitis in adults

    O. Nantes


    Full Text Available La esofagitis eosinofílica (EE es una enfermedad caracterizada por la infiltración de la mucosa del esófago por eosinófilos, cuya incidencia en adultos parece estar aumentando en los últimos años, de forma similar a lo que ocurre en otras enfermedades de probable etiología inmunoalérgica. Predomina en varones jóvenes y se manifiesta principalmente por disfagia e impactación alimentaria. Su tratamiento se basa en eliminar el alérgeno potencialmente implicado y la administración de corticoides. En el presente trabajo se revisan retrospectivamente los casos de EE diagnosticados en el Hospital de Navarra entre enero de 2002 y agosto de 2008, encontrándose 25 pacientes, lo que supone una incidencia de 2,13 casos/10(5 habitantes/año. Un 72% de nuestros pacientes presentaban disfagia y un 52% historia de impactación del bolo alimentario, encontrándose alteraciones endoscópicas en 23 de los 25 casos. De 24 pacientes estudiados, un 76% manifestaban alergia alimentaria o a neumoalérgenos, lo que apoya el fondo inmunoalérgico de la enfermedad y la necesidad de un estudio alergológico en todos las pacientes con EE. La mayoría de nuestros pacientes (22 de 24 valorados presentaron buena respuesta clínica al tratamiento, que se basó en evitar la exposición al alergeno potencialmente implicado y/o la administración de corticoides (tópicos o sistémicos y/o la administración de inhibidores de la bomba de protones.Eosinophilic esophagitis (EE is a disease characterised by the infiltration of esophageal mucosa by eosinophils, whose incidence in adults seems to have been increasing in recent years, in a way that is similar to what is occurring with other diseases of a probable immunoallergic aetiology. It predominates in young adults and is mainly expressed by dysphagia and esophageal food impactation. Treatment is based on eliminating the allergen that is potentially involved and the administration of corticoids. This article offers a

  10. Clinical and endoscopic features of Chinese reflux esophagitis patients

    Wei Li; Shu-Tian Zhang; Zhong-Lin Yu


    AIM: To analyze the clinical and endoscopic features of Chinese patients with reflux esophagitis (RE).METHODS: A total of 1405 RE patients were analyzed retrospectively. Data on gender, age, presence/absence of H pylori infection and associated esophageal hiatal hernia were collected. Esophagitis was divided into different grades according to Los Angeles Classification.RESULTS: Of 18823 patients, 1405 were diagnosed as RE. The ratio of male to female patients was 1.75:1 (P < 0.01). The mean age of male and female patients was significantly different (P = 0.01). The peak age at onset of the disease was 40-60 years. According to Los Angeles Classification, there were significant differences in the age of patients with grades A and B compared to patients with grades C and D (P < 0.01). Two hundred and seventy-seven patients were infected with H pylori, the infection rate was low (P < 0.01). Complication of esophageal hiatal hernia was found to be significantly associated with the severity of esophagitis and age in 195 patients (P < 0.01). Esophageal mucosa damages were mainly located at the right esophageal wall.CONCLUSION: The peak age of onset of RE is 40-60 years and higher in males than in females. The mean age of onset of RE is lower in males than in females. The infection rate of H pylori is significantly decreased in patients with esophagitis. Old age and esophageal hiatal hernia are associated with more severe esophagitis. Right esophageal mucosal damage can occur more often in RE patients.

  11. Eosinophilic meningitis.

    Sawanyawisuth, Kittisak; Chotmongkol, Verajit


    Eosinophilic meningitis is defined by the presence of at least 10% eosinophils in the total cerebrospinal fluid (CSF) leukocyte count. Although there are several possible causes of eosinophils in the CSF, parasitic infection is the main cause. The three common parasites causing eosinophilic meningitis include Angiostrongylus cantonensis, Gnathostoma spinigerum, and Taenia solium. Even though these parasites are endemic in tropical countries, they are now spreading globally due to extensive traveling, and physicians worldwide should pay more attention to this condition. This chapter will review risk factors, clinical manifestations, and treatment of these three parasites.

  12. Comment on "Eosinophilic gastroenteritis: Clinical experience with 15 patients"

    Peter J Kerr


    @@ To the Editor: I recently read the paper by Chen et al.[1] published in your Journal. The paper shows that there have been a few cases where medications have caused eosinophilia. Clozapine is an antipsychotic medication that can cause eosinophilia. It is pointed out in your paper "The diagnostic criteria included... 5), exclusion of intestinal lymphoma, Crohn's disease or other tumors." Table 2 shows symptoms associated with eosinophilic gastroenteritis,which are very like those in Crohn's disease.

  13. Genetics of Eosinophilic Esophagitis


    are introduced, although diagnosis in adults is also com- mon. Disease remission typically occurs with treatment, which might include dietary exclusion...have tolerance to food antigens, as defined by sustained disease remission ,15 demonstrating theIL-13: IL-13 is a TH2 cell–derived interleukin capable...dimensional gel analysis and peptide sequencing or antibody arrays, to find both previously known and unknown proteins associated with a particular

  14. Clinical manifestations of Eosinophilic meningitis due to infection with Angiostrongylus cantonensis in children.

    Sawanyawisuth, Kittisak; Chindaprasirt, Jarin; Senthong, Vichai; Limpawattana, Panita; Auvichayapat, Narong; Tassniyom, Sompon; Chotmongkol, Verajit; Maleewong, Wanchai; Intapan, Pewpan M


    Eosinophilic meningitis, caused by the nematode Angiostrongylus cantonensis, is prevalent in northeastern Thailand, most commonly in adults. Data regarding clinical manifestations of this condition in children is limited and may be different those in adults. A chart review was done on 19 eosinophilic meningitis patients aged less than 15 years in Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand. Clinical manifestations and outcomes were reported using descriptive statistics. All patients had presented with severe headache. Most patients were males, had fever, nausea or vomiting, stiffness of the neck, and a history of snail ingestion. Six patients had papilledema or cranial nerve palsies. It was shown that the clinical manifestations of eosinophilic meningitis due to A. cantonensis in children are different from those in adult patients. Fever, nausea, vomiting, hepatomegaly, neck stiffness, and cranial nerve palsies were all more common in children than in adults.

  15. Clinical characteristics that distinguish eosinophilic organ infiltration from metastatic nodule development in cancer patients with eosinophilia


    Background When new space-occupying lesions are observed together with peripheral blood eosinophilia in patients diagnosed with cancer, the possibility of eosinophilic organ involvement should be differentiated from metastasis of primary cancer, since a misdiagnosis could lead to unnecessary chemotherapy. The aim of this study is to identify the clinical characteristics of eosinophilic organ involvement that distinguish it from distant metastasis in patients with primary cancer. Methods The medical records of 43 cancer patients who developed hepatic or pulmonary nodules with peripheral blood eosinophilia between January 2005 and February 2010 in the Asan Medical Center (Seoul) were reviewed. Eosinophilic infiltration and distant metastasis were identified on the basis of pathological findings and radiological features. Fisher’s exact test, χ2 test or Mann-Whitney test were used for statistical analysis. Results In total, 33 patients (76%) were diagnosed with eosinophilic infiltration, 5 (12%) with cancer metastasis and 5 (12%) had undetermined diagnoses. Compared to the patients with metastases, the patients with eosinophilic infiltration were significantly more likely to have serology indicating a parasitic infection, a history of eating raw food, high serum levels of total IgE, normal liver function, normal C-reactive protein levels, a normal erythrocyte sedimentation rate, and fewer and smaller nodules. The most common underlying malignancy in the eosinophilic organ infiltration group was stomach cancer. Physicians tended to neglect the eosinophilia in patients with a history of cancer. Conclusions Several clinical characteristics of eosinophilic organ infiltration distinguish it from cancer metastasis. Physicians should make greater efforts to determine the causes of organ involvement with peripheral blood eosinophilia, especially in cancer patients. PMID:22929225

  16. Histomorphological and Immunophenotypic Features of Pill-Induced Esophagitis.

    Ji Won Kim

    Full Text Available The aim of this study was to investigate histomorphological and immunophenotypic features in pill-induced esophagitis. We comparatively evaluated the histomorphological, immunophenotypic features of pill-induced esophagitis vs. reflux esophagitis, as well as clinical information and endoscopic findings. Fifty-two tissue pieces from 22 cases of pill-induced esophagitis, 46 pieces from 20 reflux esophagitis, and 16 pieces from 14 control samples were subjected to immunohistochemistry for inflammatory infiltrates (CD3 for T lymphocyte, CD20 for B lymphocyte, CD56 for NK cell, CD68 for macrophage, CD117 for mast cell and eosinophil chemotaxis-associated proteins (Erk, leptin, leptin receptor, pSTAT3, phospho-mTOR. As a result, Histomorphology showed that a diffuse pattern of dilated intercellular spaces was more frequently observed in pill-induced esophagitis, while reactive atypia and subepithelial papillary elongation were more often found in reflux esophagitis (P < 0.05, respectively. Interestingly, intraepithelial eosinophilic microabscess, intraepithelial pustule and diffuse pattern of dilated intercellular spaces were observed in 14% (3 cases, 9% (2 cases and 32% (7 cases of pill-induced esophagitis, respectively, but in no cases of reflux esophagitis. Regarding intraepithelial inflammatory infiltrates in pill-induced esophagitis, T lymphocytes were the most common cells, followed by eosinophil; 11 and 7 in one x400 power field, respectively. Intraepithelial pSTAT3-positive pattern was more frequently observed in pill-induced esophagitis than in reflux esophagitis, at 45% (10 cases versus 10% (2 cases, respectively (P < 0.05. Considering the distal esophageal lesion only, intraepithelial pustule, diffuse dilated intercellular spaces and stromal macrophages were more frequently found in distal pill-induced esophagitis, whereas reactive atypia and intraepithelial mast cells in reflux esophagitis (P < 0.05, respectively. In conclusion, diffuse


    P.V. Shumilov


    Full Text Available Within the structure of the inflammatory diseases of the gastrointestinal tract among children, one may single out a specific group of the chronic pathology of the digestive apparatus — eosinophilic diseases of the gastrointestinal tract and gastroenterological manifestations of the food allergy. The food allergy is characterized by the pathologic immune reactivity among commonly genetically predisposed people. Depending on the peculiarities of the immune reactivity of a sick person and the nature of the allergen, the allergic reaction may evolve with primary involvement of the different mechanisms or th2 IgE-mediated, or Th1 non-igecmediated. Clinical picture of the food allergy is the manifestation of the immunoinflammatory process caused by the interaction of the food antigens with the structures of the lymphoid tissues associated with the mucous membranes of this or that target organ. The morphological basis of the clinical picture is mostly immune inflammation with primarily eosinophilic tissue infiltration. The eosinophilic lesions of the gastrointestinal tract include eosinophilic esophagitis, eosinophilic gastroenteritis, eosinophilic enteritis, eosinophilic colitis, eosinophilic proctitis and other states. During the food allergy each of the clinical forms of the gastrointestinal tract lesion has its own peculiarities with regards to the primary development mechanism, age of manifestation, character of the run and behaviour tactics.Key words: eosinophilic inflammation, esophagitis, gastroenteritis, colitis, food allergy.

  18. Clinical significance of expression of Klotho and β-Catenin in esophageal squamous cell carcinoma



    Objective To investigate the clinical significance of expression of Klotho and β-Catenin in esophageal carcinoma. Methods Tissue microarray technique and immunohistochemistry were used to examine Klotho and β-Catenin expression in 75 esophageal carcinoma tissue


    Vladan Ćosić


    Full Text Available Inhaled glucocorticosteroids are the most efficient anti-inflamatory drugs used in asthma treatment that can bring the improvement of clinical symptoms as well as lung function. Eosinophils (Eo are the key efector cells in asthmatic inflammation, and determination of their number and concentration of mediators which can bring about eosinophilic activation- interleukin-5 (IL-5 would contribute to the evaluation of anti-inflammatory treatment effects in asthma patients.The aim of this study was to compare clinical parameters and eosinophilic inflammation parameters in patients with asthma, after 4-week treatment with fluticasone-propionate (FP in a daily dose of 500 μg.The study involved 39 patients with bronchial asthma as well as 17 healthy subjects (controls. Asthma symptom scores, FEV1, FEV1/FVC, total number of Eo in peripheral blood and IL-5 concentracion in serum were measured in all subjects, before and after FP 500 treatment. There was a significant decrease in asthma symptom scores (p<0.001 and improvement of FEV1 and FEV1/FVC (p<0.05 after FP 500 treatment.There was also a statistically significant negative correlation beetwen asthma symptom score and FEV1 before and after the treatment (r=-0,415, p<0,01; r=-0,346, p<0,05. The concentration of eosinophilic inflammatory parameters (Eo, IL-5 was significantly reduced after the treatment (p<0.05 in groups of patients with larger number of eosinophiles prior to the therapy.Besides lung function normalisation and improvement of disease symptoms after the treatment, there were higher concentrations of eosinophilic inflammatory parameters that point to persistant inflammation of airways during well-controlled asthma. It is necessary to constantly compare the symptoms of desease, lung function, severity of desease and level of inflammation parameters in order to assess the treatment effects of inhaled glycocortico-steroids.

  20. Clinical implications of blood eosinophil count in patients with non-asthma–COPD overlap syndrome COPD

    Song JH


    Full Text Available Jin Hwa Song,1 Chang-Hoon Lee,1 Jin Woo Kim,2 Won-Yeon Lee,3 Ji Ye Jung,4 Joo Hun Park,5 Ki Suck Jung,6 Kwang Ha Yoo,7 Yong Bum Park,8 Deog Keom Kim9 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Hospital, 2Division of Pulmonology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, 3Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Gangwon-do, 4Division of Pulmonology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, 5Department of Pulmonary and Critical Care Medicine, Ajou University School of Medicine, Suwon, 6Division of Pulmonary Medicine, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University Medical School, Anyang, Gyeonggi-do, 7Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, 8Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Kangdong Sacred Heart Hospital, 9Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Republic of Korea Background: Recent studies that assessed the relevance of the blood eosinophil count as a biomarker in patients with COPD may have overestimated it because they included patients with asthma–COPD overlap syndrome (ACOS. We investigated the clinical implications of the blood eosinophil count in patients with non-ACOS COPD.Patients and methods: From a Korean COPD Subtype Study (KOCOSS cohort, we selected patients with non-ACOS COPD after excluding ACOS patients according to Spanish criteria. Clinical characteristics and the incidence of moderate-to-severe exacerbation were compared

  1. Eosinophilic Endotype of Asthma.

    Aleman, Fernando; Lim, Hui Fang; Nair, Parameswaran


    Asthma is a heterogeneous disease that can be classified into different clinical endotypes, depending on the type of airway inflammation, clinical severity, and response to treatment. This article focuses on the eosinophilic endotype of asthma, which is defined by the central role that eosinophils play in the pathophysiology of the condition. It is characterized by elevated sputum and/or blood eosinophils on at least 2 occasions and by a significant response to treatments that suppress eosinophilia. Histopathologic demonstration of eosinophils in the airways provides the most direct diagnosis of eosinophilic asthma; but it is invasive, thus, impractical in clinical practice.

  2. Eosinophilic fasciitis*

    Lamback, Elisa Baranski; Resende, Fernanda Simões Seabra; Lenzi, Thiara Cristina Rocha


    Eosinophilic fasciitis is a rare sclerodermiform syndrome of unknown etiology. It is characterized by the thickening of the muscular fascia and subcutaneous tissue, with a variable infiltration of eosinophils. Peripheral eosinophilia, poly or monoclonal hypergammaglobulinemia and increased erythrocyte sedimentation rate can be seen. Clinical features begin acutely, with local edema and a painful and symmetrical stiffening of the limbs, progressing rapidly to fibrosis, which can limit joint movements. Some cases have a history of strenuous physical exercise or trauma. The diagnosis is confirmed by a deep skin biopsy. Glucocorticoids in high doses is the treatment of choice. We report a typical eosinophilic fasciitis case with peripheral eosinophilia and dramatic response to pulse therapy with methylprednisolone.

  3. Clinical aspects of eosinophilic meningitis and meningoencephalitis caused by Angiostrongylus cantonensis, the rat lungworm.

    Murphy, Gerald S; Johnson, Stuart


    Angiostrongylus Eosinophilic Meningitis is caused by human infection with larvae of the rat lungworm, Angiostrongylus cantonensis. The clinical presentation includes a spectrum of disease, from meningitis through radiculitis, cranial nerve abnormalities, ataxia, encephalitis, coma, and rarely death. The condition is diagnosed by recognizing the triad of: the clinical syndrome, eosinophils in the cerebrospinal fluid or blood, and exposure history. A history of eating raw or poorly cooked snails is classic, but ingestion of other intermediate hosts or unwashed produce (such as lettuce) harboring hosts is not uncommon. Several serologic tests exist but none has yet been fully validated. There is good evidence that a 2 week course of high dose corticosteroids shortens the duration and severity of symptoms. There is somewhat weaker evidence that albendazole reduces symptoms. The combination of prednisolone and albendazole is being used more commonly for treatment. Some suggestions for future research are given.

  4. MicroRNA profiling in mucosal biopsies of eosinophilic esophagitis patients pre and post treatment with steroids and relationship with mRNA targets.

    Shaolei Lu

    Full Text Available BACKGROUND: The characterization of miRNAs and their target mRNAs involved in regulation of the immune process is an area of intense research and relatively little is known governing these processes in allergic inflammation. Here we present novel findings defining the miRNA and mRNA transcriptome in eosinophilic esophagitis (EoE, an increasing recognized allergic disorder. METHODS: Esophageal epithelial miRNA and mRNA from five paired biopsies pre- and post-treatment with glucocorticosteroids were profiled using Taqman and Affymetrix arrays. Validation was performed on additional paired biopsies, untreated EoE specimens and normal controls. Differentially regulated miRNAs and mRNAs were generated, within which miRNA-mRNA target pairs with high predicted confidence were identified. RESULTS: Compared to the post-glucocorticoid treated esophageal mucosa, of all the 377 miRNA sequences examined, 32 miRNAs were significantly upregulated and four downregulated in the pre-treated biopsies. MiR-214 was the most upregulated (150 fold and miR-146b-5b, 146a, 145, 142-3p and 21 were upregulated by at least 10 fold. Out of 12 miRNAs chosen for validation by qRT-PCR, five (miR-214, 146b-5p, 146a, 142-3p and 21 were confirmed and 11 shared the same trend. When the expression of the 12 miRNAs in the EoE mucosa was compared to unrelated normal mucosa, six (miR-214, 146b-5p, 146a, 21, 203, and 489 showed similar significant changes as in the paired samples and 10 of them shared the same trend. In the same five pairs of samples used to profile miRNA, 311 mRNAs were down-regulated and 35 were up-regulated in pre-treated EoE mucosa. Among them, 164 mRNAs were identified as potential targets of differentially regulated miRNAs. Further analysis revealed that immune-related genes, targeted and non-targeted by miRNAs, were among the most important genes involved in the pathogenesis of EoE. CONCLUSIONS: Our findings add to the accumulating body of data defining a

  5. Eosinophilic granuloma of the temporal bone- its clinical manifestations and management

    Kirtane Jyotsna


    Full Text Available Eosinophilic granuloma is a variety of Histiocytosis-X. Its etio-logy is unknown. When it involves the temporal bone it may mimic chronic otitis media, or a mastoid abscess, very often leading to an erroneous diagnosis. Its X-ray appearance and histopathology are characteristic. Infiltration with eosinophils and histiocytes is a constant feature. Very good results are achieved with surgery accompanied by radiotherapy. In this series of 3 patients, one pa-tient presented with facial paralysis and another one with bilateral post-auricular swellings. The first 2 cases were diagnosed only after surgery and histopathological examination of the tissue removed, while the third case was diagnosed pre-operatively on clinical and radiological findings.

  6. Eosinophilic fasciitis in a military recruit: MRI evaluation with clinical correlation

    Liou, Chang-Hsien; Juan, Chun-Jung; Chen, Cheng-Yu. [Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan (Taiwan); Huang, Guo-Shu [Department of Radiology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan (Taiwan); Department of Radiology, Tri-Service General Hospital, 325, Sec. 2, Neihu 114, Cheng-Kung Road, Taipei, Taiwan (Taiwan); Taylor, John A.M. [Department of Diagnosis, New York Chiropractic College, Seneca Falls, New York (United States); Gao, Hong-Wei [Department of Pathology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan (Taiwan)


    Eosinophilic fasciitis (EF) is an uncommon connective tissue disease. We report a patient with EF who presented with episodic swelling and stiffness of his legs and forearms in combination with peripheral eosinophilia. Imaging studies of the legs and forearms, including computed tomography (CT) and magnetic resonance imaging (MRI), clearly demonstrated the characteristic finding of fascial thickening. The complete clinical imaging and pathological findings are described in this report. Cross-sectional imaging is useful in diagnosing EF and in the appropriate clinical scenario may be helpful in differentiating EF from other connective tissue diseases. (orig.)

  7. Eosinophilic oesophagitis

    Nielsen, Rasmus Gaardskjær; Husby, Steffen


    Eosinophilic oesophagitis is characterised by age-dependent symptoms mimicking gastrooesophageal reflux disease, a distinct endoscopic appearance and a histological picture with extensive infiltration of eosinophils in the oesophageal mucosa. Eosinophilic oesophagitis is more frequently seen in m...

  8. Translational Research on Esophageal Cancer: From Cell Line to Clinic

    J.J. Boonstra (Jurjen)


    textabstractWorldwide esophageal cancer is a signifi cant and an increasing health problem. In 2005, there were 497,700 new cases, and the prevalence is expected to increase by approximately 140% by 2025. Esophageal squamous cell carcinoma (ESCC) accounts for most of the cases of esophageal cancer w

  9. Esophageal motion characteristics in thoracic esophageal cancer: Impact of clinical stage T4 versus stages T1-T3

    Yuta Kobayashi, MS


    Conclusions: The EM and the ITV margins in cT4 were significantly smaller than those in cT1-T3. The NM and the ITV margins of abdominal LNs were much larger than those of cervicothoracic LNs and the esophagus. In clinical radiation therapy planning for esophageal cancer, we should take cT stage into consideration.

  10. Dynamic CT findings of eosinophilic hepatic abscess and its clinical course

    Cho, Dae Hyoun; Chang, Jae Chun; Seong, Ki Ho [Yeungnam Univ. School of Medicine, Taegu (Korea, Republic of)


    To evaluate dynamic CT features and its clinical courses of eosinophilic hepatic abscess. Two-phase dynamic CT findings and the clinical courses of 13 pathologically proven cases of eosinophilic abscess were reviewed. All patients showed peripheral eosinophilia, and diagnoses were confirmed by ultrasound-guided biopsy(n=9) or operation(n=4). In two of the four patients who underwent segmental hepatectomy, worms of the species fasciola hepatica were detected. Follow-up CT scans after treatment with antibiotics or praziquantel were available in seven and eitht patients, respectively. All hepatic lesions were found in a subcapsular location or in contact with Glisson's capsule around the bile duct Arterial-dominant phase CT(n=11) demonstrated clusters of ill-defined low density masses without rim enhancement. Late-phase CT(n=13) more clearly depicted clustering lesions with enhancing rims and diminyution of the low-density area. Follow-up CT scans after treatment with antibiotics(n=7) showed no change in the lesions in three patients and slight shrinkage of the main mass with additional new lesions in four. On CT scans of nine patients performad after praziquantel therapy, hepatic masses were seen in all patients to be very slightly smaller after improvement of peripheral hypereosinophilia. Two-phase dynamic CT features appear to be helpful for the diagnosis of eosinophilic hepatic abscess in patients with peripheral eosinophilia. Parasitic infestation by Fasciola hepatica for example, is the presumed cause of such abscesses, though further studies are required.

  11. [Pemphigus with eosinophilic spongiosis].

    Pons, S; Ortíz Medina, A


    A bibliographic review of a new subject-pemphigus with eosinophilic spongiosis accomplished: Three clinical courses are recognized: a) pemphigus in its initial phase, b) pemphigus markedly seborrheic, which presents during its evolution, some morphologic anomalies, c) pemphigus that appear like an authentic Duhring in its initial phase and during part of its evolution. On studying the histopathology three aspects are observed; 1) pure eosinophilic spongiosis with two modalites: diffuse or vesiculate; 2) mixed eosinophilic spongiosis and, 3) alternate eosinophilic spongiosis. The review report the study of this new observation and discusses the nosological situation as well as its pausible causation.

  12. Eosinophil-rich trichoblastic carcinoma with aggressive clinical course in a young man.

    Toberer, Ferdinand; Rütten, Arno; Requena, Luis; Kazakov, Dmitry V; Enk, Alexander; Hartschuh, Wolfgang; Haenssle, Holger A


    We present the case of a 35-year-old man who developed a follicular differentiated cutaneous carcinoma with an eosinophil-rich infiltrate and an aggressive clinical behavior. After an in-depth histopathological investigation the diagnosis of trichoblastic carcinoma was made. Over the course of the disease the patient developed a cutaneous in-transit metastasis as well as an axillary lymph node metastasis 18 months after the excision of the primary tumor on his back. Based on a literature review we discuss the different concepts behind the term "trichoblastic carcinoma" and we summarize the clinical and histological details of previously reported cases. Furthermore, we focus on the phenomenon of tumor-associated eosinophilia. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Upper gastrointestinal bleeding caused by severe esophagitis: a unique clinical syndrome.

    Guntipalli, Prathima; Chason, Rebecca; Elliott, Alan; Rockey, Don C


    We have recognized a unique clinical syndrome in patients with upper gastrointestinal bleeding who are found to have severe esophagitis. We aimed to more clearly describe the clinical entity of upper gastrointestinal bleeding in patients with severe esophagitis. We conducted a retrospective matched case-control study designed to investigate clinical features in patients with carefully defined upper gastrointestinal bleeding and severe esophagitis. Patient data were captured prospectively via a Gastrointestinal Bleeding Healthcare Registry, which collects data on all patients admitted with gastrointestinal bleeding. Patients with endoscopically documented esophagitis (cases) were matched with randomly selected controls that had upper gastrointestinal bleeding caused by other lesions. Epidemiologic features in patients with esophagitis were similar to those with other causes of upper gastrointestinal bleeding. However, hematemesis was more common in patients with esophagitis 86% (102/119) than in controls 55% (196/357) (p bleeding than those without cirrhosis. We have described a unique clinical syndrome in patients with upper gastrointestinal bleeding who have erosive esophagitis. This syndrome is manifest by typical clinical features and is associated with favorable outcomes.

  14. Cisplatin-Induced Eosinophilic Pneumonia

    Hideharu Ideguchi


    Full Text Available A 67-year-old man suffering from esophageal cancer was admitted to our hospital complaining of dyspnea and hypoxemia. He had been treated with cisplatin, docetaxel, and fluorouracil combined with radiotherapy. Chest computed tomography revealed bilateral ground-glass opacity, and bronchoalveolar lavage fluid showed increased eosinophils. Two episodes of transient eosinophilia in peripheral blood were observed after serial administration of anticancer drugs before the admission, and drug-induced lymphocyte stimulation test to cisplatin was positive. Thus cisplatin-induced eosinophilic pneumonia was suspected, and corticosteroid was effectively administered. To our knowledge, this is the first reported case of cisplatin-induced eosinophilic pneumonia.

  15. Eosinophilic Oesophagitis in Infants and Children in the Region of Southern Denmark: A Prospective Study of Prevalence and Clinical Presentation

    Dalby, Kasper; Nielsen, Rasmus G; Kruse-Andersen, Soren


    OBJECTIVE:: Eosinophilic oesophagitis (EE) is a clinical entity characterised by a set of symptoms and eosinophilic infiltration of the oesophageal epithelium. Recent reports indicate that EE is increasingly diagnosed in paediatric patients. We aimed to evaluate the epidemiology of paediatric EE...... and 16 years of age, a yearly incidence of EE of 0.16/10,000 was estimated. CONCLUSION:: We report a European prospective study of EE. It was documented in 6 of 78 patients with symptoms of GERD corresponding to an annual incidence of 0.16/10,000 infants and children....


    Maria João Candeias dos Santos Sousa


    Conclusion: EoE is an emerging disease with diagnostic criteria and treatment options proved to be effective. Early diagnosis is important to prevent complications. A less invasive biomarker for diagnosis and monitoring of EoE has not yet been found. A multidisciplinary team is importante to manage these patients.

  17. EoE (Eosinophilic Esophagitis)

    ... allergic inflammatory disease of the esophagus (the tube connecting the mouth to the stomach). It occurs when ... such as rhinitis, asthma, and/or eczema. Certain families may have an inherited tendency to develop EoE. ...

  18. Esofagitis eosinofílica por sensibilización a proteínas de leche de cabra y oveja Eosinophilic esophagitis due to allergy to sheep and goat milk proteins

    M. Armisén


    Full Text Available La esofagitis eosinofílica, entidad caracterizada por la infiltración de la mucosa esofágica por más de 20 eosinófilos por campo de gran aumento, se suele presentar en forma de disfagia intermitente de larga evolución, pudiendo estar asociada a sensibilización alérgica a aeroalérgenos y/o alimentos. Presentamos el caso de un varón con clínica de disfagia intermitente coincidiendo con la toma de quesos curados de oveja y cabra que precisó asistencia urgente tras la impactación de un comprimido de ibuprofeno a 30 cm de la arcada dentaria. El estudio practicado demostró la existencia de estenosis en el esófago a ese nivel con infiltración eosinofílica difusa y sensibilización a proteínas de la leche de cabra, oveja y vaca, con especial relevancia para la IgG bovina, lactoferrina y albúmina sérica. Tras tratamiento con fluticasona deglutida y medidas de evitación se consiguió la resolución del cuadro clínico y la desaparición de los eosinófilos en la mucosa.Eosinophilic esophagitis is an inflammatory disease of the esophagus characterized by the presence of high numbers of eosinophils in the esophageal mucosal layer (> 20 high-power field. It is uncommon in adults but in such cases intermittent dysphagia and food impaction are the most common presenting symptoms. We report the case of a male with long-standing intermittent dysphagia after eating selected goat and sheep cheese types, who required medical help following the impaction of an ibuprofen pill in the esophagus. A biopsy demonstrated the presence of eosinophilic inflammation, and allergy testing showed specific IgE against proteins in the milk of goats and sheep. Topical steroid therapy with oral fluticasone, and the elimination of these dairy products from the diet induced complete symptom resolution, and biopsy specimens taken 4 months later showed no eosinophils.

  19. Clinical and epidemiologic variations of esophageal cancer in Tanzania

    Jaime V Gabel; Robert M Chamberlain; Twalib Ngoma; Julius Mwaiselage; Kendra K Schmid; Crispin Kahesa; Amr S Soliman


    AIM: To estimate the incidence of esophageal cancer(EC) in Kilimanjaro in comparison to other regions in Tanzania. METHODS: We also examined the clinical, epidemiologic, and geographic distribution of the 1332 EC patients diagnosed and/or treated at Ocean Road Cancer Institute(ORCI) during the period 2006-2013. Medical records were used to abstract patient information on age, sex, residence, smoking status, alcohol consumption, tumor site, histopathologic type of tumor, date and place of diagnosis, and type and date of treatment at ORCI. Regional variation of EC patients was investigated at the level of the 26 administrative regions of Tanzania. Total, age- and sex-specific incidence rates were calculated. RESULTS: Male patients 55 years and older had higher incidence of EC than female and younger patients. Of histopathologically-confirmed cases, squamous-cell carcinoma represented 90.9% of histopathologic types of tumors. The administrative regions in the central andeastern parts of Tanzania had higher incidence rates than western regions, specifically administrative regions of Kilimanjaro, Dar es Salaam, and Tanga had the highest rates. CONCLUSION: Further research should focus on investigating possible etiologic factors for EC in regions with high incidence in Tanzania.

  20. Chemoradiotherapy for superficial (sm{sub 2}/sm{sub 3}) esophageal cancer. Chemoradiotherapy for clinical stage I esophageal cancer

    Muro, Kei; Arai, Tatsuhiro; Hamanaka, Hisanao [National Cancer Center, Tokyo (Japan). Hospital


    We studied the clinical outcome of chemoradiotherapy for clinical Stage I squamous cell carcinoma of the esophagus. Seventy-one patients without possibility of cure by endoscopic mucosal resection (EMR) were analyzed. Patients received continuous infusion of 5FU at a dose of 700 mg/m{sup 2}/24 hours on days 1 to 4, combined with CDDP at a dose of 70 mg/m{sup 2} on day 1, and concurrent radiation therapy at a dose of 30 Gy in 15 fractions over 3 weeks. This schedule was repeated twice every 4 weeks, for a total radiation dose of 60 Gy. The 66 patients (93%) achieved a complete response. Toxicities were generally mild, but late radiation morbidity was relatively frequent. However, no toxicities interfering with function were seen. With a median follow-up duration of 23 months, the 1, 2 and 3-year survival rates were 97%, 90% and 80%, respectively. This survival rate compared with that obtained by ordinary surgery with three-field lymph node dissection. Chemoradiotherapy for clinical Stage I esophageal cancer is a promising method, because of its safety and its being a curative therapy. We should present this therapy as well as surgery as an option of possibly curative therapy to patients with clinical Stage I esophageal cancer. (author)

  1. Eosinophilic cellulitis and dermographism.

    Nguyen, Nathalie Q; Ma, Linglei


    A 26-year-old man presented with a history of intermittent erythematous plaques on his hands and legs. A peripheral blood eosinophilia was noted. Histopathologic examination showed numerous eosinophils and characteristic flame figures. The clinical presentation and histopathologic alterations are consistent with the diagnosis of Wells' syndrome, which is also known as eosinophilic cellulitis. Wells' syndrome is a rare condition of unclear etiology. We discuss its diagnosis and possible association with other conditions that manifest peripheral eosinophilia.

  2. The expression and clinical significance of metastasis suppressor gene and matrix metalloproteinase-2 in esophageal squamous cell of carcinoma.

    Guo, Xiao-Qi; Li, Xing-Ya


    To investigate the expression and clinical significance of metastasis suppressor gene and matrix metalloproteinase-2 in esophageal squamous cell of carcinoma. choose 30 cases of specimens of esophageal squamous cell carcinoma which are removed in surgery and confirmed by pathology and 30 cases of specimens of normal esophageal mucosa. Use immunohistochemistry SP method to detect the expression of nm23-H1, MMP-2 protein in esophageal squamous cell carcinoma and normal esophageal mucosal. The positive rate of nm23-H1 protein in esophageal squamous cell carcinoma was 43.3% (13/30), while that in normal esophageal mucosa was 100% (30/30), which has a significant difference between them (χ2=22. 083, P0.05), but it was related to the degree of tumor differentiation, depth of invasion and lymph node metastasis (P0.05); The expression of nm23-H1 and MMP-2 in esophageal squamous cell carcinoma was negatively correlated. nm23-H1 and MMP-2 have played a role in the development of esophageal cancer, which can promote the occurence of distant metastasis; The loss of expression of nm23-H1 may be related to cut end residual cancer; nm23-H1 and MMP-2 may be as an indicator for esophageal cancer metastasis and prognosis.

  3. Eosinophilic esophagitis in adults, an emerging cause of dysphagia: Description of 9 cases Esofagitis eosinofílica del adulto, causa emergente de disfagia: Presentación de 9 casos

    A. J. Lucendo Villarín


    Full Text Available Background: eosinophilic esophagitis is a rare condition mainly affecting children, although the number of cases reported in adults is on the increase. It is characterized by intense infiltration of eosinophilic leukocytes in the esophageal mucosa, without involvement of other sections of the alimentary canal. Material and methods: over the past year, following the performance of endoscopies and biopsies, our service identified nine patients who were diagnosed with suffering from this disorder. Each patient sought medical help for episodes of long-term, self-limited dysphagia or food impaction in the alimentary canal. Results: endoscopy revealed esophageal stenosis in the form of simultaneous contraction rings or regular stenosis. In six cases, the manometric study showed a nonspecific motor disorder of severe intensity affecting the esophageal body, and another patient had a disorder characterized by the presence of simultaneous waves and secondary peristaltic waves in the three thirds of the organ. These disorders are presumably due to eosinophilic infiltration of the muscular layer or ganglionar cells of the esophagus, and account for symptoms in these patients. Although the etiopathogenesis of this illness is uncertain, it is clearly an immunoallergic manifestation. Conclusions: as the number of diagnosed cases is on the increase, eosinophilic esophagitis is in adults a specific entity within the differential diagnosis of dysphagia in young males with a history of allergies. Eosiniphilic esophagitis responds in a different number of ways to therapies used. We successfully used fluticasone propionate, a synthetic corticoid applied topically, which proved to be efficient in the treatment of this illness by acting on the pathophysiological basis of the process. It does not have any adverse effects, thus offering advantages over other therapies such as systematic corticoids or endoscopic dilations.Introducción: la esofagitis eosinofílica es

  4. Eosinophilic Gastrointestinal Disorders%嗜酸性粒细胞性消化道炎

    周细平; 李宏


    原发性嗜酸性粒细胞性消化道炎(eosinophilic gastrointestinal disease,EGID)是以消化道嗜酸性粒细胞异常浸润为特征的炎症性疾病.该病可以累及消化道全长或某一部分,包括嗜酸性粒细胞性食管炎(eosinophilic esophagitis,EE)、胃炎、胃肠炎(eosinophilic gastroenteritis,EG)、小肠炎、结肠炎及直肠炎.在过去的几十年中,文献报道的发病率逐渐增高.其病因及发病机制并不清楚,大多数研究结果都提示,吸入和食物过敏反应可能诱发该病的发作.其临床主要表现为各种消化道症状,无特异性,诊断标准未得到一致公认,多强调以病理为主的综合诊断,同时要除外其他继发性消化道嗜酸性粒细胞增多疾病.治疗以控制饮食和糖皮质激素为主,近年出现针对发病机制的生物制剂治疗,但尚缺少充分的循证医学依据.%Primary eosinophilic gastrointestinal disorders are inflammatory disease characterized by the infiltration of gastrointestinal tract with eosinophil in the absence of known causes for eosinophilia such as parasitic infections and so on. The disorders can affect whole or part of the gastrointestinal tract, and include eosinophilic esophagitis, eosinophilic gastritis, eosinophilic gastroenteritis, eosinophilic enteritis, eosinophilic colitis and eosinophilic rectitis. In the past decades, the reported prevalence of these disorders is increasing. The etiology and pathogenesis is unclear, and many researches reveal that aeroallergen and food allergen may induce the relapse of these disorders. The clinical presentation can include all kinds of gastrointestinal symptom. Diagnosis of these disorders is dependent on the clinical presentation, endoscopic findings and most importantly, histological confirmation, and excluding the known causes for eosinophilia.Dietary modifications and corticosteroids are first-line treatment. Recent years, there are some biological agents aimed to the pathogenesis

  5. Selected feline eosinophilic skin diseases.

    Power, H T; Ihrke, P J


    Eosinophilic plaque and mosquito-bite dermatitis are recognized hypersensitivity reactions. The pathogenesis of eosinophilic granuloma and indolent ulcer are not as clearly understood. Each of these syndromes is distinctive from a clinical and histopathologic view point. Accurate diagnosis depends on history, physical findings, and histopathologic evaluation. Understanding of feline dermatology will be furthered by including these syndromes in a broader grouping that encompasses all the feline eosinophilic dermatoses.

  6. Clinical analysis of childhood eosinophilic gastroenteritis in two cases%嗜酸性胃肠炎2例临床分析

    唐运萍; 徐俊杰; 魏绪霞; 李华


    Objective To explore the clinical characteristics of eosinophilic gastroenteritis. Methods The clinical data of 2 children with eosinophilic gastroenteritis was retrospectively analyzed. Results Eosinophilia was found in both cases and path-ological examination indicated eosinophil infiltration in intestinal mucosa. The clinical symptoms were improved after hypoaller-genic diet, amino acid formula and anti-allergy treatment. Conclusions Eosinophilic gastroenteritis is characterized by eosino-phil infiltration with unknown pathogenic factor leading the treatment of eosinophilic gastroenteritis lacking of sound evidence.%目的:探讨嗜酸性胃肠炎的临床特点。方法回顾性分析2例嗜酸性胃肠炎患儿的临床资料。结果2例患儿均有外周血嗜酸性粒细胞明显增高,肠黏膜病理检测示嗜酸粒细胞浸润,经低敏膳食和氨基酸配方粉喂养及抗过敏治疗,症状即明显好转。结论嗜酸性胃肠炎以嗜酸性粒细胞浸润为其主要特征,致病因素不明确,治疗缺乏循证医学依据。

  7. Eosinophilic cystitis

    P.G. Nikkels; T.P.V.M. de Jong (Tom); P.C.M.S. Verhagen (Paul)


    textabstractWe describe four cases of eosinophilic cystitis in whom no specific cause could be found, and review the literature. Complaints at presentation included urgency, frequency, abdominal pain, and haematuria. In three patients the symptoms and ultrasound picture

  8. [Clinical aspects of the post-caustic esophageal stenosis on 116 cases].

    Mihalache, Carmen; Mihalache, S


    116 cases of post-caustic esophageal stenosis hospitalized in the Emergency Surgical Clinic of Iaşi during the period 1982-2004 have been analyzed. The patients' ages, the 4th decade of age (24.13%) prevailed. The alkaline substances prevailed (84.48%). Eight patients benefited from an endoscopic examination in the 15th day from the injury, and presented lesion degree 1-2 C. Progressive dysphagia, retrosternal pain and weight loss-symptoms were in all cases. The most of the patients (65.50%) came for a medical consultation within the first 6 months. The diagnosis and localizing the esophageal stenosis were based on the endoscopic examination and radiology. The single or double stenosis esophagus prevailed. The corrosive substances represent a frequent cause of benign esophageal stenosis.

  9. Clinical significance of GLUT-1 expression in patients with esophageal cancer treated with concurrent chemoradiotherapy.

    Chiba, Itaru; Ogawa, Kazuhiko; Morioka, Takamitsu; Shimoji, Hideaki; Sunagawa, Nao; Iraha, Shiro; Nishimaki, Tadashi; Yoshimi, Naomi; Murayama, Sadayuki


    This study aimed to investigate whether glucose transporter-1 (GLUT-1) expression in a pretreatment esophageal cancer biopsy was predictive of clinical outcomes in patients with esophageal cancer undergoing concurrent chemoradiotherapy (CRT). A total of 25 patients with esophageal cancer treated with concurrent CRT were reviewed. Radiotherapy was administered up to total doses of 40-66.6 Gy (median 66.6 Gy) with a single fraction of 1.8-2 Gy. Regarding chemotherapy, cisplatin (80 mg/m(2) on day 1) and 5-fluorouracil (800 mg/m(2) on days 2-6) were used concurrently with radiotherapy, every 3-4 weeks for a total of 1-2 courses. Tissue samples from esophageal carcinoma were obtained from the 25 patients by biopsy prior to concurrent CRT, and a semiquantitative analysis of GLUT-1 expression was performed using immunohistochemical staining. High GLUT-1 expression was observed in 7 of 25 (28%) patients, and GLUT-1 expression was significantly correlated with clinical T stage (p=0.0454), clinical N stage (p=0.0324) and initial response to CRT (p=0.0185). Patients with a high GLUT-1 expression had significantly poorer local control (LC) (5-year LC 28.6%) than those with a low expression (5-year LC 73.4%, pGLUT-1 and the number of chemotherapy courses were independent prognostic factors for LC. Patients with a high GLUT-1 expression had significantly lower recurrence-free survival (RFS) compared to those with a low GLUT-1 expression (p=0.0405). Multivariate analysis revealed that GLUT-1, the number of chemotherapy courses and clinical M stage were independent prognostic factors for RFS. GLUT-1 expression was significantly correlated with clinical T stage, clinical N stage and initial response to concurrent CRT, and was predictive of LC and RFS for patients with esophageal cancer treated with concurrent CRT.

  10. Histopathologic diagnosis of eosinophilic conditions in the gastrointestinal tract.

    Hurrell, Jennifer M; Genta, Robert M; Melton, Shelby D


    Eosinophils, a constitutive component of the columnar-lined gastrointestinal tract, play an essential role in allergic responses and parasitic infections. The tissue density of these cells also increases in a variety of conditions of uncertain etiology. With the exception of the esophageal squamous epithelium, in which no eosinophils are normally present, the population of normal eosinophils in the remainder of the luminal gut is poorly defined. Therefore, histopathologists must rely on their subjective judgment to determine when a diagnosis of eosinophilic gastritis, enteritis, or colitis should be rendered. Eosinophilic esophagitis is currently the best defined and most studied eosinophilic condition of the digestive tract; therefore, the confidence in accurate diagnosis is increasing. In contrast, the characteristic clinicopathologic features of eosinophilic conditions affecting other parts of the digestive tract remain somewhat elusive. This review was designed to present pathologists with simple and practical information for the biopsy-based histopathologic diagnosis of eosinophilic esophagitis, gastritis, enteritis, and colitis. It was prepared by critically reviewing more than 200 articles on the topic, along with incorporating evidence accumulated through our own collective experience. We anticipate that by increasing pathologists' confidence in reporting these abnormal but often nameless eosinophilic infiltrates, we can help better define and characterize their significance.

  11. Eosinophilic annular erythema in childhood - Case report*

    Abarzúa, Alvaro; Giesen, Laura; Silva, Sergio; González, Sergio


    Eosinophilic annular erythema is a rare, benign, recurrent disease, clinically characterized by persistent, annular, erythematous lesions, revealing histopathologically perivascular infiltrates with abundant eosinophils. This report describes an unusual case of eosinophilic annular erythema in a 3-year-old female, requiring sustained doses of hydroxychloroquine to be adequately controlled. PMID:27579748

  12. Clinical Study of Time Optimizing of Endoscopic Photodynamic Therapy on Esophageal and/or Gastric Cardiac Cancer


    Stage I Esophageal Adenocarcinoma; Stage II Esophageal Adenocarcinoma; Stage III Esophageal Adenocarcinoma; Stage I Esophageal Squamous Cell Carcinoma; Stage II Esophageal Squamous Cell Carcinoma; Stage III Esophageal Squamous Cell Carcinoma

  13. Eosinophilic granuloma of the skull base: patient with unique clinical moreover, radiographic presentation.

    Hosein Dalili


    Full Text Available This case report presents an eight-year-old girl having periauricular swelling and severe pain during mouth opening on the right-side temporomandibular joint (TMJ. CBCT showed extensive destruction of the base of the skull and the roof of the glenoid fossa on the right side. The findings based on CT and MRI images with and without contrast are discussed herein. This report highlights a skull base eosinophilic granuloma that mimics TMJ disorder and the importance of proper evaluation of CBCT images to make an early diagnosis.

  14. Esophageal replacement.

    Kunisaki, Shaun M; Coran, Arnold G


    This article focuses on esophageal replacement as a surgical option for pediatric patients with end-stage esophageal disease. While it is obvious that the patient׳s own esophagus is the best esophagus, persisting with attempts to retain a native esophagus with no function and at all costs are futile and usually detrimental to the overall well-being of the child. In such cases, the esophagus should be abandoned, and the appropriate esophageal replacement is chosen for definitive reconstruction. We review the various types of conduits used for esophageal replacement and discuss the unique advantages and disadvantages that are relevant for clinical decision-making. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Eosinophilic myocarditis: case series and literature review.

    Sohn, Kyoung-Hee; Song, Woo-Jung; Kim, Byung-Keun; Kang, Min-Koo; Lee, Suh-Young; Suh, Jung-Won; Yoon, Yeonyee E; Kim, Sae-Hoon; Youn, Tae-Jin; Cho, Sang-Heon; Chang, Yoon-Seok


    Eosinophilic myocarditis is a condition resulting from various eosinophilic diseases, including helminth infection, drug hypersensitivity, systemic vasculitis or idiopathic hypereosinophilic syndromes. Clinical manifestations of eosinophilic myocarditis may vary from early necrosis to endomyocardial fibrosis. Eosinophilic myocarditis is one of the most fatal complications of hypereosinophilia. However, eosinophilic myocarditis has been rarely reported in the literature, particularly in Asia Pacific regions, reflecting the under-recognition of the disease among clinicians. Early recognition is crucial for improving clinical outcomes of eosinophilic myocarditis. Early administration of systemic corticosteroid is necessary in eosinophilic myocarditis regardless of underlying causes, as delayed treatment may result in fatal outcomes. In addition, differential diagnoses of underlying causes for eosinophilia are necessary to improve long-term outcomes.

  16. Is the schatzki ring a unique esophageal entity?

    Michaela Müller; Ines Gockel; Philip Hedwig; Alexander J Eckardt; Kathrin Kuhr; Jochem K(o)nig; Volker F Eckardt


    AIM: To study, whether the association of Schatzki rings with other esophageal disorders support one of the theories about its etiology.METHODS: From 1987 until 2007, all patients with newly diagnosed symptomatic Schatzki rings (SRs)were prospectively registered and followed. All of them underwent structured interviews with regards to clinical symptoms, as well as endoscopic and/or radiographic examinations.Endoscopic and radiographic studies determined the presence of an SR and additional morphological abnormalities.RESULTS: One hundred and sixty-seven patients (125 male, 42 female) with a mean age of 57.1 ± 14.6 years were studied. All patients complained of intermittent dysphagia for solid food and 113 (79.6%) patients had a history of food impaction. Patients experienced symptoms for a mean of 4.7 ± 5.2 years before diagnosis. Only in 23.4% of the 64 patients who had endoscopic and/or radiological examinations before their first presentation to our clinic, was the SR previously diagnosed. At presentation, the mean ring diameter was 13.9 ± 4.97 mm. One hundred and sixty-two (97%) patients showed a sliding hiatal hernia. Erosive reflux esophagitis was found in 47 (28.1%) patients. Twenty-six (15.6%) of 167 patients showed single or multiple esophageal webs; five (3.0%) patients exhibited eosinophilic esophagitis; and four (2.4%) had esophageal diverticula. Four (7%) of 57 patients undergoing esophageal manometry had nonspecific esophageal motility disorders.CONCLUSION: Schatzki rings are frequently associated with additional esophageal disorders, which support the assumption of a multifactorial etiology. Despite typical symptoms, SRs might be overlooked.

  17. Eosinophilic diseases in two Cavalier King Charles spaniels.

    German, A J; Holden, D J; Hall, E J; Day, M J


    This report describes the clinical presentation of two Cavalier King Charles spaniels with different eosinophilic diseases. The first case presented with dyspnoea and a non-productive cough, and investigations demonstrated eosinophilic bronchopneumonopathy. The second dog was referred for the investigation of haemorrhagic vomiting and diarrhoea and was eventually diagnosed with eosinophilic enteritis. Both dogs had concurrent eosinophilic stomatitis, and both responded completely to immunosuppressive glucocorticoid therapy. This report is the first to describe the concurrence of eosinophilic stomatitis and systemic eosinophilic disease in Cavalier King Charles spaniels, and suggest that this breed may be predisposed to eosinophilic syndromes.

  18. Eosinophilic colitis in infants

    Adriana Chebar Lozinsky


    Full Text Available OBJECTIVE: To review the literature for clinical data on infants with allergic or eosinophilic colitis. DATA SOURCE: MEDLINE search of all indexes was performed using the words ''colitis or procto-colitis and eosinophilic'' or ''colitis or proctocolitis and allergic'' between 1966 and February of 2013. All articles that described patients' characteristics were selected. DATA SYNTHESIS: A total of 770 articles were identified, of which 32 met the inclusion criteria. The 32 articles included a total of 314 infants. According to the available information, 61.6% of infants were male and 78.6% were younger than 6 months. Of the 314 patients, 49.0% were fed exclusively breast milk, 44.2% received cow's milk protein, and 6.8% received soy protein. Diarrheal stools were described in 28.3% of patients. Eosinophilia was found in 43.8% (115/263 of infants. Colonic or rectal biopsy showed infiltration by eosinophils (between 5 and 25 perhigh-power field in 89.3% (236/264 of patients. Most patients showed improvement with theremoval of the protein in cow's milk from their diet or the mother's diet. Allergy challenge tests with cow's milk protein were cited by 12 of the 32 articles (66 patients. CONCLUSIONS: Eosinophilic colitis occurs predominantly in the first six months of life and in males. Allergy to cow's milk was considered the main cause of eosinophilic colitis. Exclusion of cow'smilk from the diet of the lactating mother or from the infant's diet is generally an effective therapeutic measure.

  19. Esophageal perforation: diagnostic work-up and clinical decision-making in the first 24 hours

    Søreide Jon


    Full Text Available Abstract Esophageal perforation is a rare and potentially life-threatening condition. Early clinical suspicion and imaging is important for case management to achieve a good outcome. However, recent studies continue to report high morbidity and mortality greater than 20% from esophageal perforation. At least half of the perforations are iatrogenic, mostly related to endoscopic instrumentation used in the upper gastrointestinal tract, while about a third are spontaneous perforations. Surgical treatment remains an important option for many patients, but a non-operative approach, with or without use of an endoscopic stent or placement of internal or external drains, should be considered when the clinical situation allows for a less invasive approach. The rarity of this emergency makes it difficult for a physician to obtain extensive individual clinical experience; it is also challenging to obtain firm scientific evidence that informs patient management and clinical decision-making. Improved attention to non-specific symptoms and signs and early diagnosis based on imaging may translate into better outcomes for this group of patients, many of whom are elderly with significant comorbidity.

  20. Clinical outcomes of self-expandable stent placementfor benign esophageal diseases: A pooled analysis of theliterature

    Emo E van Halsema; Jeanin E van Hooft


    AIM: To analyze the outcomes of self-expandable stentplacement for benign esophageal strictures and benignesophageal leaks in the literature.METHODS: The PubMed, Embase and Cochranedatabases were searched for relevant articles publishedbetween January 2000 and July 2014. Eight prospectivestudies were identified that analyzed the outcomesof stent placement for refractory benign esophagealstrictures. The outcomes of stent placement forbenign esophageal leaks, perforations and fistulaewere extracted from 20 retrospective studies thatwere published after the inclusion period of a recentsystematic review. Data were pooled and analyzedusing descriptive statistics.RESULTS: Fully covered self-expandable metal stents(FC SEMS) (n = 85), biodegradable (BD) stents (n =77) and self-expandable plastic stents (SEPS) (n = 70)were inserted in 232 patients with refractory benignesophageal strictures. The overall clinical success ratewas 24.2% and according to stent type 14.1% forFC SEMS, 32.9% for BD stents and 27.1% for SEPS.Stent migration occurred in 24.6% of cases. Theoverall complication rate was 31.0%, including major(17.7%) and minor (13.4%) complications. A total of643 patients were treated with self-expandable stentsmainly for postsurgical leaks (64.5%), iatrogenicperforations (19.6%), Boerhaave's syndrome (7.8%)and fistulae (3.7%). FC SEMS and partially coveredSEMS were used in the majority of patients. Successfulclosure of the defect was achieved in 76.8% ofpatients and according to etiology in 81.4% forpostsurgical leaks, 86.0% for perforations and 64.7%for fistulae. The pooled stent migration rate was16.5%. Stent-related complications occurred in 13.4%of patients, including major (7.8%) and minor (5.5%)complications.CONCLUSION: The outcomes of stent placementfor refractory benign esophageal strictures were poor.However, randomized trials are needed to put thisinto perspective. The evidence on successful

  1. Nimotuzumab combined with radiotherapy for esophageal cancer: preliminary study of a Phase II clinical trial

    Liang J


    Full Text Available Jun Liang,1 Mingyan E,2 Gang Wu,3 Lujun Zhao,4 Xia Li,5 Xia Xiu,6 Ning Li,1 Bo Chen,1 Zhouguang Hui,1 Jima Lv,1 Hui Fang,1 Yu Tang,1 Nan Bi,1 Wenqing Wang,1 Yirui Zhai,1 Tao Li,1 Dongfu Chen,1 Shuangmei Zou,7 Ning Lu,7 Rolando Perez-Rodríguez,8 Junqi Zheng,9 Luhua Wang11Department of Radiotherapy, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China; 2Department of Radiotherapy, Cancer Hospital of Harbin Medical University, Harbin, People's Republic of China; 3Department of Radiotherapy, Tongji Cancer Center Hospital, Wuhan, People's Republic of China; 4Department of Radiotherapy, Cancer Hospital of Tianjin Medical University, Tianjin, People's Republic of China; 5Department of Radiotherapy, LiaoNing Province Cancer Hospital, Shenyang, People's Republic of China; 6Department of Radiotherapy, Beijing Hospital, Beijing, People's Republic of China; 7Department of Pathology, Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, People's Republic of China; 8Center of Molecular Immunology, Havana, Cuba; 9School of Medicine, Tongji University, Shanghai, People's Republic of ChinaObjective: To determine the safety and therapeutic effects of nimotuzumab (h-R3 combined with radiotherapy in esophageal cancer.Methods: This Phase II clinical trial involved 42 patients with stage II (inoperable or refused surgery to stage IV (supraclavicular lymph node metastasis only esophageal cancers treated between November 2008 and July 2010. All patients had squamous cell carcinomas, and all received three-dimensional conformal radiotherapy and 200 mg nimotuzumab per week during radiotherapy.Results: There were 9, 25, and 8 patients with stage II, III and IV disease, respectively. All except two patients received 50–70 Gy radiation; 37 patients (88.1% received more than five nimotuzumab doses. Grade III toxicities (21.4% of all adverse events included esophagitis and gastrointestinal, dermatological and hematological

  2. Eosinophilic Fasciitis Associated with Myositis

    Yuko Adachi


    Full Text Available Eosinophilic fasciitis is clinically characterized by symmetrical scleroderma-like indurations of the skin with pain. The histological features are fascial inflammation with lymphocytes and eosinophils as well as thickened and fibrotic fascia. Lymphocytic infiltration and degeneration of the underlying muscle are rarely observed. We report a 69-year-old Japanese woman who presented with multiple areas of glossy induration and painful peau d'orange-like lesions on the chest and four extremities. T2-weighted magnetic resonance imaging showed significant hyperintense thickening of the fascia of the lower extremities. Histopathological examination of a biopsy specimen from the induration showed marked fibrinoid degeneration of the fascia and the neighboring muscle with mixed cellular infiltration of lymphocytes and eosinophils. The predominant CD8+ lymphocytic infiltrates were observed by immunohistological study. A diagnosis of eosinophilic fasciitis with myositis was made. Oral administration of prednisolone and discontinuation of exercise significantly improved the lesions and pain.

  3. Clinical implementation of a novel applicator in high-dose-rate brachytherapy treatment of esophageal cancer

    Ivan M. Buzurovic


    Full Text Available Purpose : In this study, we present the clinical implementation of a novel transoral balloon centering esophageal applicator (BCEA and the initial clinical experience in high-dose-rate (HDR brachytherapy treatment of esophageal cancer, using this applicator. Material and methods: Acceptance testing and commissioning of the BCEA were performed prior to clinical use. Full performance testing was conducted including measurements of the dimensions and the catheter diameter, evaluation of the inflatable balloon consistency, visibility of the radio-opaque markers, congruence of the markers, absolute and relative accuracy of the HDR source in the applicator using the radiochromic film and source position simulator, visibility and digitization of the applicator on the computed tomography (CT images under the clinical conditions, and reproducibility of the offset. Clinical placement of the applicator, treatment planning, treatment delivery, and patient’s response to the treatment were elaborated as well. Results : The experiments showed sub-millimeter accuracy in the source positioning with distal position at 1270 mm. The digitization (catheter reconstruction was uncomplicated due to the good visibility of markers. The treatment planning resulted in a favorable dose distribution. This finding was pronounced for the treatment of the curvy anatomy of the lesion due to the improved repeatability and consistency of the delivered fractional dose to the patient, since the radioactive source was placed centrally within the lumen with respect to the clinical target due to the five inflatable balloons. Conclusions : The consistency of the BCEA positioning resulted in the possibility to deliver optimized non-uniform dose along the catheter, which resulted in an increase of the dose to the cancerous tissue and lower doses to healthy tissue. A larger number of patients and long-term follow-up will be required to investigate if the delivered optimized treatment can

  4. Eosinophilic Fasciitis: A Rare Skin Sclerosis

    Amandine Servy


    Full Text Available Eosinophilic fasciitis (Schulman's syndrome is a rare disease with specific clinical symptoms such as the groove sign which facilitate diagnosis. We report a typical case of eosinophilic fasciitis in an otherwise healthy 49-year-old man who presented with “prayer and groove signs”. Histological analysis showed sclerosis and eosinophilic infiltration of the fascia. The patient was successfully treated with systemic corticotherapy and Cyclosporine. A short review of the clinicopathological features of the lesions is presented.

  5. Clinical Study of Endostar Combined with DP Protocol in Treatment of Advanced Esophageal Cancer

    Wen-ying DENG


    Full Text Available Objective: To observe the clinical outcomes of Endostar combined with DP regimen for treating advanced esophageal cancer.Methods: A total of 62 patients with advanced esophageal cancer admitted from May, 2011 to May, 2013 were enrolled for a prospective, randomized controlled trial and 2 cases were excluded from the study because of Ⅳ degree of digestive tract reaction and myelosuppression. Therefore, 60 cases could be evaluated, and then divided into combined group (given Endostar+DP plan and single chemotherapy group, 30 cases in each group. The level of VEGF, tumor size and CT perfusion (CTP parameters, including blood flow (BF, blood volume (BV, mean transit time (MTT, and permeability surface (PS before and after treatment were determined for comparison. Kaplan-Merier method was used to analyze the overall survival (OS of 2 groups.Results: The efficacy of combined group was superior to single chemotherapy group. The level of vascular endothelial growth factor (VEGF in combined group was obviously lower than that in single chemotherapy group after treatment (P<0.01. Compared with treatment before in combined group, BF, BV and PS decreased while MTT increased after treatment (P<0.05. However, there were no significant differences in single chemotherapygroup before and after treatment (P>0.05. The median OS was 30 months (95%CI: 20.935-39.065 for combined group and 21 months (95%CI: 15.109-26.591 for single chemotherapy group, respectively (P=0.048. The 1-, 2- and 3-year survival rates were 86.2%, 59.3% and 36.6% in combined group, and 70.8%, 32.1% and 17.8% in single chemotherapy group, respectively.Conclusion: Endostar can down-regulate the expression of VEGF, improve the state of hypertransfusion and high permeability of tumor vessels, has better curative effect without slighter adverse reactions, and prolong the survival time of patients with advanced esophageal cancer when combined with chemotherapy.

  6. Clinical Study of Endostar Combined with DP Protocol in Treatment of Advanced Esophageal Cancer

    DENG Wen-ying; LI Ning; LUO Su-xia


    Objective: To observe the clinical outcomes of Endostar combined with DP regimen for treating advanced esophageal cancer. Methods: A total of 62 patients with advanced esophageal cancer admitted from May, 2011 to May, 2013 were enrolled for a prospective, randomized controlled trial and 2 cases were excluded from the study because ofⅣ degree of digestive tract reaction and myelosuppression. Therefore, 60 cases could be evaluated, and then divided into combined group (given Endostar+DP plan) and single chemotherapy group, 30 cases in each group. The level of VEGF, tumor size and CT perfusion (CTP) parameters, including blood flow (BF), blood volume (BV), mean transit time (MTT), and permeability surface (PS) before and after treatment were determined for comparison. Kaplan-Merier method was used to analyze the overall survival (OS) of 2 groups. Results:The efifcacy of combined group was superior to single chemotherapy group. The level of vascular endothelial growth factor (VEGF) in combined group was obviously lower than that in single chemotherapy group after treatment (P0.05). The median OS was 30 months (95%CI: 20.935-39.065) for combined group and 21 months (95%CI: 15.109-26.591) for single chemotherapy group, respectively (P=0.048). The 1-, 2- and 3-year survival rates were 86.2%, 59.3% and 36.6% in combined group, and 70.8%, 32.1% and 17.8% in single chemotherapy group, respectively. Conclusion: Endostar can down-regulate the expression of VEGF, improve the state of hypertransfusion and high permeability of tumor vessels, has better curative effect without slighter adverse reactions, and prolong the survival time of patients with advanced esophageal cancer when combined with chemotherapy.

  7. Clinical significance of serum expression of GROβ in esophageal squamous cell carcinoma

    Qiao-Mei Dong; Jin-Qiang Zhang; Qian Li; Jacqueline C Bracher; Denver T Hendricks; Xiao-Hang Zhao


    AIM: To determine the association between serum levels of growth-related gene product β (GROβ) and clinical parameters in esophageal squamous cell carcinoma (ESCC). METHODS: Using enzyme-linked immunosorbent assay, serum GROβ levels were measured in ESCC patients (n = 72) and healthy volunteers (n = 83). The association between serum levels of GROβ and clinical parameters of ESCC was analyzed statistically. RESULTS: The serum GROβ levels were much higher in ESCC patients than in healthy controls (median: 645 ng/L vs 269 ng/L, P < 0.05). Serum GROβ levels were correlated positively with tumor size, lymph node metastasis, and tumor-node-metastasis (TNM) staging, but not with gender or the histological grade of tumors in ESCC patients. The sensitivity and specificity of the assay for serum GROβ were 73.61% and 56.63%, respectively. CONCLUSION: GROβ may function as an oncogene product and contribute to tumorigenesis and metastasis of ESCC.

  8. Eosinophilic Esophagitis in Pediatric and Adolescent Patients

    ... allergies. EoE may also run in the family. Screening/Diagnosis Taking a thorough medical history is usually ... the body. Acid reducing medications: Medications that decrease stomach acid production, which include H2 receptor antagonists or ...

  9. Eosinophilic Esophagitis (EE) or (EoE)

    ... puncture with a prick device that has a drop of allergen. Foods used in allergy testing sometimes ... of EoE. The foods excluded usually include dairy, egg, wheat, soy, peanut, tree nuts and fish/shellfish. ...

  10. Prediction of esophageal and gastric histology by macroscopic diagnosis during upper endoscopy in pediatric celiac disease

    Boschee, Erin D; Yap, Jason Y K; Turner, Justine M


    AIM To determine the sensitivity of macroscopic appearance for predicting histological diagnosis at sites other than duodenum in pediatric celiac disease (CD). METHODS Endoscopic and histologic findings in pediatric patients undergoing upper endoscopy for first-time diagnosis of CD at Stollery Children’s Hospital from 2010-2012 were retrospectively reviewed. RESULTS Clinical charts from 140 patients were reviewed. Esophageal and gastric biopsies were taken in 54.3% and 77.9% of patients, respectively. Endoscopic appearance was normal in the esophagus and stomach in 75% and 86.2%. Endoscopic esophageal diagnoses were eosinophilic esophagitis (EE) (11.8%), esophagitis (7.9%), glycogenic acanthosis (1.3%) and non-specific abnormalities (3.9%). Endoscopic gastric diagnoses were gastritis (8.3%), pancreatic rest (0.9%), and non-specific abnormalities (4.6%). Histology was normal in 76.3% of esophageal and 87.2% of gastric specimens. Abnormal esophageal histology was EE (10.5%), esophagitis (10.5%), glycogenic acanthosis (1.3%) and non-specific (1.3%). Gastritis was reported in 12.8% of specimens. Sensitivity and specificity of normal endoscopy for predicting normal esophageal histology was 86.2% and 61.1%, and for normal gastric histology was 87.4% and 21.4%. CONCLUSION In the absence of macroscopic abnormalities, routine esophageal and gastric biopsy during endoscopy for pediatric CD does not identify major pathologies. These findings have cost and time saving implications for clinical practice. PMID:28216971

  11. Eosinophilic cystitis: Report of two- cases and clinical analysis%嗜酸性膀胱炎2例临床分析

    卜仁戈; 宋永胜; 吴斌


    Objective; To evaluate the clinical presentations, diagnosis and treatment of eosinophilic cystitis. Methods:Two cases of eosinophilic cystitis were analyzed. Results:They both underwent transurethral resection of the lesions and were treated with oral steroids and antibiotics. Postoperative pathology confirmed as eosinophilic cystitis in both cases. Both cases were followed up for 1 year. Their voiding urgency and frequency disappeared, microscopic haematuria was unfound, and image and cystoscopic examination showed no tumor like changes. Conclusion: Eosino-philic cystitis is a very rare tumor-like inflammatory disease. Cystoscopy and biopsy are the gold standard for the diagnosis. The principles of treatment are removing lesions, anti-allergic therapy.%目的:探讨嗜酸性膀胱炎的临床表现及诊治方法.方法:对2例嗜酸性膀胱炎的临床资料进行回顾性分析.结果:2例均行经尿道病变电切术并辅以皮质激素、抗生索治疗.术后病理均为嗜酸性膀胱炎.随访1年,尿频、尿急症状消失,无镜下及肉眼血尿,影像学及膀胱镜检查未见膀胱占位性病变.结论:嗜酸性膀胱炎临床少见,确诊需要膀胱镜检查及组织活检,治疗为以切除病变组织和抗炎、抗过敏为主的治疗方法.

  12. Eosinophils in asthma



    @@ The contribution of eosinophils to host-defense and inflammatory responses has undergone periodic reevalu-ations. Thirty years ago, eosinophil was considered as a principal effector cell in host-defense against parasites.

  13. Eosinophil count - absolute

    ... Abnormal Results Mean A high number of eosinophils (eosinophilia) are often linked to a variety of disorders. ... Accessed March 29, 2017. Klion AD, Weller PF. Eosinophilia and eosinophil-related disorders. In: Adkinson NF, Bochner ...

  14. Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

    Fermín Mearin; Julio Ponce; Marta Ponce; Agustín Balboa; Miguel A González; Javier Zapardiel


    AIM:To investigate usefulness of adherence to gastroesophageal reflux disease (GERD) guideline established by the Spanish Association of Gastroenterology.METHODS:Prospective,observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily practice.Patients (aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD (heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms,such as dyspeptic symptoms and/or supraesophageal symptoms.Diagnostic and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease specialists.RESULTS:Endoscopy was indicated in 123 (41%)patients:50 with alarm symptoms,32 with age > 50years without alarm symptom.Seventy-two patients (58.5%) had esophagitis (grade A,23,grade B,28,grade C,18,grade D,3).In the presence of alarm symptoms,endoscopy was indicated consistently with recommendations in 98% of cases.However,in the absence of alarm symptoms,endoscopy was indicated in 33% of patients > 50 years (not recommended by the guideline).Adherence for proton pump inhibitors (PPIs) therapy was 80%,but doses prescribed were lower (half) in 5% of cases and higher (double) in 15%.Adherence regarding duration of PPI therapy was 69%; duration was shorter than recommended in 1% (4 wk in esophagitis grades C-D) or longer in 30%(8 wk in esophagitis grades A-B or in patients without endoscopy).Treatment response was higher when PPI doses were consistent with guidelines,although differences were not significant (95% vs 85%).CONCLUSION:GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms; PPIs were

  15. Eosinophilic cystitis

    Mosholt, Karina Sif Søndergaard; Dahl, Claus; Azawi, Nessn Htum


    frequency, dysuria, urgency, pain and haematuria. Common clinical findings were presence of bladder mass, peripheral eosinophilia and thickened bladder wall. A variety of medical treatments were used, most frequently steroids, antibiotics and antihistamines. Recurrence occurred in patients on tapering...

  16. Effect of proton pump inhibitor on esophageal eosinophilia.

    Schroeder, Shauna; Capocelli, Kelley E; Masterson, Joanne C; Harris, Rachel; Protheroe, Cheryl; Lee, James J; Furuta, Glenn T


    Differentiation between the common etiologies of dense esophageal eosinophilia such as gastroesophageal reflux disease (GERD) and eosinophilic esophagitis can be difficult. We hypothesized that histologic features may provide diagnostic clues concerning the etiology of esophageal eosinophilia. : We performed a retrospective chart review of 204 children with the diagnosis of esophagitis characterized by ≥ 15 eosinophils (eos) per high-power field (HPF) in at least 1 biopsy. We then restricted our analysis to subjects who had received at least 8 weeks of only proton pump inhibitors (PPIs) followed by endoscopy and who had a clinicopathologic response to this treatment. Symptoms, endoscopic findings, and pathologic descriptions were reviewed and an eosinophil peroxidase (EPX) index was determined to assess for degranulation/eosinophil activation. Of the 204 identified charts, 7 subjects identified met the inclusion criteria. Five of these 7 patients showed a clinicopathologic response to PPIs after their follow-up endoscopy, (mean peak eosinophil count: 92 vs 5 eos/HPF, and EPX index: 39.2 vs 14.6, pre- and posttreatment, respectively). Two patients experienced initial resolution of symptoms and esophageal eosinophilia with PPI therapy; however, within 17-23 months they redeveloped symptoms and esophageal eosinophilia while receiving PPI therapy at the time of a third endoscopy (mean peak eosinophil count: 40 vs 11 vs 36 eos/HPF, and EPX index: 44 vs 21 vs 36.5, pre-, post- and posttreatment, respectively). No clinicopathologic features or degranulation patterns differentiated subjects with GERD/PPI responsive esophageal eosinophilia from those who had transient response to PPI treatment. No clinicopathologic features differentiated subjects who responded to PPI treatment. PPI treatment can be helpful to exclude GERD and PPI responsive esophageal eosinophilia but long-term follow-up is critical in the management of esophagitis.

  17. Histopathological study of feline eosinophilic dermatoses.

    Fondati, A; Fondevila, D; Ferrer, L


    A retrospective study was conducted on skin specimens from 24 cats with eosinophilic granuloma complex. The specimens were stained with haematoxylin and eosin and Gallego's trichrome stain. In all specimens, flame figures and/or large foci of so-called "collagen degeneration" were detected and histopathological features were not predictive of the clinical picture. Use of the term eosinophilic dermatosis was advocated in diagnostic dermatopathology. On trichrome-stained sections, normally stained collagen fibres were identified in the middle of both flame figures and large foci of "collagen degeneration" and the debris surrounding collagen bundles showed the same tinctorial properties as eosinophil granules. Eosinophil degranulation around collagen bundles seemed to represent the major pathogenetic event in these lesions, analogous with human flame figures. The term flame figures might therefore be more accurately used to designate those foci of eosinophilic to partly basophilic debris commonly referred to as "collagen degeneration".

  18. Relationship between nasolaryngoscopic findings and pH probe esophageal monitoring in children with clinical manifestations of extra-esophageal reflux

    Oliveira, Neide Fatima Cordeiro Diniz


    Full Text Available Introduction: The gastroesophageal reflux diagnosis, mainly in patients with atypical manifestations, has been receiving increasing importance. Objective: To relate the nasolaryngoscopic findings with prolonged pH probe esophageal monitoring in children with clinical manifestations of extra-esophageal reflux. Method: Transversal prospective clinical study, in which we evaluated 44 children from one to 12 years old, of both genders, by means of nasolaryngoscopy. All were submitted to pH probe monitoring for research of hidden reflux due to cases of otitis, sinusitis, asthma, laryngitis and/or dysphonia in the last 12 months. Results: Out of 44 children, 15 (34% presented with normal pH monitoring and 29 (66% with altered monitoring. Out of 29 with altered pH monitoring, 19 (65.5% were boys and 10 (34.5% were girls. There was no statistically significant difference between gender and the positive results of pH monitoring, in spite of a discreet predominance of occurrence in the male population. All children had smaller adenoids than 75% of the cavity of concha aerial column. Six presented with purulent secretion in nasal cavity. Eight (18% had nodes in vocal cords and five (11% of whom had an altered pH monitoring and three (7% of whom were normal. We found at least one alteration upon nasolaryngoscopy in 80% of the 15 children with normal pH monitoring and in 89.7% of the 29 who had an altered pH monitoring. Conclusion: The prevalence of gastroesophageal reflux in children with recurrent respiratory and otorhinolaryngological affections was high. However, the data obtained didn't show any statistically significant difference (p<0.05 among the nasolaryngoscopic findings, associated or not with gastroesophageal reflux, confirmed by pH monitoring. Therefore, no relationship was found between the pathological gastric acid reflux and nasolaryngoscopic alterations.

  19. Pattern-recognition receptors in human eosinophils.

    Kvarnhammar, Anne Månsson; Cardell, Lars Olaf


    The pattern-recognition receptor (PRR) family includes Toll-like receptors (TLRs), nucleotide-binding oligomerization domain (NOD) -like receptors (NLRs), RIG-I-like receptors (RLRs), C-type lectin receptors (CLRs) and the receptor for advanced glycation end products (RAGE). They recognize various microbial signatures or host-derived danger signals and trigger an immune response. Eosinophils are multifunctional leucocytes involved in the pathogenesis of several inflammatory processes, including parasitic helminth infection, allergic diseases, tissue injury and tumour immunity. Human eosinophils express several PRRs, including TLR1-5, TLR7, TLR9, NOD1, NOD2, Dectin-1 and RAGE. Receptor stimulation induces survival, oxidative burst, activation of the adhesion system and release of cytokines (interleukin-1β, interleukin-6, tumour necrosis factor-α and granulocyte-macrophage colony-stimulating factor), chemokines (interleukin-8 and growth-related oncogene-α) and cytotoxic granule proteins (eosinophil cationic protein, eosinophil-derived neurotoxin, eosinophil peroxidase and major basic protein). It is also evident that eosinophils play an immunomodulatory role by interacting with surrounding cells. The presence of a broad range of PRRs in eosinophils indicates that they are not only involved in defence against parasitic helminths, but also against bacteria, viruses and fungi. From a clinical perspective, eosinophilic PRRs seem to be involved in both allergic and malignant diseases by causing exacerbations and affecting tumour growth, respectively.

  20. Expressions of HPV 16-E6 in Esophageal Carcinoma and its Clinical Significance

    Xing Zhao


    Full Text Available Background and Objective: The role of (Human Papilloma Virus HPV in cancer of certain anatomical location, such as cervix, has been widely recognized. The present study was conducted to explore the association between HPV 16-E6 protein and esophageal squamous cell carcinoma. Methods: SP immunohistochemical method was used to examine the expression of HPV 16-E6 in 50 cases of esophageal squamous cell carcinoma, 10 cases of normal esophageal squamous cell and 10 cases of adjacent tissue. Results: The expression of HPV 16-E6 was significantly higher in esophageal carcinoma than in normal esophageal mucosa and in adjacent tissue. The expressions of HPV 16-E6 had significant correlation with invasive depth (P<0.05, but not with patient age, lymph node metastasis, tumor size (P>0.05. Conclusion: HPV 16-E6 can promote the growth and metastasis of esophageal squamous cell carcinoma and can be a prognostic factor of esophageal squamous cell carcinoma.DOI: JCMS Nepal 2014; 10(4:1-5 

  1. Novel targeted therapies for eosinophilic disorders

    Wechsler, Michael E.; Fulkerson, Patricia C.; Bochner, Bruce S.; Gauvreau, Gail M.; Gleich, Gerald J.; Henkel, Tim; Kolbeck, Roland; Mathur, Sameer K.; Ortega, Hector; Patel, Jatin; Prussin, Calman; Renzi, Paolo; Rothenberg, Marc E.; Roufosse, Florence; Simon, Dagmar; Simon, Hans-Uwe; Wardlaw, Andrew; Weller, Peter F.; Klion, Amy D.


    Hypereosinophilic syndromes (HESs) are a diverse group of conditions characterized by clinical manifestations attributable to eosinophilia and eosinophilic infiltration of tissues. HESs are chronic disorders with significant morbidity and mortality. Although the availability of targeted chemotherapeutic agents, including imatinib, has improved quality of life and survival in some patients with HESs, additional agents with increased efficacy and decreased toxicity are sorely needed. The purpose of this review is to provide an overview of eosinophil biology with an emphasis on potential targets of pharmacotherapy and to provide a summary of potential eosinophil-targeting agents, including those in development, in clinical trials, or approved for other disorders. PMID:22935585

  2. Eosinophilic granuloma of the mandibular condyle

    Huh, Kyung Hoe; Yi, Won Jin; Oh, Sung Won; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Mun Kyung [Department of Oral and Maxillofacial Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Seoul (Korea, Republic of)


    The present study reports a case of eosinophilic granuloma of the mandibular condyle. Eosinophilic granulomas on the mandibular condyle are very rare, but there are several common clinical and radiographic presentations. The clinical presentations involve swelling on preauricular area, limitation of opening, TMJ pain, etc. The radiographic presentations involve radiolucent lytic condylar lesion with or without pathologic fracture. Sometimes new bone formations are observed. The purpose of the article is to add new cases to the literatures.

  3. Less-invasive MR indices of clinically evident esophageal variceal bleeding in biliary atresia patients

    Yuan Heng Mo


    Conclusion: Less-invasive indices, including the corrected splenic length platelet ratio and the splenic volume index-to-platelet count ratio, may be valuable predictors of esophageal variceal bleeding in patients with biliary atresia.

  4. Clinical evaluation of radiotherapy for advanced esophageal cancer after metallic stent placement

    You-Tao Yu; Guang Yang; Yan Liu; Bao-Zhong Shen


    AIM: To evaluate the therapeutic effect of radiotherapy for esophageal cancer after expandable metallic stent placement.METHODS: Ten cases of advanced esophageal cancer were evaluated, 7 having complete obstruction and 3 with digestive-respiratory fistula. Ten nitinol stents were placed at the site of stenosis. Patients were treated with a total dose of 1 200 cGy divided into 3 fractions of 400 cGy 4-7 d after stents placement.RESULTS: All the 10 stents were placed successfully at one time. After radiotherapy for advanced esophageal cancer, the survival period of the cases ranged from 14 to 22 mo, with a mean survival of 17 mo. No re-stenosis occurred among all the 10 cases.CONCLUSION: Stent placement combined with radiotherapy for esophageal cancer is helpful to prolong patients' survival and reduce occurrence of re-stenosis.

  5. Detection of Apoptotic Inhibitor Gene Survivin in Peripheral Blood of Patients with Esophageal Cancer by Real-time Fluorescence Quantitative PCR and its Clinical Signiifcance

    CHEN Sheng


    Objective:To explore the clinical signiifcance of apoptotic inhibitor gene Survivin in peripheral blood of patients with esophageal cancer. Methods:Real-time lfuorescence quantitative PCR was used to detect the expression of Survivin mRNA in peripheral blood of 93 patients with benign and malignant esophageal lesions. The relationship of Survivin mRNA expression and clinicopathologic feature was observed. Results:The expression of Survivin mRNA in peripheral blood which was associated with differentiated degree and clinical staging was progressively increased from benign lesion to carcinoma in situ and invasive carcinoma. Conclusion:The expression of Survivin mRNA in peripheral blood is significantly related to the genesis and progression of esophageal carcinoma. Real-time fluorescence quantitative PCR used to detect the expression of Survivin m-RNA in peripheral blood may be more convenient for diagnosing and guiding the treatment of esophageal carcinoma.

  6. Clinical Outcomes of Resectable Esophageal Cancer with Supraclavicular Lymph Node Metastases Treated with Curative Intent.

    Honma, Yoshitaka; Hokamura, Nobukazu; Nagashima, Kengo; Sudo, Kazuki; Shoji, Hirokazu; Iwasa, Satoru; Takashima, Atsuo; Kato, Ken; Hamaguchi, Tetsuya; Boku, Narikazu; Umezawa, Rei; Ito, Yoshinori; Itami, Jun; Koyanagi, Kazuo; Igaki, Hiroyasu; Tachimori, Yuji


    In the seventh edition of the Union for International Cancer Control (UICC) TNM classification, supraclavicular lymph node (SCLN) in regard to thoracic esophageal cancer (EC) is regarded as a distant organ, therefore, if resectable, SCLN metastasis is considered a candidate for systemic chemotherapy. The purpose of this study was to clarify the survival outcome in patients with resectable thoracic EC with SCLN metastases (M1LYM) treated with curative intent. Clinical outcomes in patients with resectable thoracic EC with SCLN metastases (M1LYM) treated by esophagectomy or definitive chemoradiotherapy (dCRT) were retrospectively analyzed. A total of 102 patients were divided in three groups: Surgery with perioperative therapy, n=45; surgery alone, n=19; and dCRT, n=38. Overall, median progression-free survival and median survival time were 9.3 and 26.7 months, respectively. The median survival time was 27.5 months in the group treated with surgery with perioperative treatment, 50.6 months in those treated with surgery alone, and 22 months in the dCRT group. No significant survival difference was seen among the three groups. Over 30% of patients with resectable M1LYM treated with curative intent achieved long-term survival. Copyright© 2017, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.

  7. Expression of midkine and its clinical significance in esophageal squamous cell carcinoma

    Ying-Jia Ren; Qing-Yun Zhang


    AIM: To investigate the expression of midkine in esophageal squamous cell carcinoma (ESCC) and analyze its relationship with clinicopathological features.METHODS: RT-PCR and immunocytochemical staining were used to detect the expression of midkine mRNA and protein in EC109 cells, respectively. Then the expression of midkine in 66 cases of ESCC samples were detected by immunohistochemistry using monoclonal antibodies against human midkine. RESULTS: Midkine was expressed in EC109 cell by RTPCR and immunocytochemistry. The immunoreactivity was detected in 56.1% (37/66) of the ESCC samples.The expression of midkine was found in cytoplasm of tumor cells. Notably, the intensity of midkine was stronger at the area abundant in vessels and the invading border of the tumors. Midkine was more intensely expressed in well differentiated tumors (76.9%)than in moderately and poorly differentiated tumors (43.1% and 41.2%, respectively) (P<0.05). There was no statistically significant correlation between midkine expression and gender, age, clinical stage, lymph node metastasis or survival in ESCC.CONCLUSION: Midkine is overexpressed in ESCC. It may play a role in tumor angiogenesis and invasion.The expression of midkine is correlated with tumor cell differentiation in ESCC. The more poorly tumor cells differentiate, the weaker midkine expresses.

  8. Mapping patterns of nodal metastases in esophageal carcinoma: rethinking the clinical target volume for supraclavicular nodal irradiation

    Luo, Yijun; Liu, Yuhui; Wang, Xiaoli; Zhang, Bin; Yu, Jinming; Wang, Chengang; Huang, Yong


    Background To map detail distribution of metastatic supraclavicular (SCV) lymph nodes (LN) in esophageal cancer (EC) patients and determine the precise radiation therapy clinical target volume (CTV). Methods A total of 101 thoracic esophageal carcinoma patients after surgery experienced SCV LN metastasis were retrospectively examined. The SCV region is further divided into four subgroups. Using hand drawings registration, nodes were mapped to a template computed tomogram to provide a visual impression of nodal frequencies and anatomic distribution. Results In all, 158 nodes were considered to be clinical metastatic in the SCV region in the 101 patients, 74 on the left and 84 on the right. Seven of 158 (4.4%) positive LN were located in group I, 78 of 158 (49.37%) were located in group II, 72 of 158 nodes (45.6%) were located in group III, 1 of 158 (0.63%) located in group IV. Conclusions According to our results, the SCV group II and group III are considered to be the high risk regions of esophageal squamous cell carcinoma (ESCC) LN metastasis, which were defined as elective nodal irradiation (ENI) areas. PMID:28066592

  9. Idiopathic Eosinophilic Cholecystitis

    Huseyin Tas


    Eosinophilic cholecystitis is one of the rare causes of cholecystitis. Diagnosis is made by exclusion of other causes for eosinophilic cholecystitis and by pathological examination of the gallbladder wall infiltration with more than 90% of the eosinophilic leukocytes. We have aimed to present a case of 24 year old man who had Eosinophilia in blood tests, progressive complaints after medical treatment, was diagnosed with acute acalculous cholecystitis and was treated with cholecystectomy. Idio...

  10. Proteomics of Eosinophil Activation

    Deane F. Mosher


    Full Text Available We recently identified and quantified >7,000 proteins in non-activated human peripheral blood eosinophils using liquid chromatography coupled to tandem mass spectrometry (LC–MS/MS and described phosphoproteomic changes that accompany acute activation of eosinophils by interleukin-5 (IL5 (1. These data comprise a treasure trove of information about eosinophils. We illustrate the power of label-free LC–MS/MS quantification by considering four examples: complexity of eosinophil STATs, contribution of immunoproteasome subunits to eosinophil proteasomes, complement of integrin subunits, and contribution of platelet proteins originating from platelet–eosinophil complexes to the overall proteome. We describe how isobaric labeling enables robust sample-to-sample comparisons and relate the 220 phosphosites that changed significantly upon treatment with IL5 to previous studies of eosinophil activation. Finally, we review previous attempts to leverage the power of mass spectrometry to discern differences between eosinophils of healthy subjects and those with eosinophil-associated conditions and point out features of label-free quantification and isobaric labeling that are important in planning future mass spectrometric studies.

  11. Eosinophilic Granuloma of a Child

    Ozgur Demir


    Full Text Available Eosinophilic granuloma is part of Langerhans' cell histiocytosis. It is a rare, benign bone tumor, often involving the head bones. Most patients present between 5 and 15 years of age. Lesions of eosinophilic granuloma may disappear spontaneously. Painful lesions can be treated with radiotherapy, chemotherapy, surgical curettage of the tumor or local infusion of cortisone. A six year old girl presented to our clinic with severe painful swelling on the right parietal region with a gradual increase in size and frequent episodes of headache for 2 months. Radiological findings demonstrated right parietal cranial lytic lesion with intra and extracranial extension. The patient was treated with gross total excision of tumor and cranioplasty without any adjuvant therapy. Histopathology of the tumor showed cellular components of Langerhan' cells admixed with chronic cellular infiltrate and eosinophils. Findings were consistent with eosinophillic granuloma. The patient recovered well with no known recurrence till date. There is no definitive treatment option for this disorder. Treatment option may be changed depending on the extent of the disease and the symptoms. We recommend surgical excision in the presence of intracranial extension of painful lesion. [J Contemp Med 2016; 6(4.000: 343-347

  12. 嗜酸细胞性胃肠炎的临床多样性%Clinical variety of in eosinophilic gastroenteritis

    段丽萍; 吕愈敏; 王爱英; 叶嗣懋; 林三仁; 胡传松


    目的 分析嗜酸细胞性胃肠炎(eosinophilic gastroenteritis, EG)临床表现多样性、非特异性以及误诊的主要原因。方法 对4例EG患者的病史、l临床表现、生化和特殊检查结果 进行分析,结合文献报道,分析EG患者的临床特点和误诊原因。结果  EG患者多以消化不良为首发症状,可伴腹泻。随着疾病的发展可出现肠梗阻和/或腹水。症状与嗜酸细胞浸润所累积的部位和深度有关。误诊原因:(1)对EG认识不足,缺乏内镜下足够部位和深度的黏膜活检;(2)对腹水患者未行腹水涂片检查嗜酸细胞;(3)腹腔镜检查不普及。结论  EG多以消化不良为主要表现。内镜表现缺乏特异性,胃肠道黏膜组织病理学检查是诊断的关键,浆膜病变应查腹水嗜酸细胞,腹腔镜检查有助于此类患者的诊断。%Objective To evaluate the clinical variety and the possible causes of misdiagnosis in eosinophilic gastroenteritis (EG) patients. Methods Clinical manifestation, laboratory tests and endoscopy of 4 patients diagnosed as having eosinophilic gastroenteritis (EG) were analyzed. Combining with the references, we evaluated the clinical characteristics of EG and the possible causes of misdiagnosis. Results Symptoms of dyspepsia, such as epigastric pain, discomfort and nausea, were the commonest and earliest manifestation of EG, some patients accompanied with diarrhea. With the progress of EG, the patients might develop bowel obstruction and/or ascites. Symptoms of EG were related with the site and depth of eosinophilic infiltration in the gastrointestinal tract. Misdiagnosis could occur when: ( 1 ) There is no sufficient understanding of EG, therefore those patients do not undergo endoscopic mucosal biopsy in sufficient sites and depth; (2) Lacking of ascites smear for cellular examination in patient with ascites; (3) Laparoscopy is not wildly used yet. Conclusions Symptoms of dyspepsia are the

  13. Eosinophilic meningitis: a case series and review of literature of Angiostrongylus cantonensis and Gnathostoma spinigerum.

    Shah, I; Barot, S; Madvariya, M


    Eosinophilic meningitis is defined as the presence of >10 eosinophils/μL in cerebrospinal fluid (CSF) or at least 10% eosinophils in the total CSF leukocyte count. Eosinophilic meningitis has been reported in two case series and two case reports in India till date and has not been reported in children below 15 years of age. We present two children with eosinophilic meningitis with peripheral eosinophilia and the proposed etiologic agents based on the clinical setting and their response to antihelminthic agents.

  14. Ultrastructural study of cutaneous lesions in feline eosinophilic granuloma complex.

    Bardagí, Mar; Fondati, Alessandra; Fondevila, Dolors; Ferrer, Lluís


    The purpose of this study was to investigate the ultrastructural appearance of flame figures, reported to comprise a mixture of degenerate collagen and degranulated eosinophils, in feline eosinophilic granuloma complex (EGC). Skin specimens from eight cats with EGC and from two clinically healthy cats were examined by transmission electron microscopy. Flame figures appeared to comprise ultrastructurally normal collagen fibrils separated by oedema and surrounded by large numbers of degranulating eosinophils. Longitudinal sections of collagen fibrils displayed the characteristic cross-striation of normal dermal collagen. Feline eosinophils, analogous to human eosinophils, degranulated both by cytolysis and piecemeal degranulation. The results of this study suggest that flame figures form in feline EGC due to eosinophil recruitment and degranulation, and that collagen fibres are partially disrupted but collagen fibrils are not damaged. These findings suggest that eosinophil accumulation and the release of granule contents represent the primary events in feline EGC.

  15. Migratory eosinophilic alveolitis caused by radiation therapy.

    Lim, Jun Hyeok; Nam, Hae-Seong; Kim, Hun Jung; Choi, Chang-Hwan; Park, In-Suh; Cho, Jae Hwa; Ryu, Jeong-Seon; Kwak, Seung Min; Lee, Hong Lyeol


    Although radiation pneumonitis is usually confined to irradiated areas, some studies have reported that radiation-induced lymphocytic alveolitis can also spread to the non-irradiated lung. However, there have been few reports of radiation-induced eosinophilic alveolitis. We report the case of a 27-year-old female with radiation pneumonitis, occurring 4 months after radiation therapy for cancer of the left breast. Clinical and radiological relapse followed withdrawal of corticosteroids. Examination of bronchoalveolar lavage (BAL) in patchy airspace consolidations revealed increased eosinophil counts. Finally, clinical and radiological signs resolved rapidly after reintroduction of corticosteroids. Eosinophilic alveolitis may be promoted by radiation therapy. In the present case report, possible mechanisms for radiation-induced eosinophilic alveolitis are also reviewed.

  16. Eosinophilic mastitis masquerading as breast carcinoma.

    Garg, M; Kumar, S; Neogi, S


    We report the sixth case of Eosinophilic Mastitis, presenting similarly enough to be confused with breast carcinoma. A 50 year old lady presented with a six month history of progressively enlarging asymptomatic breast lump, cough and breathlessness. Clinical examination, mammography and axillary lymphadenopathy suggested malignant disease. Ronchi were heard on chest auscultation. Needle cytology was twice inconclusive and Tru-cut biopsy showed acute on chronic inflammation. Blood investigations revealed significant peripheral eosinophilia. Open biopsy reported eosinophilic mastits, correlating with peripheral eosinophilia and pulmonary symptoms. The patient responded to conservative management. Eosinophilic infiltration of the breast is a rare manifestation of tissue involvement in peripheral eosinophilia. Asthma, Churgh-Strauss Syndrome and hyper-eosinophilic syndromes are associated. Importantly, if a clinically and radiologically malignant breast lump in asthmatic ladies with peripheral eosinophilia is not confirmed on cytology, this entity could be a diagnosis, potentially saving the patient from surgery.

  17. Giant esophageal fibrovascular polyp with clinical behaviour of inflammatory pseudotumor: A case report and the literature review

    Ćuk Vladimir


    Full Text Available Introduction. Esophageal fibrovascular polyps are rare, benign, intraluminal, submucosal tumor-like lesions, characterized by pedunculated masses which can demonstrate enormous growth. The most frequent symptoms are dysphagia, vomiting and weight loss. Fibrovascular polyps with long stalks can regurgitate into the airways and cause asphyxia. Esophageal inflammatory pseudotumor is extremely rare lesion accompanied with various systemic manifestations as fever, anemia and thrombocytosis. Case report. We presented a 29-year-old man complaining of a long-lasting fever and dysphagia. He was found to have huge pedunculated submucosal tumor of esophagus, surgically completely resected. Histopathological examination showed that this giant tumor, 24 x 9 x 6 cm, was a fibrovascular polyp. The postoperative course was uneventful. The preoperative fever, anemia and thrombocytosis disappeared and did not recur in the postoperative course. Conclusion. We reported a patient with giant esophageal pedunculated tumor with clinical manifestations of inflammatory pseudotumor and histopathological picture of fibrovascular polyp, that we have not found described in the literature before.

  18. Esophageal cell proliferation in gastroesophageal reflux disease: Clinical-morphological data before and after pantoprazole

    Carlo Calabrese; Davide Treré; Giuseppina Liguori; Veronica Gabusi; Manuela Vici; Giovanna Cenacchi; Massimo Derenzini; Giulio Di Febo


    AIM: To evaluate esophageal mucosal defense mechanisms at an epithelial level to establish if pantoprazole treatment can induce ultrastructural healing and improvement in the proliferation activity of the esophageal epithelium in gastroesophageal reflux disease (GERD). METHODS: This was a single-blinded study for pHmonitoring, and histological, ultrastructural and MIB1 immunostaining evaluation. Fifty eight patients with GERD were enrolled and underwent 24 h pH-monitoring and endoscopy. Patients were treated for 12 and 24 mo with pantoprazole. Esophageal specimens were taken for histological and ultrastructural evaluation, before and after the treatment. RESULTS: With transmission electron microscopy, all patients with GERD showed ultrastructural signs of damage with dilation of intercellular spaces (DIS). After 3 mo of therapy the mean DIS values showed a significant reduction and the mean MIB1-LI values of GERD showed an increase in cell proliferation. A further 3 mo of therapy significantly increased cell proliferation only in the erosive esophagitis (ERD) group. CONCLUSION: Three months of pantoprazole therapy induced ultrastructural healing of mucosal damage in 89% and 93% of ERD and non-erosion patients, respectively. Moreover, long-term pantoprazole treatment may be helpful in increasing the capability for esophageal cell proliferation in GERD, particularly in ERD patients.

  19. Balloon Dilatation for Corrosive Esophageal Strictures in Children: Radiologic and Clinical Outcomes

    Youn, Byung Jae; Kim, Woo Sun; Cheon, Jung Eun; Kim, Wha Young; Shin, Su Mi; Kim, In One; Yeon, Kyung Mo [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    We retrospectively evaluated the effectiveness of the esophageal balloon dilatation (EBD) in children with a corrosive esophageal stricture. The study subjects included 14 patients (M:F = 8:6, age range: 17-85 months) who underwent an EBD due to a corrosive esophageal stricture. The causative agents for the condition were glacial acetic acid (n = 9) and lye (n = 5). A total of 52 EBD sessions were performed in 14 patients (range 1-8 sessions). During the mean 15-month follow-up period (range 1-79 months), 12 patients (86%) underwent additional EBD due to recurrent esophageal stricture. Dysphagia improved after each EBD session and oral feeding was possible between EBD sessions. Long-term success (defined as dysphagia relief for at least 12 months after the last EBD) was achieved in two patients (14%). Temporary success of EBD (defined as dysphagia relief for at least one month after the EBD session) was achieved in 17 out of 52 sessions (33%). A submucosal tear of the esophagus was observed in two (4%) sessions of EBD. Only a limited number of children with corrosive esophageal strictures were considered cured by EBD. However, the outcome of repeated EBD was sufficient to allow the children to eat per os prior to surgical management.

  20. Esophageal Cancer

    ... from your throat to your stomach. Early esophageal cancer usually does not cause symptoms. Later, you may ... You're at greater risk for getting esophageal cancer if you smoke, drink heavily, or have acid ...

  1. Mitochondria in the Center of Human Eosinophil Apoptosis and Survival

    Pinja Ilmarinen


    Full Text Available Eosinophils are abundantly present in most phenotypes of asthma and they contribute to the maintenance and exacerbations of the disease. Regulators of eosinophil longevity play critical roles in determining whether eosinophils accumulate into the airways of asthmatics. Several cytokines enhance eosinophil survival promoting eosinophilic airway inflammation while for example glucocorticoids, the most important anti-inflammatory drugs used to treat asthma, promote the intrinsic pathway of eosinophil apoptosis and by this mechanism contribute to the resolution of eosinophilic airway inflammation. Mitochondria seem to play central roles in both intrinsic mitochondrion-centered and extrinsic receptor-mediated pathways of apoptosis in eosinophils. Mitochondria may also be important for survival signalling. In addition to glucocorticoids, another important agent that regulates human eosinophil longevity via mitochondrial route is nitric oxide, which is present in increased amounts in the airways of asthmatics. Nitric oxide seems to be able to trigger both survival and apoptosis in eosinophils. This review discusses the current evidence of the mechanisms of induced eosinophil apoptosis and survival focusing on the role of mitochondria and clinically relevant stimulants, such as glucocorticoids and nitric oxide.

  2. Comprehensive clinical study of concurrent chemotherapy breathing IMRT middle part of locally advanced esophageal cancer

    Jung, Jae Hong; Moon, Seong Kwon [Dept. of Radiation Oncology, College of Medicine, Soonchunhyang University , Asan (Korea, Republic of); Kim, Seung Chul [Dept. of Radiology, Songho College, Hoengseong (Korea, Republic of)


    The standard treatment of locally advanced type of mid-esophageal cancer is concurrent chemoradiation therapy (CRT). We evaluated the feasibility of chemotherapy with adding docetaxel to the classical basic regimens of cisplatin plus 5-fluorouracil (5-FU) and radiotherapy up to 70.2 Gy using dose escalations for esophageal cancer. It was possible to escalate radiation treatment dose up to 70.2 Gy by the respiratory-gated intensity- modulated radiotherapy (gated-IMRT) based on the 4DCT-simulation, with improving target coverage and normal tissue (ex., lung, heart, and spinal cord) sparing. This study suggested that the definitive chemo-radiotherapy with docetaxel, cisplatin, and 5-fluorouracil (i.e., DCF-R) and gating IMRT is tolerable and active in patients with locally advanced mid-esophageal cancer (AEC)

  3. Comparison of the clinical characteristics and treatment outcomes of patients requiring hospital admission to treat eosinophilic and neutrophilic exacerbations of COPD [Corrigendum

    Kang HS


    Full Text Available Kang HS, Rhee CK, Kim SK, Kim JW, Lee SH, Yoon HK, Ahn JH, Kim YH. Int J Chron Obstruct Pulmon Dis. 2016;11:2467–2473.Page 2467, Abstract, Results section, line 1, the text “COPD exacerbations (177 eosinophilic and 380 neutrophilic were included” should read “COPD exacerbations (177 eosinophilic, 380 neutrophilic and 48 paucigranulocytic were included. Of these, we compared patients with eosinophilic and neutrophilic COPD exacerbations”.Read the original article

  4. The Morbidity Situation of Eosinophilic Gastroenteritis in Infants%婴儿嗜酸细胞性胃肠炎发病概况

    程艳波; 王艳丽; 王爱平; 史长松


    Objective To analyze the clinical morbidity situation of infants with eosinophilic gastroenteritis in recent years.Methods 54 infants with allergic gastroenteritis in our hospital were retrospectively analyzed. The tests and incidence of infants with eosinophilic gastroenteritis were analyzed.Results 35 cases of gastrointestinal endoscopy in children in 22 patients addicted to acid cells increased in line with the baby addicted eosinophilic gastroenteritis pathological criteria for the diagnosis of 13 cases (37.1%), which is addicted to eosinophilic esophagitis in 2 cases (5.7%), eosinophil cells acid gastritis in 4 cases (11.4%), addicted acid cell esophageal inflammation with gastritis in 1 case (2.8%), eosinophil eosinophilic enteritis in 6 cases (17.1%).Conclusion It is very important to get early diagnosis and treatment on infants with eosinophilic gastroenteritis. Allergen test and avoiding foods are effective way for infants that could not test by endoscopy.%目的:分析近年来婴儿嗜酸细胞性胃肠炎临床发病情况。方法回顾性分析我院收治的54例食物过敏性胃肠疾病婴儿的临床资料,对婴儿嗜酸细胞性胃肠炎的相关检查及发生率进行分析。结果35例行胃肠镜检查的患儿中22例嗜酸细胞升高,符合婴儿嗜酸细胞性胃肠炎病理诊断标准13例(37.1%),其中嗜酸细胞性食管炎2例(5.7%),嗜酸细胞性胃炎4例(11.4%),嗜酸细胞性食管炎伴胃炎1例(2.8%),嗜酸细胞性肠炎6例(17.1%)。结论早期诊断和治疗婴儿嗜酸细胞性胃肠炎非常重要,无条件做胃肠镜的患儿,过敏原检测及食物回避也是一种有效的方式。

  5. Eosinophilic leukaemia in a cat.

    Sharifi, Hassan; Nassiri, Seyed Mahdi; Esmaelli, Hossein; Khoshnegah, Javad


    A 14-year-old female domestic shorthair cat was presented to Tehran University Veterinary Teaching Hospital for a persistent fever, anorexia, intermittent vomiting, weight loss and weakness. The main clinical signs were pale mucous membranes, dehydration and splenomegaly. The complete blood count and serum biochemistry tests revealed non-regenerative anaemia, thrombocytopenia and increased alkaline phosphatase (ALP) activity. An enzyme-linked immunosorbent assay (ELISA) test for feline leukaemia virus was negative. Blood film and bone marrow examination revealed a large number of immature eosinophils with variable sizes and numbers of faintly azurophilic granules. Cytochemical staining of blood film demonstrated 70% positive cells for ALP activity. Four percent CD34 positive cells were detected by flow cytometry. As eosinophilic leukaemia is difficult to identify by light microscopy, well-defined diagnostic criteria and the use of flow cytometry and cytochemical staining can improve the ability to correctly diagnose this type of leukaemia in cats.

  6. Relationship between clinical factors and severity of esophageal candidiasis according to Kodsi's classification.

    Asayama, N; Nagata, N; Shimbo, T; Nishimura, S; Igari, T; Akiyama, J; Ohmagari, N; Hamada, Y; Nishijima, T; Yazaki, H; Teruya, K; Oka, S; Uemura, N


    Severe Candida esophagitis (CE) may lead to development of strictures, hemorrhage, esophagotracheal fistula, and a consequent decrease in quality of life. Although the severity of CE has been classified based on macroscopic findings on endoscopy, the clinical significance remains unknown. The aim of the study was to elucidate the predictive clinical factors for endoscopic severity of CE. Patients who underwent upper endoscopy and answered questionnaires were prospectively enrolled. Smoking, alcohol, human immunodeficiency virus (HIV) infection, diabetes mellitus, chronic renal failure, liver cirrhosis, systemic steroids use, proton pump inhibitor use, H2 blocker use, and gastrointestinal (GI) symptoms were assessed on the same day of endoscopy. GI symptoms including epigastric pain, heartburn, reflux, hunger cramps, nausea, dysphagia, and odynophagia were assessed on a 7-point Likert scale. Endoscopic severity was classified as mild (Kodsi's grade I/II) or severe (grade III/IV). Of 1855 patients, 71 (3.8%) were diagnosed with CE (mild, n = 48; severe, n = 23). In the CE patients, 50.0% (24/48) in the mild group and 23.1% (6/23) in the severe group did not have any GI symptoms. In HIV-infected patients (n = 17), a significant correlation was found between endoscopic severity and declining CD4 cell count (Spearman's rho = -0.90; P < 0.01). Multivariate analysis revealed that GI symptoms (odds ratio [OR], 3.32) and HIV infection (OR, 3.81) were independently associated with severe CE. Patients in the severe group experienced more epigastric pain (P = 0.02), reflux symptoms (P = 0.04), dysphagia (P = 0.05), and odynophagia (P < 0.01) than those in the mild group. Of the GI symptoms, odynophagia was independently associated with severe CE (OR 9.62, P = 0.02). In conclusion, the prevalence of CE in adults who underwent endoscopy was 3.8%. Silent CE was found in both mild and severe cases. Endoscopic severity was associated with

  7. Review of idiopathic eosinophilic meningitis in dogs and cats, with a detailed description of two recent cases in dogs : review and clinical communication

    J.H. Williams


    Full Text Available Eosinophilic meningoencephalitis (EME has been described in various species of animals and in humans. In dogs it has been associated with protozoal infections, cuterebral myiasis and various other aetiologies. Ten cases of idiopathic eosinophilic meningoencephalitis have been reported in dogs and one in a cat where the origin was uncertain or unknown. The dogs were all males, of various breeds but with a predominance of Golden Retrievers and Rottweilers; they generally had a young age of onset. Two cases with no apparent underlying aetiology were diagnosed on post mortem examination. The 18-month-old, male Boerboel presented with sudden onset of cerebellar ataxia, as well as various asymmetrical cranial nerve deficits of 2 weeks' duration and without progression. Haematology revealed a peripheral eosinophilia. Necropsy showed extreme generalised congestion especially of the meninges and blood smear and histological sections of various tissues showed intravascular erythrocyte fragmentation with the formation of microcytes. Histopathology revealed severe diffuse cerebrocortical subarachnoidal meningitis and submeningeal encephalitis, the exudate containing variable numbers of eosinophils together with neutrophils and mononuclear cells. There was also deeper white matter and hippocampal multifocal perivascular mononuclear encephalitis and multifocal periventricular malacia, gliosis and phagocytosis of white matter. The cerebellum, brain stem and spinal cord showed only mild multifocal oedema or scattered occasional axon and myelin degeneration respectively, with no inflammation. Immunohistochemical staining of central nervous tissue for Toxoplasma gondii failed to show any antigen in the central nervous tissue. Ultrastructure of a single submeningeal suspected parasitic cyst showed it to be chromatin clumping within a neuron nucleus indicating karyorrhexis. Gram stain provided no evidence of an aetiological agent. The 3-year-old Beagle bitch had a

  8. [Eosinophils and eosinophilia].

    Scarlata, Francesco


    Eosinophils were previously considered granulocytes involved in host protection against helminth infections and in inflammation related to atopic diseases. Instead, as supported by recent studies, eosinophils are today considered multifunctional cells involved also in homeostasis of the gastrointestinal tract and other organs, conferring innate and adaptive immunity to certain bacteria and viruses, and perhaps in the control of oncogenicity. Unexplained eosinophilia could be an expression of paraneoplastic syndrome or constitutional factors. Irrespective of the underlying conditions and aetiology of eosinophilia, eosinophil-derived substances may induce potentially irreversible organ damage. A diagnostic algorithm is discussed.

  9. Eosinophilic annular erythema.

    Sempau, Leticia; Larralde, Margarita; Luna, Paula Carolina; Casas, Jose; Staiger, Hernan


    Eosinophilic annular erythema is a rare benign recurrent disease, originally described in children, characterized by the recurrent appearance of persistent non-pruritic, urticarial annular lesions. Histologically a perivascular infiltrate composed of lymphocytes and abundant eosinophils in the dermis is exhibited. We report the case of a 15-year-old boy who presented with a 4-year history of recurrent flares of erythematous annular plaques on the trunk and extremities. The lesions resolved spontaneously after 3-5 weeks with no accompanying signs. A biopsy showed a mainly perivascular lymphocytic infiltrate with numerous eosinophils in the dermis.

  10. Epigenetic subgroups of esophageal and gastric adenocarcinoma with differential GATA5 DNA methylation associated with clinical and lifestyle factors.

    Xinhui Wang

    Full Text Available BACKGROUND: Adenocarcinomas located near the gastroesophageal junction have unclear etiology and are difficult to classify. We used DNA methylation analysis to identify subtype-specific markers and new subgroups of gastroesophageal adenocarcinomas, and studied their association with epidemiological risk factors and clinical outcomes. METHODOLOGY/PRINCIPAL FINDINGS: We used logistic regression models and unsupervised hierarchical cluster analysis of 74 DNA methylation markers on 45 tumor samples (44 patients of esophageal and gastric adenocarcinomas obtained from a population-based case-control study to uncover epigenetic markers and cluster groups of gastroesophageal adenocarcinomas. No distinct epigenetic differences were evident between subtypes of gastric and esophageal cancers. However, we identified two gastroesophageal adenocarcinoma subclusters based on DNA methylation profiles. Group membership was best predicted by GATA5 DNA methylation status. We analyzed the associations between these two epigenetic groups and exposure using logistic regression, and the associations with survival time using Cox regression in a larger set of 317 tumor samples (278 patients. There were more males with esophageal and gastric cardia cancers in Cluster Group 1 characterized by higher GATA5 DNA methylation values (all p<0.05. This group also showed associations of borderline statistical significance with having ever smoked (p-value = 0.07, high body mass index (p-value = 0.06, and symptoms of gastroesophageal reflux (p-value = 0.07. Subjects in cluster Group 1 showed better survival than those in Group 2 after adjusting for tumor differentiation grade, but this was not found to be independent of tumor stage. CONCLUSIONS/SIGNIFICANCE: DNA methylation profiling can be used in population-based studies to identify epigenetic subclasses of gastroesophageal adenocarcinomas and class-specific DNA methylation markers that can be linked to

  11. 嗜酸性粒细胞黏蛋白性鼻鼻窦炎的临床特征%Clinical features of eosinophilic mucin rhinosinusitis

    费捷; 李继红; 袁媛; 周卫东


    Objective o explore the clinical features of eosinophilic mucin rhinosinusitis(EMRS).Methods EMRS patients were enrolled for the retrospective study.Data including sex,age,symptoms,laboratory examinations,imaging findings,pathological presentations,treatments and prognosis were analyzed.Results Twelve patients were diagnosed as EMRS.This included seven males and five females,whose age ranged from nine to fifty-four years.All subjects presented chronic rhinosinusitis with nasal polyps,including seven with unilateral disease and five with bilateral disease.Eight subjects showed positive skin prick test.Elevated serum total IgE and eosinophil count were found in six cases and eight cases respectively.Most of the patients showed patchy or nebulous increased attenuation within the completely opacified sinuses on CT scan.Histopathological examination of the eosinophilic mucus revealed abundant eosinophilic infiltration but no obvious fungal hyphae,and fungal culture was negative.All EMRS patients received endoscopic sinus surgery,oral and topical corticosteroids were administered postoperatively.Three patients recurred within one year after surgery.Conclusion EMRS was a subgroup of chronic rhinosinusitis with special characteristics.Prompt and accurate diagnosis of EMRS was dependent on histopathological examination postoperatively,surgical therapy along with corticosteroid use stood as main strategy for management.%目的:研究嗜酸性粒细胞黏蛋白性鼻-鼻窦炎(EMRS)的临床特征。方法回顾性分析EMRS患者的临床特征,包括性别、年龄、症状、实验室检查、影像学表现、病理结果、治疗及预后。结果12例EMRS患者男性7例、女性5例;年龄9~54岁;单侧7例、双侧5例;均具有慢性鼻鼻窦炎伴息肉的表现。8例变应原皮肤点刺试验阳性,6例血清总IgE升高,8例外周血嗜酸性粒细胞升高。鼻窦CT多表现为受累鼻窦腔内中间呈斑片状或云雾状高密度影。

  12. The Eosinophil in Infection.

    Ravin, Karen A; Loy, Michael


    First described by Paul Ehrlich in 1879, who noted its characteristic staining by acidophilic dyes, for many years, the eosinophil was considered to be an end-effector cell associated with helminth infections and a cause of tissue damage. Over the past 30 years, research has helped to elucidate the complexity of the eosinophil's function and establish its role in host defense and immunity. Eosinophils express an array of ligand receptors which play a role in cell growth, adhesion, chemotaxis, degranulation, and cell-to-cell interactions. They play a role in activation of complement via both classical and alternative pathways. Eosinophils synthesize, store and secrete cytokines, chemokines, and growth factors. They can process antigen, stimulate T cells, and promote humoral responses by interacting with B cells. Eosinophils can function as antigen presenting cells and can regulate processes associated with both T1 and T2 immunity. Although long known to play a role in defense against helminth organisms, the interactions of eosinophils with these parasites are now recognized to be much more complex. In addition, their interaction with other pathogens continues to be investigated. In this paper, we review the eosinophil's unique biology and structure, including its characteristic granules and the effects of its proteins, our developing understanding of its role in innate and adaptive immunity and importance in immunomodulation, and the part it plays in defense against parasitic, viral, fungal and bacterial infections. Rather than our worst enemy, the eosinophil may, in fact, be one of the most essential components in host defense and immunity.

  13. Eosinophilic fasciitis after parasite infection

    Marta Oliveira


    Full Text Available Eosinophilic fasciitis is a systemic inflammatory disease characterized by symmetrical swelling and skin induration of the distal portions of the arms and/or legs, evolving into a scleroderma-like appearance, accompanied by peripheral blood eosinophilia. It is a rare disease with a poorly understood etiology. Corticosteroid treatment remains the standard therapy, either taken alone or in association with an immunosuppressive drug. This paper presents a case of a male patient with palpebral edema and marked eosinophilia, diagnosed with intestinal parasitic infection in October 2006. He was treated with an antiparasitic drug, but both the swelling and the analytical changes remained. This was followed by a skin and muscle biopsy, which turned out to be compatible with eosinophilic fasciitis. There was progressive worsening of the clinical state, with stiffness of the abdominal wall and elevated inflammatory parameters, and the patient was referred to the Immunology Department, medicated with corticosteroids and methotrexate. Over the years there were therapeutic adjustments and other causes were excluded. Currently the patient continues to be monitored, and there is no evidence of active disease. The case described in this article is interesting because of the diagnosis of eosinophilic fasciitis probably associated/coexisting with a parasite infection. This case report differs from others in that there is an uncommon cause associated with the onset of the disease, instead of the common causes such as trauma, medication, non-parasitic infections or cancer.

  14. Eosinophilic fasciitis after parasite infection.

    Oliveira, Marta; Patinha, Fabia; Marinho, Antonio


    Eosinophilic fasciitis is a systemic inflammatory disease characterized by symmetrical swelling and skin induration of the distal portions of the arms and/or legs, evolving into a scleroderma-like appearance, accompanied by peripheral blood eosinophilia. It is a rare disease with a poorly understood etiology. Corticosteroid treatment remains the standard therapy, either taken alone or in association with an immunosuppressive drug. This paper presents a case of a male patient with palpebral edema and marked eosinophilia, diagnosed with intestinal parasitic infection in October 2006. He was treated with an antiparasitic drug, but both the swelling and the analytical changes remained. This was followed by a skin and muscle biopsy, which turned out to be compatible with eosinophilic fasciitis. There was progressive worsening of the clinical state, with stiffness of the abdominal wall and elevated inflammatory parameters, and the patient was referred to the Immunology Department, medicated with corticosteroids and methotrexate. Over the years there were therapeutic adjustments and other causes were excluded. Currently the patient continues to be monitored, and there is no evidence of active disease. The case described in this article is interesting because of the diagnosis of eosinophilic fasciitis probably associated/coexisting with a parasite infection. This case report differs from others in that there is an uncommon cause associated with the onset of the disease, instead of the common causes such as trauma, medication, non-parasitic infections or cancer.

  15. Epidemiological investigation of esophageal carcinoma

    Hong Zhang; Shao-Hua Chen; You-Ming Li


    AIM: To review the characteristics of esophageal carcinoma in recent 30 years in the epidemiological investigation.METHODS: A total of 1 520 cases of esophageal carcinoma in the First Affiliated Hospital of Zhejiang University Medical College admitted from 1970 until now were reviewed. Their age, gender, position of carcinoma and histological type were analyzed.RESULTS: The morbidity of esophageal carcinoma was increasing during the observation period. Compared with the 1970s (9.5%), the ratio of adenocarcinoma significantly increased after the 1980s (19.1%). The difference was significant (P≤0.05).CONCLUSION: The morbidity of esophageal adenocarcinoma was increasing and advanced clinical study should be strengthened.

  16. Clinical Outcomes of Endoscopic Submucosal Dissection for Early Esophageal Squamous Cell Neoplasms: A Retrospective Single-Center Study in China

    Yanfang Chen


    Full Text Available Aims. To retrospectively analyze the clinical outcomes for a large number of endoscopic submucosal dissections (ESDs in early esophageal squamous cell neoplasms (ESCNs at the First Affiliated Hospital of Nanjing Medical University. Patients and Methods. From January 2010 to February 2014, 296 patients (mean age 61.4 years, range 31–85 years; 202 men with 307 early ESCNs (79 intramucosal invasive esophageal squamous cell carcinomas (ESCCs and 228 high-grade intraepithelial neoplasia (HGIN cases were included from a total of 519 consecutive patients who were treated by esophageal ESD at our hospital. The primary end points of the study were rates of en bloc resection and complete resection. Secondary end points were complications, residual and recurrence rates, and mortality during follow-up. Results. The en bloc resection rate and complete resection rate were 93.5% and 78.2%, respectively. Complications included strictures (8.4%, perforations (1.0%, and bleedings (0.7%. Twenty-seven (9.1% patients experienced residual and 18 (6.1% patients experienced recurrence during a mean follow-up period of 30 months. Thirteen patients died from causes unrelated to ESCC, and no cancer-related death was observed. Conclusions. Our study showed that ESD is a successful and relatively safe treatment for intramucosal invasive ESCC and HGIN, fulfilling the criteria of lymph node negative tumors. This should encourage clinicians to select ESD performed by experienced operators as a potential or even preferred treatment option for lesions amenable to endoscopic treatment.

  17. [Clinical observation on treatment of gastro-esophageal reflux with modified zhizhu pill].

    Ghen, Jian-yong; Qiu, Jian-rong; Pan, Feng


    To observe the therapeutic effect of modified Zhizhu pill (ZZP) in treating gastro-esophageal reflux disease (GERD) and to explore its mechanism. Sixty-three GERD patients were randomly divided into the treated group (n = 30) and the control group (n = 33). The treated group was treated with ZZP 100 ml, twice daily by orally taking half an hour before meal. The control group was treated with Ranitidine 0.15 g, twice daily and Cisapride 10 mg, three times a day by orally taking before meal. The therapeutic course for both groups was 8 weeks. The changes of symptom scoring, endoscopic examination, esophageal pressure, 24 hrs monitoring on pH and blood level of motilin in the two groups were recorded and compared. After treatment, the symptom scoring, esophageal pressure, 24 hrs monitoring on pH and blood motilin level were improved in both groups (P < 0.05), and the improvement in the treated group was more significant than that in the control group (P < 0.05). ZZP has good effect in treating GERD.

  18. Conservative management of eosinophilic enteritis presenting with acute abdominal syndrome

    Marco Bassi


    Full Text Available Eosinophilic enteritis, an increasing recognized condition, is rare and often presents with non-specific symptoms. We report a case of a 46-year old female who presented with acute onset abdominal pain and nausea associated with ascites, small bowel thickening and peripheral eosinophilia. Diagnosis was confirmed by biopsies taken at esophagogastroduodenoscopy demonstrating diffuse infiltration by inflammatory cells, mainly eosinophils. Appropriate therapy was instituted. The patient recovered well and was symptom-free at 1-month follow up. In this report, we discuss the clinical presentation and the diagnostic criteria of the eosinophilic enteritis, and examine the pathophysiological theories and therapeutic strategies. The relevant literature on eosinophilic enteritis is summarized.

  19. Enterobiliary Fistula as a Complication of Eosinophilic Gastroenteritis: a Case Report

    Kim, Han Myun; Woo, Ji Young [Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul (Korea, Republic of)


    Eosinophilic gastroenteritis is an uncommon disease with variable clinical features characterized by eosinophilic infiltration. Clinical manifestations range from non-specific gastrointestinal complaints such as nausea, vomiting, crampy abdominal pain, and diarrhea to specific findings such as malabsorption, protein loosing enteropathy, luminal obstruction, eosinophilic ascites and effusion. We report here on a case of eosinophilic gastroenteritis causing enterobiliary fistula which is an extremely unusual complication

  20. Clinical relevance of novel Otarine herpesvirus-3 in California sea lions (Zalophus californianus: lymphoma, esophageal ulcers, and strandings

    Venn-Watson Stephanie


    Full Text Available Abstract Herpesviruses have been recognized in marine mammals, but their clinical relevance is not always easy to assess. A novel otarine herpesvirus-3 (OtHV3 was detected in a geriatric California sea lion (Zalophus californianus, and using a newly developed quantitative PCR assay paired with histology, OtHV3 was associated with esophageal ulcers and B cell lymphoblastic lymphoma in this animal. The prevalence and quantities of OtHV3 were then determined among buffy coats from 87 stranded and managed collection sea lions. Stranded sea lions had a higher prevalence of OtHV3 compared to managed collection sea lions (34.9% versus 12.5%; p = 0.04, and among the stranded sea lions, yearlings were most likely to be positive. Future epidemiological studies comparing the presence and viral loads of OtHV3 among a larger population of California sea lions with and without lymphoid neoplasia or esophageal ulcers would help elucidate the relevance of OtHV3-associated pathologies to these groups.

  1. Clinical relevance of novel Otarine herpesvirus-3 in California sea lions (Zalophus californianus): lymphoma, esophageal ulcers, and strandings.

    Venn-Watson, Stephanie; Benham, Celeste; Gulland, Frances M; Smith, Cynthia R; St Leger, Judy; Yochem, Pam; Nollens, Hendrik; Blas-Machado, Uriel; Saliki, Jeremiah; Colegrove, Katie; Wellehan, James Fx; Rivera, Rebecca


    Herpesviruses have been recognized in marine mammals, but their clinical relevance is not always easy to assess. A novel otarine herpesvirus-3 (OtHV3) was detected in a geriatric California sea lion (Zalophus californianus), and using a newly developed quantitative PCR assay paired with histology, OtHV3 was associated with esophageal ulcers and B cell lymphoblastic lymphoma in this animal. The prevalence and quantities of OtHV3 were then determined among buffy coats from 87 stranded and managed collection sea lions. Stranded sea lions had a higher prevalence of OtHV3 compared to managed collection sea lions (34.9% versus 12.5%; p = 0.04), and among the stranded sea lions, yearlings were most likely to be positive. Future epidemiological studies comparing the presence and viral loads of OtHV3 among a larger population of California sea lions with and without lymphoid neoplasia or esophageal ulcers would help elucidate the relevance of OtHV3-associated pathologies to these groups.

  2. Eosinophilic Granulomatosis With Polyangiitis With Thrombotic Microangiopathy: Is Simultaneous Systemic Lupus Erythematosus Associated With Clinical Manifestations?: A Case Report and Review of the Literature.

    Fukui, Shoichi; Iwamoto, Naoki; Tsuji, Sosuke; Umeda, Masataka; Nishino, Ayako; Nakashima, Yoshikazu; Suzuki, Takahisa; Horai, Yoshiro; Koga, Tomohiro; Kawashiri, Shin-Ya; Ichinose, Kunihiro; Hirai, Yasuko; Tamai, Mami; Nakamura, Hideki; Origuchi, Tomoki; Kinoshita, Naóe; Kawakami, Atsushi


    Eosinophilic granulomatosis with polyangiitis (EGPA) is one of the antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, which is characterized by vasculitis of the small to medium-sized vessels. On the contrary, thrombotic microangiopathy (TMA) is a life-threatening condition which can cause ischemic organ injury. Although several case reports have described patients with TMA associated with ANCA-associated vasculitis except for EGPA, there are no previous case reports of EGPA associated with TMA.A 71-year-old Japanese man was diagnosed with EGPA based on his asthma, eosinophilia, lung opacity, refractory sinusitis, and positive myeloperoxidase-ANCA. He was also diagnosed with TMA based on peripheral schizocytes and hemolytic anemia. We performed plasmapheresis and started high-dose corticosteroid therapy; thereafter, he improved promptly. His case also fulfilled the classification criteria of systemic lupus erythematosus (SLE) based on the pleural effusion, renal disorder, anemia, thrombocytopenia, positive antidouble-stranded DNA antibody, and low complement. Elements of SLE were thought to affect his clinical course.We reviewed 11 patients with EGPA or hypereosinophilic syndrome (HES) associated with SLE, including our case. Patients with EGPA or HES associated with SLE had more heart complications than patients with simple EGPA or simple HES did. Patients with EGPA or HES associated with SLE had more pleural effusion than patients with simple SLE did.Clinical manifestations of eosinophilia with SLE or SLE with eosinophilia may differ from simple SLE or simple eosinophilia.

  3. Steroid responsive eosinophilic gastric outlet obstruction in a child

    Richard Kellermayer; Nina Tatevian; William Klish; Robert J Shulman


    Gastric outlet obstruction is a rare complication of eosinophilic gastroenteritis, most commonly treated surgically. We report a case of eosinophilic gastric outlet obstruction in a child that responded to conservative medical management. A brief review of this clinical entity is also provided.

  4. New Insights into Eosinophilic Otitis Media.

    Kanazawa, Hiromi; Yoshida, Naohiro; Iino, Yukiko


    Eosinophilic otitis media (EOM) is a type of intractable otitis media that occurs mainly in patients with bronchial asthma (BA). In 2011, the diagnostic criteria for EOM were established. EOM is characterized by the presence of a highly viscous yellowish effusion containing eosinophils and immunoglobulin E (IgE), eosinophil chemoattractants, such as eosinophil cationic protein, interleukin-5, and eotaxin. Local sensitization against foreign agents such as fungi or bacteria (e.g., Staphylococcus aureus) may result in local IgE production in the middle ear and may be responsible for the severity of EOM. The clinical features of EOM closely resemble localized eosinophilic granulomatosis polyangiitis, therefore it is necessary to be vigilant to the symptoms of mononeuritis, polyneuritis, and skin purpura during diagnosis. Standard treatment for EOM is the instillation of triamcinolone acetonide into the mesotympanum. However, severe cases exhibiting strong inflammation and otorrhea are not easily controlled with antibiotics and/or corticosteroids. We proposed the introduction of a severity score to evaluate the severity of EOM. This score correlated with local IgE levels in middle ear effusion. Clinically, the risk factors associated with this severity score were body mass index, and the duration of bronchial asthma (from the onset of BA to the age of the first consultation of otitis media to our hospital). We emphasize that early diagnosis and adequate treatment are vital in preventing progressive and sudden hearing loss resulting from EOM.

  5. Determining the lymph node clinical target volume of upper esophageal carcinoma with computed tomography

    Li Minghuan


    Full Text Available Radiation is an important modality for cervical and upper-thoracic esophageal squamous cell carcinoma (ESCC. Delineating the lymph node clinical target volume (CTVn for EC remains a challenging task. The present paper retrospectively analyzes the distribution of affected lymph nodes of cervical and upper thoracic ESCC on CT images to provide a reference for determination of CTVn. The cases of untreated cervical or upper-thoracic ESCC patients with regional lymph node metastases at diagnosis were retrospectively analyzed. CT scans were done to assess the extent of circumferential involvement and the local-regional lymph node status. Based on the CT criteria (cervical, mediastinal and upper abdominal lymph nodes were considered to be positive for malignancy when they were larger than 8-12 mm in short-axis diameter according to different station respectively. Detailed lymph node stations were recorded for every case and the distribution information of loco-regional node metastasis for these patients was analyzed. A total of 256 patients were diagnosed with node metastasis and qualified for the study, including 206 men and 50 women (age range 37-85 years, median 60. This included 205 upper thoracic cases and 51 of cervical lesion. The length of the primary tumors ranged from 1.0 cm to 9.0 cm, median 4.5 cm. The size of the enlarged lymph nodes ranged from 0.8 to 5.0 cm median 1.4 cm, mean 1.61 cm. The number of involved stations ranged from 1 to 7 median 2. The lymph node stations, with an involved probability of 10% or more, included the upper and middle neck, supraclavicular and lower neck, upper paraesophageal and upper paratracheal area for cervical lesions, and the supraclavicular and lower neck, upper paraesophageal, upper paratracheal, lower paratracheal, aortopulmonary and subcarinal areas for upper thoracic EC, respectively. The mid-upper neck nodes were more likely to be involved in cervical EC than thoracic EC (X 2 test, p=0.000. Fewer

  6. Changes of serum p53 antibodies and clinical significance of radiotherapy for esophageal squamous cell carcinoma

    Hong-Yi Cai; Xiao-Hu Wang; Ying Tian; Li-Ying Gao; Li-Juan Zhang; Zhi-Yan Zhang


    AIM: To explore the relationship between serum p53 antibodies (p53-Abs) and clinicopathological characteristics and therapeutic effect in patients with esophageal carcinoma (EC), and to investigate sequential changing regularity of serum p53-Abs after radiotherapy.METHODS: The serum p53-Ab levels were detected in 46 EC patients and 30 healthy adults by enzyme linked immunosorbent assay (ELISA). The blood samples were collected on the day before radiotherapy and on the administration of an irradiation dose of 20 Gy/10 f/12 d, 40 Gy/20 f/24 d and 60 Gy/30 f/36 d after radiotherapy.RESULTS: The level and positive rate of serum p53-Abs in EC patients were significantly higher than those in normal individuals (P<0.05). Serum anti-p53 antibodies were positive in 18 of 46 EC patients (39.1%). The positive rate of p53-Abs in EC was related to histological grade, disease stage and lymph node metastasis (P<0.05), but it was not significantly related to sex, age and to the size and site of tumor. The level and positive rate of p53-Abs had significant differences between before radiotherapy and after administration of an irradiation dose of 40 Gy/20 f/24 d and 60 Gy/30 f/36 d (P<0.05 or P<0.01). The positive rate of p53-Abs in EC patients with effect was significantly lower than that in those without effect after radiotherapy (P<0.0001).CONCLUSION: Detection of serum p53-Abs is helpful to the diagnosis of esophageal carcinoma. Monitoring for sequential change of serum p53-Abs before and after radiotherapy in patients with esophageal carcinoma is also useful to evaluate the response to the treatment and prognosis of the patients.

  7. Nonpathogenic, environmental fungi induce activation and degranulation of human eosinophils.

    Inoue, Yoshinari; Matsuwaki, Yoshinori; Shin, Seung-Heon; Ponikau, Jens U; Kita, Hirohito


    Eosinophils and their products are probably important in the pathophysiology of allergic diseases, such as bronchial asthma, and in host immunity to certain organisms. An association between environmental fungal exposure and asthma has been long recognized clinically. Although products of microorganisms (e.g., lipopolysaccharides) directly activate certain inflammatory cells (e.g., macrophages), the mechanism(s) that triggers eosinophil degranulation is unknown. In this study we investigated whether human eosinophils have an innate immune response to certain fungal organisms. We incubated human eosinophils with extracts from seven environmental airborne fungi (Alternaria alternata, Aspergillus versicolor, Bipolaris sorokiniana, Candida albicans, Cladosporium herbarum, Curvularia spicifera, and Penicillium notatum). Alternaria and Penicillium induced calcium-dependent exocytosis (e.g., eosinophil-derived neurotoxin release) in eosinophils from normal individuals. Alternaria also strongly induced other activation events in eosinophils, including increases in intracellular calcium concentration, cell surface expression of CD63 and CD11b, and production of IL-8. Other fungi did not induce eosinophil degranulation, and Alternaria did not induce neutrophil activation, suggesting specificity for fungal species and cell type. The Alternaria-induced eosinophil degranulation was pertussis toxin sensitive and desensitized by preincubating cells with G protein-coupled receptor agonists, platelet-activating factor, or FMLP. The eosinophil-stimulating activity in Alternaria extract was highly heat labile and had an M(r) of approximately 60 kDa. Thus, eosinophils, but not neutrophils, possess G protein-dependent cellular activation machinery that directly responds to an Alternaria protein product(s). This innate response by eosinophils to certain environmental fungi may be important in host defense and in the exacerbation of inflammation in asthma and allergic diseases.

  8. First reports of esophageal adenocarcinoma with white globe appearance in Japanese and Caucasian patients

    Tonai, Yusuke; Ishihara, Ryu; Yamasaki, Yasushi; Kanesaka, Takashi; Yamamoto, Sachiko; Akasaka, Tomofumi; Hanaoka, Noboru; Takeuchi, Yoji; Higashino, Koji; Uedo, Noriya; Tomita, Yasuhiko; Iishi, Hiroyasu


    Background and study aims: Better endoscopic diagnosis in case of Barrett’s esophagus is still needed. White globe appearance (WGA) is a novel endoscopic marker for gastric adenocarcinoma, with high sensitivity for differentiating between gastric cancer/high-grade dysplasia and other lesions. We report 2 cases of esophageal adenocarcinoma with WGA. In Case 1, esophagogastroduodenoscopy (EGD) revealed a 10-mm esophageal adenocarcinoma in a 48-year-old Japanese woman with short-segment Barrett’s esophagus. A small (< 1 mm) white globular lesion, typical of WGA, was observed under the epithelium by magnifying narrow-band imaging. A dilated neoplastic gland with eosinophilic material and necrotic epithelial fragments was identified at the site of the WGA by histologic examination. In Case 2, EGD revealed a 5-mm esophageal adenocarcinoma in a 60-year-old Caucasian man with long-segment Barrett’s esophagus. A typical WGA was observed by magnifying narrow-band imaging and similar histologic findings were identified at the site of the WGA. WGA could be a reliable endoscopic finding for target biopsy in esophageal adenocarcinoma, if its specificity is as high as in gastric cancer. The clinical implications of WGA in patients with Barrett’s esophagus should be investigated further. PMID:27747281

  9. Esophageal cancer.

    Vakil, Nimish; Affi, Aboud


    Despite advances in our knowledge of esophageal cancer, 50% of patients present with incurable disease, and the overall survival after diagnosis is poor. The incidence of esophageal adenocarcinoma of the distal esophagus is rising at a rapid rate in developed countries. Recent advances in the epidemiology of esophageal cancer offer insights into preventive strategies in patients who are at risk. New developments in diagnosis may help detect the disease at an early stage. New diagnostic modalities permit more accurate staging procedures and allow appropriate selection of therapy. New studies provide more information on multimodality therapy for esophageal cancer, and new endoscopic techniques allow resection of small lesions without surgery. New stent designs provide better palliation by providing tumor ingrowth. These developments in the treatment of esophageal cancer are the focus of this review.

  10. Significance of supraclavicular lymph node involvement on determination of clinical staging for thoracic esophageal carcinoma

    Wu, Hong Gyun; Park, Charn II; Ha, Sung Whan; Kim, Il Han [College of Medicine, Seoul National Univ., Seoul (Korea, Republic of)


    Involvement of supraclavicular lymph nodes (SCL) is considered distant metastasis for thoracic esophageal carcinoma in AJCC staging system revised in 1997. We investigated significance of SCL involvement compared to other regional lymph node involvement. Two- hundred eighty-nine patients with unresectable esophageal carcinoma were treated with radiation therapy from June of 1979 through December 1992. of these patients, 25 were identified having SCL involvement. Survival rate and relapse patterns were compared with that of mediastinal and perigastric lymph node positive patients to evaluate prognostic significance of SCL involvement. Median survival for patients with SCL involvement was 7 months and 2- and 5-year overall survival rates were 12.0% and 4.0% respectably. Corresponding features for regional node positive patients were 9 month, 17.0% and 3.8%. There was no significant difference between two groups. There was also no difference in patterns of recurrence. Results of this analysis showed that SCL involvement should be staged as nodal disease in contrast to present classification of metastatic disease.

  11. Clinical study of simultaneous lung volume reduction surgery during resection of pulmonary or esophageal neoplasms

    TANG Yi-jun; WANG Chao-yang; WANG Cheng-de; DONG Yao-zhong


    Background If the emphysema lesions are not symmetrical, unilateral lung volume reduction surgery (LVRS) can be carried out on the more severe side. The aim of this research was to evaluate the feasibility and effects of LVRS performed simultaneously with resection of pulmonary and esophageal neoplasms.Methods Forty-five patients with pulmonary neoplasm and 37 patients with esophageal neoplasm were randomly assigned to group A or group B. In group A, LVRS was performed simultaneously on the same side as thoracotomy. In group B, only tumor resection was performed. The nonfunctional lung area was determined by preoperative chest computed tomography and lung ventilation/perfusion scan. The lung volume removed was about 20% to 30% of the lobes on one side. Preoperative and postoperative indexes including pulmonary function testing variables, arterial blood gas analysis variables, dyspnea scale, 6-minute walk distance, etc., were compared between the groups.Results There were no surgical deaths in this study. The postoperative forced vital capacity in 1 second, PaO_2, PaCO_2,dyspnea scale, and 6-minute walk distance were improved significantly in group A, whereas these indexes did not change or decreased slightly in group B.Conclusions For tumor patients who have associated emphysema, simultaneous LVRS not only increases the chance of receiving surgical therapy, but also improves the postoperative quality of life of the patient. LVRS has expanded thesurgical indication for tumor patients.

  12. Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis: diagnostic criteria.

    Uri, N; Ronen, O; Marshak, T; Parpara, O; Nashashibi, M; Gruber, M


    Chronic sinusitis is one of the most common otolaryngological diagnoses. Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis can easily be misdiagnosed and treated as chronic sinusitis, causing continuing harm. To better identify and characterise these two subgroups of patients, who may suffer from a systemic disease requiring multidisciplinary treatment and prolonged follow up. A retrospective, longitudinal study of all patients diagnosed with allergic fungal sinusitis or eosinophilic mucin rhinosinusitis within one otolaryngology department over a 15-year period. Thirty-four patients were identified, 26 with eosinophilic mucin rhinosinusitis and 8 with allergic fungal sinusitis. Orbital involvement at diagnosis was commoner in allergic fungal sinusitis patients (50 per cent) than eosinophilic mucin rhinosinusitis patients (7.7 per cent; p sinusitis patients. Allergic fungal sinusitis and eosinophilic mucin rhinosinusitis have the same clinical presentation but different clinical courses. The role of fungus and the ability to confirm its presence are still problematic issues, and additional studies are required.

  13. Olanzapine-induced eosinophilic pleuritis

    Matthew Evison


    Eosinophilic pleural fluid is not a marker of non-malignant aetiology and eosinophilic pleural effusions require a careful and systematic diagnostic work-up. This is the second case report to identify olanzapine as a causative agent in eosinophilic pleural effusion.

  14. Clinical Studies of Postoperative Arterial Infusion Chemotherapy in Patients with Pathologic T3 Esophageal Squamous Carcinoma

    Baodong Liu; Zongjun Dong; Xiuyi Zhi; Qingsheng Xu


    OBJECTIVE To evaluate how arterial infusion chemotherapy after radical surgery influences long-term survival of patients with pathologic T3 (pT3) esophageal squamous carcinoma.METHODS We divided 190 patients with pathologic pT3 esophageal squamous carcinoma, confirmed by consecutive radical surgery, into an experimental group (surgery + intra-arterial infusion, 56 T3N0M0 and 52 T3N1M0 cases), and the remaining patients into a control group (surgery alone, 48 T3N0M0 and 34 T3N1M0 cases). The experimental group was sub-grouped into 56 cases (26 T3N0M0 and 30 T3N1M0 cases) receiving 1 or 2 periods of chemotherapy, while 52 cases (30 T3N0M0 and 22 T3N1M0 cases) underwent 3 or more than 3 periods of chemotherapy. We used one to seven courses of selected arterial infusion chemotherapy of cisplatin (80 mg/m2 of body-surface area) and fluorouracil (800 mg/m2) with or without epirubicin at 3~4 weeks post operation. The interval between each period was 3~4 weeks. All cases were followed-up for more than 5 years. Survival rates were calculated by the Kaplan-Meier methods and survival differences between patients with and without selected arterial infusion chemotherapy were compared with the Log-rank test. Prognostic variables were entered into a Cox regression analysis model controlling for age, site, lymph node status, and treatment received.RESULTS The overall survival rates were not significantly different between the experimental group and the control group, but there was better survival for patients who received 3 or more than 3 courses of chemotherapy. Lymph node status (N) was an important factor in the prognosis.CONCLUSION Trans-catheter arterial infusion chemotherapy is a safe and effective method of therapy. Postoperative selective arterial infusion chemotherapy can improve the survival rate in patients with esophageal squamous carcinoma who were previously treated by radical surgery.However, this modality of therapy needs further investigation.

  15. Esophageal Cancer Prevention

    ... the lower part of the esophagus, near the stomach. See the following PDQ summaries for more information about esophageal cancer: Esophageal Cancer Screening Esophageal Cancer Treatment Esophageal cancer is found more ...

  16. Esophageal Cancer Screening

    ... Esophageal Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Screening (PDQ®)–Patient Version What is screening? Go to ... the esophagus and the stomach). Being overweight . Esophageal Cancer Screening Key Points Tests are used to screen for ...

  17. Potential clinical insights into microRNAs and their target genes in esophageal carcinoma.

    Li, Su Q; Wang, He M; Cao, Xiu F


    Esophageal carcinoma (EC) are characterized by dysregulation of microRNAs, which play an important roles as a posttranscriptional regulators in protein synthesis, and are involved in cellular processes, such as proliferation, apoptosis, and differentiation. Recently, altered miRNAs expression has been comprehensively studied in EC by high-throughput technology. Increased understanding of miRNAs target genes and their potential regulatory mechanisms have clarified the miRNAs activities and may provide exciting opportunities for cancer diagnosis and miRNA-based genetherapy. Here, we reviewed the most recently discovered miRNA target genes, with particular emphasis on the deciphering of their possible mechanisms and the potential roles in miRNAs-based tumour therapeutics.

  18. Clinical Outcome in Definitive Concurrent Chemoradiation With Weekly Paclitaxel and Carboplatin for Locally Advanced Esophageal and Junctional Cancer.

    Noronha, Vanita; Prabhash, Kumar; Joshi, Amit; Patil, Vijay Maruti; Talole, Sanjay; Nakti, Dipti; Sahu, Arvind; Shah, Srushti; Ghosh-Laskar, Sarbani; Patil, Prachi S; Mehta, Shaesta A; Jambhekar, Nirmala; Mahajan, Abhishek; Purandare, Nilendu


    There are little data on the efficacy and safety of taxane/platinum with definitive radiotherapy (RT) for esophageal/GEJ cancer. This article is a retrospective analysis of patients who received weekly paclitaxel 50 mg/m(2) and carboplatin AUC 2 with radical definitive RT for locally advanced esophageal/GEJ cancer. Between February 2011 and July 2014, 179 patients were included. The median age was 54 years. Ninety-two percent of patients had squamous histology. Mean RT dose was 58.7 Gy in 32 fractions over 53 days, with mean of six chemotherapy cycles. Fifty-six percent of patients developed ≥grade 3 acute toxicities, commonly febrile neutropenia (12%) and infection (11%); ≥grade 3 laboratory abnormalities included hyponatremia (38%), leukopenia (49%), neutropenia (27%), and anemia (16%). Twelve percent of patients developed ≥grade 3 chronic toxicity. Fatal toxicities included six during CRT, eight within 30 days of completing CRT, and three chronic. Radiologic response was 49% (CR 5.6%, PR 43%). Follow-up endoscopy showed remission in 53% and residual disease in 14%. At a median follow-up of 28 months, median PFS was 11 months (95% CI: 8-13.9), median OS was 19 months (95% CI: 15.4-22.6), and estimated 1-year, 2-year, and 3-year survivals were 70%, 47%, and 39%, respectively. Weekly paclitaxel-carboplatin concurrently with definitive RT is efficacious with manageable toxicity. [The trial was registered with the Clinical Trials Registry-India (CTRI), registration number: CTRI/2014/07/004776.].

  19. Assessing esophageal dysphagia.

    Kruger, Danielle


    Dysphagia, or difficulty swallowing, is a common problem. Although most cases are attributable to benign disease processes, dysphagia is also a key symptom in several malignancies, making it an important symptom to evaluate. The differential diagnosis of dysphagia requires an understanding of deglutition, in particular the oropharyngeal versus esophageal stages. Stroke is the leading cause of oropharyngeal dysphagia, which is common in older adults and frequently presents as part of a broader complex of clinical manifestations. In esophageal dysphagia, difficulty swallowing is often the main complaint and is caused by localized neuromuscular disorders or obstructive lesions.

  20. Eosinophilic infiltration in Korea: idiopathic?

    Lim, Jae Hoon; Lee, Kyung Soo [Sungkyunkwan University School of Medicine, Seoul (Korea, Republic of)


    Eosinophilia is defined as the presence of more than 500 eosinophils/{mu}L in the peripheral blood, and may be accompanied by eosinophil infiltration in tissues. Focal eosinophilic infiltration in the lungs and liver is relatively common and is often associated with a parasitic infection, drug hypersensitivity, allergic diseases, collagen vascular diseased, and internal malignancies such as Hodgkin's disease, as well as cancer of the lung, stomach, pancreas or ovary. An eosinophilic abscess refers to a lesion of massive eosinophil infiltration and associated destroyed tissue, and an eosinophilic granuloma refers to a lesion consisting of central necrosis and mixed inflammatory cell infiltrates with numerous eosinophils, a number of neutrophils and lymphocytes, and a palisade of epithelioid histiocytes and/or giant cells.

  1. Eosinophilic Pleural Effusion: A Rare Manifestation of Hypereosinophilic Syndrome

    Ndubuisi C. Okafor


    Full Text Available Several causes of eosinophilic pleural effusions have been described with malignancy being the commonest cause. Hypereosinophilic syndrome (HES is a rare disease and very few cases have been reported of HES presenting as eosinophilic pleural effusion (EPE. We report a case of a 26-year-old male who presented with shortness of breath. He had bilateral pleural effusions, generalized lymphadenopathy, splenomegaly, and leukocytosis with marked peripheral blood eosinophilia. The pleural fluid was exudative, with 25%–30% eosinophilis, and absence of neoplastic cells. Hypereosinophilic syndrome was diagnosed after other causes of eosinophilia were excluded. He continued to be dyspneic with persistent accumulation of eosinophilic pleural fluid, even after his peripheral eosinophil count had normalized in response to treatment. This patient represents a very unusual presentation of HES with dyspnea and pleural effusions and demonstrates that treatment based on response of peripheral eosinophil counts, as is currently recommended, may not always be clinically adequate.

  2. An Atypical Case of Eosinophilic Gastroenteritis Presenting as Hypovolemic Shock

    Miguel Martillo


    Full Text Available Eosinophilic gastroenteritis is an uncommon condition characterized by focal or diffuse infiltration of eosinophils in the gastrointestinal tract in the absence of secondary causes. The pathogenesis of this condition is not well understood and its clinical presentation depends on the segment and layer of the gastrointestinal tract affected. The definition of eosinophilic gastroenteritis may be difficult, as the normal ranges of eosinophil numbers in normal and abnormal gastric and intestinal mucosa are not standardized. We present the case of a 59-year-old male who came to the hospital with hypovolemic shock and lethargy secondary to severe diarrhea. Laboratory analysis was significant for peripheral eosinophilia, and pathology from both the duodenum and colon showed marked eosinophilic infiltration.

  3. Eosinophilic gastroenteritis associated with multiple gastric cancer.

    Otowa, Yasunori; Mitsutsuji, Masaaki; Urade, Takeshi; Chono, Teruhiro; Morimoto, Haruki; Yokoyama, Kunio; Hirata, Kenro; Kawamura, Shiro; Shimada, Etsuji; Fujita, Masayuki


    Eosinophilic gastroenteritis (EG) is an inflammation of the digestive tract that is characterized by eosinophilic infiltration. There are no specific symptoms, and are related to the layer in which eosinophilic infiltration is observed. A 69-year-old Japanese man presented to our hospital with a history of general malaise, diarrhea, and dysgeusia. Esophagogastroduodenoscopy showed reddish elevated lesions that were edematous all over the gastric mucosa. In addition, three tumors were also observed. The biopsies of the reddish elevated mucosa revealed eosinophilic infiltration and tubular adenocarcinoma from the tumors. Colonoscopy showed abnormal reddish elevated mucosa. The biopsies from the reddish elevated mucosa showed eosinophilic infiltration. From the abdominal contrast computed tomography scan, tumor stain was seen in the anterior wall of the gastric body. No ascites, intestinal wall thickening, or lymph node swelling were found. A slight elevation in the serum immunoglobulin E (IgE), 480 IU/ml, was found from the laboratory test results; other laboratory results were within normal limits including the number of peripheral eosinophils. No specific allergen was found from the multiple antigen simultaneous test and from the skin patch test. The parasitic immunodiagnosis was negative. He was diagnosed with EG associated with gastric cancer and underwent total gastrectomy, regional lymph node dissection with reconstruction by a Roux-en-Y method. He was prescribed prednisolone after the operation and showed a good clinical response. There are many case reports on EG, but none of them were associated with cancer. We encountered a case of EG associated with multiple gastric cancer; the patient underwent total gastrectomy.

  4. Proton pump inhibitor responsive esophageal eosinophilia, a distinct disease entity?

    Munday, William; Zhang, Xuchen


    Recent studies have suggested the existence of a patient population with esophageal eosinophilia that responds to proton pump inhibitor therapy. These patients are being referred to as having proton pump inhibitor responsive esophageal eosinophilia (PPI-REE), which is currently classified as a distinct and separate disease entity from both gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE). The therapeutic effect of proton pump inhibitor (PPI) on PPI-REE is thought to act directly at the level of the esophageal mucosa with an anti-inflammatory capacity, and completely independent of gastric acid suppression. The purpose of this manuscript is to review the mechanistic data of the proposed immune modulation/anti-inflammatory role of the PPI at the esophageal mucosa, and the existence of PPI-REE as a distinct disease entity from GERD and EoE.

  5. Unexpected esophageal diseases appeared in thyroid resections

    Ye-huan, Liu; Shi-xu, Lyu; Yi-li, Zhou; Ou-chen, Wang; Xiao-hua, Zhang


    Objective In order to avoid the misdiagnosis of thyroid diseases, we need to discuss the clinical features and diagnostic methods of cervical esophageal cancer and Zenker’s diverticulum. Methods The clinical and laboratory data of seven cases were reviewed retrospectively, and in all cases, esophageal-related diseases were misdiagnosed as thyroid diseases preoperatively. Among them, two cases were cervical esophageal cancer metastasized to thyroids but initially, they were misdiagnosed as thy...

  6. Esophageal ulceration complicating doxycycline therapy

    Mohammad A. Al-Mofarreh; Ibrahim A. Al Mofleh


    AIM: To report present state of iatrogenic drug-induced esophageal injury (DIEI) induced by medications in a private clinic.METHODS: Iatrogenic drug-induced esophageal injury (DIEI) induced by medications has been more frequently reported. In a private clinic we encountered 36 cases of esophageal ulcerations complicating doxycycline therapy in a mainly younger Saudi population (median age 29 years).RESULTS: The most frequent presenting symptoms were oclynophagia, retrostemal burning pain and dysphagia (94 %,75 % and 56 %, respectively). The diagnosis was according to medical history and confirmed by endoscopy in all patients.Beside withdrawal of doxycycline, when feasible, all patients were treated with a proton-pump inhibitor (PPI) and a prokinetic. Thirty patients who reported to the clinic after treatment were improved within 1-7 (median 1.7) days.CONCLUSION: Esophageal ulceration has to be suspected in younger patients with odynophagia, retrosternal burning pain and/or clysphagia during the treatment with doxycycline.

  7. Gender effects on esophageal motility

    Dantas R.O.


    Full Text Available It has been suggested that there are no gender effects on esophageal motility. However, in previous studies the subjects did not perform multiple swallows and the quantitative features of esophageal contractions were not evaluated. In order to investigate the gender effects on esophageal motility we studied 40 healthy normal volunteers, 20 men aged 37 ± 15 years (mean ± SD, and 20 women aged 38 ± 14 years. We used the manometric method with an eight-lumen polyvinyl catheter and continuous perfusion. The upper and lower esophageal sphincter pressures were measured by the rapid pull-through method. With the catheter positioned with one lumen opening in the lower esophageal sphincter, and the others at 5, 10 and 15 cm above the sphincter, ten swallows of a 5-ml water bolus alternated with ten dry swallows were performed. Statistical analysis was done by the Student t-test and Mann-Whitney test. Gender differences (P<0.05 were observed for wet swallows in the duration of contractions 5 cm above the lower esophageal sphincter (men: 3.7 ± 0.2 s, women: 4.5 ± 0.3 s, mean ± SEM, and in the velocity of contractions from 15 to 10 cm above the lower esophageal sphincter (men: 4.7 ± 0.3 cm/s, women: 3.5 ± 0.2 cm/s. There was no difference (P>0.05 in sphincter pressure, duration and percentage of complete lower esophageal sphincter relaxation, amplitude of contractions, or in the number of failed, multipeaked and synchronous contractions. We conclude that gender may cause some differences in esophageal motility which, though of no clinical significance, should be taken into consideration when interpreting esophageal motility tests.

  8. Clinical significance and prognostic value of TRIM24 expression in esophageal squamous cell carcinoma

    Chi, Jun; Yang, Qing; Xie, Xiao-Feng; Yang, Xian-Zi; Zhang, Mei-Yin; Wang, Hui-Yun; Xu, Guo-Liang


    Tripartite motif-containing 24 (TRIM24), a member of the transcription intermediary factor 1 family, is defined as a co-regulator with several nuclear receptors, such as RARα. TRIM24 has been reported to be involved in many cancers. In this study, we aimed to investigate the expression pattern and prognostic significance of TRIM24 and its relationship with RARα in esophageal squamous cell cancer (ESCC). Both mRNA and protein expression levels of TRIM24 were found to be significantly decreased in ESCC, as judged by qRT-PCR and western blot. Immunohistochemistry staining shows that the reduced TRIM24 protein is associated with lymph node metastasis (P=0.024), advance pathological TNM (pTNM) stage (P=0.046) and recurrence/metastasis (P=0.001). Upregulated TRIM24 protein predicts longer overall survival and disease-free survival (both P<0.001) and is an independent predictor for good prognosis (HR, 0.519; 95%CI, 0.341-0.788; P=0.002). TRIM24 expression has been proven remarkably to improve prediction of survival of pTNM stage in ESCC patients, especially in stage I and II. However, no significant relationship was found between TRIM24 and RARα expression levels. In conclusion, reduced TRIM24 protein is associated with poor survival in ESCC patients, suggesting TRIM24 protein is a potential prognostic biomarker for ESCC. PMID:27689360

  9. Changes in Cardiac Varices and Their Clinical Significance after Eradication of Esophageal Varices by Band Ligation

    Seung Woon Park


    Full Text Available Background and Aims. Cardiac varices (CVs in patients with type 1 gastroesophageal varices (GOV1s usually disappear with treatment for esophageal varices (EVs by endoscopic injection sclerotherapy (EIS. However, whether this applies to patients treated with endoscopic band ligation (EBL for EVs remains unclear. We evaluated the effect of EVs eradication by EBL on CVs. Methods. We included cirrhotic patients whose EVs had been eradicated using EBL and excluded those who had been treated using EIS, those who had received endoscopic therapy for CVs, and those who were combined with hepatocellular carcinoma. Results. A total of 123 patients were enrolled. The age was 59.7 ± 11.7 years, and 96 patients (78.0% were men. Thirty-eight patients (30.9% had EVs only, while 85 (69.1% had GOV1s. After EVs eradication, the CVs disappeared in 55 patients (64.7%. EVs recurred in 40 patients, with recurrence rates at 1, 2, and 3 years of 16.0%, 29.6%, and 35.6%, respectively, the recurrence being more frequent in patients who had undergone EBL for secondary prophylaxis and in those with persisting CVs after EVs eradication (P=0.003. Conclusions. CVs frequently disappeared when EVs were eradicated using EBL in patients with GOV1s. Persistence of CVs after EVs eradication by EBL was associated with EVs recurrence.

  10. Esophageal anastomosis.

    Yuan, Y; Wang, K-N; Chen, L-Q


    This review gives an overview of the esophageal anastomosis. The history, various techniques and substitution organs, their advantages and disadvantages, healing mechanism, complications, and actual trend of this essential part of esophageal surgery are described. The history of the esophageal anastomosis extending from the first anastomosis in 1901 to today has undergone more than one century. In the early days, the success rate of the anastomosis was extremely low. As the technology progressed, the anastomosis got significant achievement. Various anastomotic techniques are currently being used. However, controversies exist on the choice of anastomotic method concerning the success rate, postoperative complication and quality of life. How to choose the method, no one can give the best answer. We searched the manuscripts about the esophageal anastomoses in recent years and studied the controversy questions about the anastomosis. Performing an esophageal anastomosis is a technical matter, and suture healing is independent of the patient's biologic situation. Every anastomosis technique has its own merit, but the outcomes were different if it was performed by different surgeons, and we also found that the complication rate of the anastomosis was mainly associated with the surgeons. So the surgeons should learn from their previous experience and others to avoid technical errors.

  11. Caustic ingestion and esophageal function

    Cadranel, S.; Di Lorenzo, C.; Rodesch, P.; Piepsz, A.; Ham, H.R. (Children University Hospital, Brussels (Belgium))


    The aim of the present study was to investigate esophageal motor function by means of krypton-81m esophageal transit scintigraphy and to compare the results with the functional and morphological data obtained by means of triple lumen manometry and endoscopy. In acute and subacute stages of the disease, all clinical, anatomical, and functional parameters were in good agreement, revealing significant impairment. In chronic stages, the severity of the dysphagia was not correlated to the importance of the residual stenosis. Conversely, 81mKr esophageal transit and manometric's findings were in good agreement with the clinical symptoms, during the entire follow-up period ranging between 3 months to 7 years. The 81mKr test is undoubtedly the easiest and probably the most physiological technique currently available for long-term functional evaluation of caustic esophagitis.

  12. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis.

    del-Moral-Martínez, María; Barrientos-Delgado, Andrés; Crespo-Lora, Vicente; Cervilla-Sáez-de-Tejada, María Eloísa; Salmerón-Escobar, Javier


    Eosinophilic cholecystitis (EC) is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed. Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms was found.

  13. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis

    María del Moral-Martínez


    Full Text Available Eosinophilic cholecystitis (EC is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. When imaging tests revealed acalculous cholecystitis, an urgent cholecystectomy was performed. Histological examination of the surgical specimen revealed eosinophilic cholecystitis. No cause of the symptoms was found.

  14. Comparative clinical trial of S-pantoprazole versus racemic pantoprazole in the treatment of gastro-esophageal reflux disease

    Vikas G Pai; Nitin V Pai; Hemant P Thacker; Jaisingh K Shinde; Vijay P Mandora; Subhash S Erram


    AIM: To compare the efficacy and tolerability of S-pantoprazole (20 mg once a day) versus racemic Pantoprazole (40 mg once a day) in the treatment of gastroesophageal reflux disease (GERD).METHODS: This multi-centre, randomized, double-blind clinical trial consisted of 369 patients of either sex suffering from GERD. Patients were randomly assigned to receive either one tablet (20 mg) of S-pantoprazole once a day (test group) or 40 mg racemic pantoprazole once a day (reference group) for 28 d. Patients were evaluated for reduction in baseline on d 0, GERD symptom score on d 14 and 28, occurrence of any adverse effect during the course of therapy. Gastrointestinal (GI) endoscopy was performed in 54 patients enrolled at one of the study centers at baseline and on d 28.RESULTS: Significant reduction in the scores (mean and median) for heart burn (P < 0.0001), acid regurgitation (P < 0.0001), bloating (P < 0.0001), nausea (P < 0.0001)and dysphagia (P < 0.001) was achieved in both groups on d 14 with further reduction on continuing the therapy till 28 d. There was a statistically significant difference in the proportion of patients showing improvement in acid regurgitation and bloating on d 14 and 28 (P = 0.004for acid regurgitation; P = 0.03 for bloating) and heart burn on d 28 (P = 0.01) between the two groups, with a higher proportion in the test group than in the reference group. Absolute risk reductions for heartburn/acid regurgitation/bloating were approximately 15% on d 14 and 10% on d 28. The relative risk reductions were 26%-33% on d 14 and 15% on d 28. GI endoscopy showed no significant difference in healing of esophagitis (P= 1) and gastric erosions (P = 0.27) between the two groups. None of the patients in either group reported any adverse effect during the course of therapy.CONCLUSION: In GERD, S-pantoprazole (20 mg) is more effective than racemic pantoprazole (40 mg) in improving symptoms of heartburn, acid regurgitation,bloating and equally

  15. Relationship of clinical characteristics between eosinophils and chronic rhinosinusitis with nasal polyp%嗜酸性粒细胞与慢性鼻-鼻窦炎合并鼻息肉的临床特征的关系

    石帅; 高下


    目的:探讨嗜酸性粒细胞(Eos)与慢性鼻-鼻窦炎伴鼻息肉(CRSwNP)的临床特征的关系。方法62例慢性鼻-鼻窦炎伴鼻息肉并行鼻内镜下鼻窦开放手术患者,根据外周血嗜酸性粒细胞比例,分为Eos组与正常密度嗜酸性粒细胞(NEos)组。比较两组患者鼻息肉组织嗜酸性粒细胞计数、鼻腔鼻窦结局测量20条(SNOT-20)评分以及鼻窦CT 的Lund-Mackay 评分等。结果Eos组鼻息肉组织中的嗜酸性粒细胞计数显著高于NEos组(P0.05),鼻息肉组织中嗜酸性粒细胞计数与SNOT-20评分无相关性(r=0.246,P=0.126>0.05);两组CT的Lund-Mackay评分比较差异有统计学意义(P0.05). Eosinophils count in polyp tissue and SNOT-20 was not correlated (r=0.246,P=0.126>0.05). The difference of CT Lund-Mackay scores had statistical significance between the two groups (P<0.05). Peripheral blood eosinophils proportion was positively correlated with histopathological outcome (r=0.512,P<0.05). Area under curve (AUC) of ROC was 0.808, with cutoff value as 3.65%. It contained sensitivity and specificity as 78.9% and 71.4% in diagnosis of eosinophils chronic rhinosinusitis with nasal polyp (ECRSwNP).Conclusion Eosinophils has effects on clinical characteristics of chronic rhinosinusitis with nasal polyp. It is necessary to pay attention to peripheral blood eosinophils proportion in diagnosing ECRSwNP, in order to make appropriate treatment strategy for patients.

  16. Proton therapy posterior beam approach with pencil beam scanning for esophageal cancer. Clinical outcome, dosimetry, and feasibility

    Zeng, Yue-Can [Shengjing Hospital of China Medical University, Department of Medical Oncology, Cancer Center, Shenyang (China); University of Washington Medical Center, Department of Radiation Oncology, 1959 NE Pacific Street, Campus Box 356043, Seattle, WA (United States); Vyas, Shilpa; Apisarnthanarax, Smith; Zeng, Jing [University of Washington Medical Center, Department of Radiation Oncology, 1959 NE Pacific Street, Campus Box 356043, Seattle, WA (United States); Dang, Quang; Schultz, Lindsay [Seattle Cancer Care Alliance Proton Therapy Center, Seattle, WA (United States); Bowen, Stephen R. [University of Washington Medical Center, Department of Radiation Oncology, 1959 NE Pacific Street, Campus Box 356043, Seattle, WA (United States); University of Washington Medical Center, Department of Radiology, Seattle, WA (United States); Shankaran, Veena [University of Washington Medical Center, Department of Medical Oncology, Seattle, WA (United States); Farjah, Farhood [University of Washington Medical Center, Department of Surgery, Division of Cardiothoracic Surgery, Seattle, WA (United States); University of Washington Medical Center, Department of Surgery, Surgical Outcomes Research Center, Seattle, WA (United States); Oelschlager, Brant K. [University of Washington Medical Center, Department of Surgery, Seattle, WA (United States)


    The aim of this study is to present the dosimetry, feasibility, and preliminary clinical results of a novel pencil beam scanning (PBS) posterior beam technique of proton treatment for esophageal cancer in the setting of trimodality therapy. From February 2014 to June 2015, 13 patients with locally advanced esophageal cancer (T3-4N0-2M0; 11 adenocarcinoma, 2 squamous cell carcinoma) were treated with trimodality therapy (neoadjuvant chemoradiation followed by esophagectomy). Eight patients were treated with uniform scanning (US) and 5 patients were treated with a single posterior-anterior (PA) beam PBS technique with volumetric rescanning for motion mitigation. Comparison planning with PBS was performed using three plans: AP/PA beam arrangement; PA plus left posterior oblique (LPO) beams, and a single PA beam. Patient outcomes, including pathologic response and toxicity, were evaluated. All 13 patients completed chemoradiation to 50.4 Gy (relative biological effectiveness, RBE) and 12 patients underwent surgery. All 12 surgical patients had an R0 resection and pathologic complete response was seen in 25 %. Compared with AP/PA plans, PA plans have a lower mean heart (14.10 vs. 24.49 Gy, P < 0.01), mean stomach (22.95 vs. 31.33 Gy, P = 0.038), and mean liver dose (3.79 vs. 5.75 Gy, P = 0.004). Compared to the PA/LPO plan, the PA plan reduced the lung dose: mean lung dose (4.96 vs. 7.15 Gy, P = 0.020) and percentage volume of lung receiving 20 Gy (V{sub 20}; 10 vs. 17 %, P < 0.01). Proton therapy with a single PA beam PBS technique for preoperative treatment of esophageal cancer appears safe and feasible. (orig.) [German] Wir stellen die Vergleichsdosimetrie, Realisierbarkeit und die vorlaeufigen klinischen Ergebnisse einer neuen Pencil-Beam-Scanning(-PBS)/Posterior-Beam-Methode innerhalb der Protonentherapie fuer Speiseroehrenkrebs im Setting einer trimodalen Therapie vor. Von Februar 2014 bis Juni 2015 erhielten 13 Patienten mit lokal fortgeschrittenem

  17. Loss of Protein Tyrosine Phosphatase Receptor J Expression Predicts an Aggressive Clinical Course in Patients with Esophageal Squamous Cell Carcinoma.

    Qiao, Dongfeng; Li, Ming; Pu, Juan; Wang, Wanwei; Zhu, Weiguo; Liu, Haiyan


    Protein Tyrosine Phosphatase Receptor J (PTPRJ) has been reported to be a tumor suppressor in various human cancers. The aim of this study was to investigate the clinical significance of PTPRJ in ESCC patients and its effects on biological behaviors of ESCC cells. PTPRJ expression, at mRNA and protein levels, were respectively detected by quantitative real-time PCR, western blot and immunohistochemistry, based on 106 newly diagnosed ESCC patients. The associations between PTPRJ expression and clinicopathological characteristics of ESCC patients were statistically analyzed. Then, the effects of PTPRJ in migration and invasion were determined by wound healing and transwell assays based on ESCC cell line transfected with siRNA or expression vector of PTPRJ. Expression of PTPRJ at mRNA and protein levels were both significantly lower in ESCC tissues than those in normal esophageal mucosa. Immunohistochemistry showed that PTPRJ protein was localized in the cytoplasm of cancer cells in ESCC tissues. In addition, PTPRJ downregulation was found to be closely correlated with advanced tumor stage (P = 0.01) and poor differentiation (P = 0.03). Moreover, knockdown of PTPRJ in KYSE510 cells could significantly promote cell migration and invasion (both P ESCC patients. PTPRJ may function as a tumor suppressor and play an important role in the regulation of ESCC cell motility, suggesting its potentials as a therapeutic agent for human ESCC.

  18. [Clinical evaluations of neoadjuvant chemotherapy with DN and FP regimens for patients with middle or lower thoracic locally advanced esophageal squamous cell carcinoma].

    Yang, Hongxia; Yao, Juan; Wen, Hong; Yu, Lan; Liu, Wu; Liang, Hua; Han, Shuhong


    To explore the efficacies and side effects of neoadjuvant chemotherapy with DN (docetaxel plus cisplatin) and FP (nedaplatin plus cisplatin) regimens for patients with upper or middle thoracic locally advanced esophageal squamous cell carcinoma. From January 2008 to January 2012, a total of 124 patients with upper or middle thoracic locally advanced esophageal squamous cell carcinoma were randomized into DN group (n = 64) and FP group (n = 60). Both groups received neoadjuvant chemotherapy. The treatment schedule was recycled every 3 weeks. After 2 cycles, those with potential surgical resection underwent surgery. The 2-year overall, locoregional relapse-free and distant metastasis-free survival rates in DN and FP groups were 71.1% and 66.7%, 65.0% and 63.0%, 78.3% and 74.3% respectively (P > 0.05). The incidence of leucopenia was higher in DN group than that in FP group (P DN group. No perioperative mortality occurred with a low incidence of postoperative complications. The rates of overall response, resection, postoperative complications and pathological complete rates response were similar in two groups. And the rates of downstage and R0 resection were significantly higher in DN group than those in FP group (P < 0.05). For patients with middle or lower thoracic locally advanced esophageal squamous cell carcinoma, neoadjuvant chemotherapies of docetaxel and nedaplatin may achieve excellent outcomes in clinical response and 2-year survival rate. And the side effects are clinically acceptable.

  19. Genetics Home Reference: eosinophil peroxidase deficiency

    ... invaders. EPX gene mutations reduce or prevent eosinophil peroxidase production or result in a protein that is unstable and nonfunctional. As a result, eosinophils have severely reduced amounts of eosinophil peroxidase or none at all. Other proteins within affected ...

  20. Proton pump inhibitor-responsive esophageal eosinophilia: a historical perspective on a novel and evolving entity

    Javier Molina-Infante

    Full Text Available Eosinophilic esophagitis (EoE is an emerging chronic esophageal disease, first described in 1993, with a steadily increasing incidence and prevalence in western countries. Over the 80's and early 90's, dense esophageal eosinophilia was mostly associated gastroesophageal reflux disease (GERD. For the next 15 years, EoE and GERD were rigidly considered separate entities: Esophageal eosinophilia with pathological acid exposure on pH monitoring or response to proton pump inhibitor (PPI therapy was GERD, whereas normal pH monitoring or absence of response to PPIs was EoE. Updated guidelines in 2011 described a novel phenotype, proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE, referring to patients who appear to have EoE clinically, but who achieve complete remission after PPI therapy. Currently, PPI-REE must be formally excluded before diagnosing EoE, since 30-40 % of patients with suspected EoE are eventually diagnosed with PPI-REE. Interestingly, PPI-REE and EoE remain undistinguishable based on clinical, endoscopic, and histological findings, pH monitoring, and measurement of tissue markers and cytokines related to eosinophilic inflammation. This review article aims to revisit the relatively novel concept of PPI-REE from a historical perspective, given the strong belief that only GERD, as an acid peptic disorder, could respond to the acid suppressing ability of PPI therapy, is becoming outdated. Evolving evidence suggests that PPI-REE is genetically and phenotypically undistinguishable from EoE and PPI therapy alone can almost completely reverse allergic inflammation. As such, PPI-REE might constitute a subphenotype of EoE and PPI therapy may be the first therapeutic step and diet/ steroids may represent step up therapy. Possibly, the term PPI-REE will be soon replaced by PPI-responsive EoE. The mechanism as to why some patients respond to PPI therapy (PPI-REE while others do not (EoE, remains to be elucidated.

  1. Gefitinib in definitive management of esophageal or gastroesophageal junction cancer: a retrospective analysis of two clinical trials.

    Sohal, D P S; Rice, T W; Rybicki, L A; Rodriguez, C P; Videtic, G M M; Saxton, J P; Murthy, S C; Mason, D P; Phillips, B E; Tubbs, R R; Plesec, T; McNamara, M J; Ives, D I; Bodmann, J W; Adelstein, D J


    The role of epidermal growth factor receptor inhibition in resectable esophageal/gastroesophageal junction (E/GEJ) cancer is uncertain. Results from two Cleveland Clinic trials of concurrent chemoradiotherapy (CCRT) and surgery are updated and retrospectively compared, the second study differing only by the addition of gefitinib (G) to the treatment regimen. Eligibility required a diagnosis of E/GEJ squamous cell or adenocarcinoma, with an endoscopic ultrasound stage of at least T3, N1, or M1a (American Joint Committee on Cancer 6th). Patients in both trials received 5-fluorouracil (1000 mg/m(2) /day) and cisplatin (20 mg/m(2) /day) as continuous infusions over days 1-4 along with 30 Gy radiation at 1.5 Gy bid. Surgery followed in 4-6 weeks; identical CCRT was given 6-10 weeks later. The second trial added G, 250 mg/day, on day 1 for 4 weeks, and again with postoperative CCRT for 2 years. Preliminary results and comparisons have been previously published. Clinical characteristics were similar between the 80 patients on the G trial (2003-2006) and the 93 patients on the no-G trial (1999-2003). Minimum follow-up for all patients was 5 years. Multivariable analyses comparing the G versus no-G patients and adjusting for statistically significant covariates demonstrated improved overall survival (hazard ratio [HR] 0.64, 95% confidence interval [CI] = 0.45-0.91, P = 0.012), recurrence-free survival (HR 0.61, 95% CI = 0.43-0.86, P = 0.006), and distant recurrence (HR 0.68, 95% CI = 0.45-1.00, P = 0.05), but not locoregional recurrence. Although this retrospective comparison can only be considered exploratory, it suggests that G may improve clinical outcomes when combined with CCRT and surgery in the definitive treatment of E/GEJ cancer.


    Ortemenka, Ye P


    Based on a complex examination of 11 school age children with eosinophilic phenotype of bronchial asthma, it has been demonstrated that combination of inhaled corticosteroids with oral sustained release theophillines were more effective as a basic anti-inflammatory asthma therapy, in comparison with monotherapy by inhaled corticosteroids. The usage of such combined anti-relapsing asthma treatment has been reduced both the relative risk (RR = 57%) and the attributable risk (AR = 36.3%) of insufficient control of bronchial asthma in children with eosinophilic type of airways inflammation. At the same time, the minimum number of patients, which have to be treated by such method with the object of preventing at least one case of poor asthma control, came to 3 children.

  3. Esophageal cancer

    Mortensen, M. B.


    The distribution of adenocarcinomas and squamous cell carcinomas in esophageal cancer (EC) has changed, and focus directed towards tumors of the distal esophagus and the esophagogastric junction. The genetic events leading to EC are not fully clarified, but important risk factors have been...

  4. Eosinophilic cholecystitis: an infrequent cause of acute cholecystitis

    María del Moral-Martínez; Andrés Barrientos-Delgado; Vicente Crespo-Lora; María Eloísa Cervilla-Sáez-de-Tejada; Javier Salmerón-Escobar


    Eosinophilic cholecystitis (EC) is a rare disease that is characterised by eosinophilic infiltration of the gallbladder. Its pathogenesis is unknown, although many hypotheses have been made. Clinical and laboratory manifestations do not differ from those of other causes of cholecystitis. Diagnosis is histological and usually performed after analysis of the surgical specimen. We report the case of a woman aged 24 years, with symptoms of fever, vomiting and pain in the right upper quadrant. Whe...

  5. Eosinophils, probiotics, and the microbiome.

    Rosenberg, Helene F; Masterson, Joanne C; Furuta, Glenn T


    There is currently substantial interest in the therapeutic properties of probiotic microorganisms as recent research suggests that oral administration of specific bacterial strains may reduce inflammation and alter the nature of endogenous microflora in the gastrointestinal tract. Eosinophils are multifunctional tissue leukocytes, prominent among the resident cells of the gastrointestinal mucosa that promote local immunity. Recent studies with genetically altered mice indicate that eosinophils not only participate in maintaining gut homeostasis, but that the absence of eosinophils may have significant impact on the nature of the endogenous gut microflora and responses to gut pathogens, notably Clostridium difficile Furthermore, in human subjects, there is an intriguing relationship between eosinophils, allergic inflammation, and the nature of the lung microflora, notably a distinct association between eosinophil infiltration and detection of bacteria of the phylum Actinobacteria. Among topics for future research, it will be important to determine whether homeostatic mechanisms involve direct interactions between eosinophils and bacteria or whether they involve primarily eosinophil-mediated responses to cytokine signaling in the local microenvironment. Likewise, although is it clear that eosinophils can and do interact with bacteria in vivo, their ability to discern between pathogenic and probiotic species in various settings remains to be explored.

  6. Transcriptome analysis of proton pump inhibitor-responsive esophageal eosinophilia reveals proton pump inhibitor-reversible allergic inflammation.

    Wen, Ting; Dellon, Evan S; Moawad, Fouad J; Furuta, Glenn T; Aceves, Seema S; Rothenberg, Marc E


    Esophageal eosinophilia can be proton pump inhibitor (PPI) resistant or responsive, representing 2 entities known as eosinophilic esophagitis (EoE) and PPI-responsive esophageal eosinophilia (PPI-REE), respectively. Although they present with similar clinical features, EoE is accepted to be an antigen-driven, TH2-associated allergic disorder, whereas the cause of PPI-REE remains a mystery. In this study, our aim was to investigate the pathogenesis of PPI-REE by using a recently described EoE diagnostic panel (EDP) composed of a set of 94 esophageal transcripts and to determine whether PPI therapy reverses any esophageal transcriptional abnormalities. We evaluated the EDP signature in biopsy samples obtained from adult and pediatric patients with PPI-REE from 4 institutions and compared the pre- and post-PPI therapy expression profiles of these subjects with those of patients with active EoE. The EDP differentiated patients with EoE from control subjects with 100% accuracy among the 4 clinical sites. Bioinformatics analysis revealed largely overlapping transcriptomes between patients with PPI-REE and those with EoE, including the genes for eosinophil chemotaxis (eotaxin 3, CCL26), barrier molecules (desmoglein 1, DSG1), tissue remodeling (periostin, POSTN), and mast cells (carboxypeptidase A, CPA3). PPI monotherapy alone almost completely reversed the allergic inflammatory transcriptome of patients with PPI-REE. Furthermore, we identified a set of candidate genes to differentiate patients with EoE from those with PPI-REE before treatment. These findings provide definitive evidence that PPI-REE is a disease entity with significant molecular overlap with EoE, suggesting that many patients with PPI-REE represent a continuum of the same pathogenic allergic mechanisms that underlie EoE and thus might constitute a subphenotype of patients with EoE. The ability of PPI therapy to nearly entirely reverse gene expression associated with PPI-REE, particularly that associated

  7. Ultrasonographic findings of esophageal varices

    Kang, Hyo Seouk; Seol, Byeong Ryong; Rha, Seung Woon [Shilla General Hospital, Seoul (Korea, Republic of)


    To demonstrate the clinical usefulness of ultrasonography for detecting esophageal varices. In 20 cases of esophaged varix, the authors analysed the transabdominal ultrasonographic findings of the esophagogastric junction and compared mural thickness, the anteroposterior diameter of the esophagus, and the echogenic nature of the esophageal mucosal layer with those of 78 normal patients. The anterior and posterior mural thickeness of normal esophagus was 2.2{+-}0.7 and 2.4{+-}0.8mm respectively, but for variceal esophagus, the corresponding readings were 5.9{+-}1.3 and 5.2{+-}1.3mm respectively. The anteroposterior diameter of normal esophagus was 7.9{+-}2.1mm and that of variceal esophagus was 14.0{+-}1.8mm. There was a stastically significant difference (p<0.01) in mural thickness and anteroposterior diameter of the esophagus between a normal and variceal patient with regard to change of echogenic nature at the esphagogastric junction. Normal esophageal mucosa showed a thin and uniform echogenic line, but for variceal mucosa, the echogenic pattern was irregular, tortuous and thick. The athors believe that transabdominal US is helpful for detecting esophageal varices in patients with liver cirrhosis and UGI bleeding. Important clinically useful sonographic findings in diagnosing esophageal varix are as follows:1) mural thickness more than 6mm; 2) anteroposterior diameter of the esophagus of more than 15mm;3) irregular, tortuous and thickened echogenic mucosa.

  8. Eosinophilic gastroenteritis with ascites and colon involvement.

    Levinson, J D; Ramanathan, V R; Nozick, J H


    The case of a 39-year old white man with eosinophilic gastroenteritis is presented. The major clinical features were gastric outlet obstruction, diarrhea and massive ascites. At surgery, significant involvement of the entire gastrointestinal tract from the gastric antrum to the sigmoid colon was found. Histologic documentation of colon involvement was obtained. The response to corticosteroids was prompt and sustained. At present, he is maintained on an alternating day schedule of steroid administration.

  9. Distribution of lymph node metastasis and clinical validity of gastric tube reconstruction in lower thoracic esophageal squamous cell carcinoma with gastric invasion.

    Matsuda, Satoru; Tsubosa, Yasuhiro; Niihara, Masahiro; Sato, Hiroshi; Takebayashi, Katsushi; Kawamorita, Keisuke; Mori, Keita; Tsushima, Takahiro; Yasui, Hirofumi; Takeuchi, Hiroya; Kitagawa, Yuko


    The distribution of lymph node (LN) metastases of esophageal squamous cell carcinoma (SCC) with gastric invasion remains unclear. The purpose of this study was to clarify the relationship between gastric invasion and abdominal LN metastasis in patients with esophageal SCC. Furthermore, the clinical validity of gastric tube reconstruction for those with gastric invasion was investigated. Patients who underwent subtotal esophagectomy at our institution were reviewed. Gastric invasion was evaluated with pretreatment upper gastrointestinal endoscopy and classified into 3 groups: no invasion, Gr 0; slight invasion (0-19 mm), Gr 1; and massive invasion (20 mm or longer), Gr 2. The correlations between gastric invasion, the number of abdominal LN metastases, and postoperative recurrence were investigated. Of 79 patients, the distribution of pretreatment gastric invasion was Gr 0, 1, and 2 in 57, 15, and 7 patients, respectively. All patients underwent subtotal esophagectomy with gastric tube reconstruction. There was no significant difference in the number of abdominal LN metastases among groups. In survival analysis, the location of the distal end of the tumor was not a predictive factor for postoperative recurrence. Regarding patterns of recurrence, in patients with gastric invasion, there was no remarkable increase in the frequency of recurrence in the abdominal LNs or the regional LNs around the gastric tube. Pretreatment gastric invasion did not significantly influence abdominal LN metastasis and postoperative recurrence. In patients with esophageal SCC at the lower thoracic esophagus with gastric invasion, subtotal esophagectomy with gastric tube reconstruction might be a valid surgical procedure.

  10. The Characteristics of Celiac Trunk Lymph-node Metastases of Esophageal Cancer in the Thoracic Segment and Clinical Significance for Wide-Excision

    Hongjiang Wang; Zuoliang Pang; Sikandaer; Wei Sun; Warasijiang; Zhiqin Fan; Feng Xue


    OBJECTIVE To understand the characteristics of celiac trunk lymph-node metastases of thoracic esophageal carcinoma and their influence on prognosis of the patients, and to investigate a reasonable range for regional celiac trunk lymph-node clearance.METHODS Clinical specimens of 241 patients receiving resection of a thoracic esophageal carcinoma were analyzed retrospectively.RESULTS The rate of the patient celiac lymph-node metastases was 32.4%(78/241), and of the lymph nodes examined, 9.8% were found to have metastasis. The extent of metastases adjacent to the common hepatic artery and celiac trunk and within the hepatoduodenal ligaments was 6.6%, 6.9% and 6.3%, respectively. The tumor site, extent of invasion and level of cell differentiation were the factors influencing lymph-node metastases, but they were unrelated to the length of the tumor. The overall rate of regional celiac recurrence for the patients 3 years after operation was 5.4%. The 3-year survivals for the patients with metastases of the celiac lymph nodes was 42.3%, which was lower compared to the non-metastatic patients (70.6%) (P<0.01).CONCLUSION Celiac lymph-node metastases are one of key factors affecting the prognosis of the patients receiving resection of esophageal cancer, and extensive clearance of the celiac-trunk lymph nodes can reduce the rate of postoperative regional metastases.

  11. Canine Oral Eosinophilic Granuloma Treated with Electrochemotherapy

    Matías Nicolás Tellado


    Full Text Available A case of a canine oral eosinophilic granuloma in a 14-year-old female crossbred is described. The dog was presented with a history of ptyalism, halitosis, local pain, decreased appetite, and blood staining noted on food and water bowls. Clinical, hematologic, and biochemical examinations, abdominal ultrasonography, and 3-view chest radiographs were performed, and no metastases were found. Histopathologic examination of two 6 mm punch biopsies from the oral lesion revealed the presence of eosinophilic granulomatous lesions in the submucosa. After treatment with corticosteroids and wide spectrum antibiotics no significant changes in clinical signs and lesion size were observed. Electrochemotherapy (ECT, a novel tumor treatment routinely used for cutaneous and subcutaneous tumors in human patients in the European Union since 2006, was used to treat the eosinophilic granuloma. The procedure was performed under general anesthesia, followed by intravenous administration of bleomycin. Six weeks after treatment a complete response with disappearance of the mass and improvement of clinical signs were observed.

  12. Pharm GKB: Leukemia, Eosinophilic, Acute [PharmGKB

    Full Text Available Overview Alternate Names: Synonym Acute Eosinophilic Leukemia; Acute Eosinophilic Leukemias; Acute... eosinophilic leukemia; Eosinophilic Leukemia, Acute; Eosinophilic Leukemias, Acute; Leukemia, Acute... Eosinophilic; Leukemias, Acute Eosinophilic PharmGKB Accession Id: PA446179 External Vocabularies Me...SH: Leukemia, Eosinophilic, Acute (D015472) SnoMedCT: Acute eosinophilic leukemia... (277604002) UMLS: C0023439 (C0023439) NDFRT: Leukemia, Eosinophilic, Acute [Disease/Finding] (N0000003269)

  13. Black esophagus (acute esophageal necrosis) after spinal anesthesia.

    Román Fernández, A; López Álvarez, A; Fossati Puertas, S; Areán González, I; Varela García, O; Viaño López, P M


    Acute esophagic necrosis or black esophagus is an uncommon clinical entity that owes its name to the endoscopic view of the necrotic esophageal mucosa. It is always related with a critical medical condition and usually has an ischemic etiology. We report the first case of acute esophageal necrosis after a spinal anesthetic for partial hip joint arthroplasty. We discuss the underlying pathophysiological mechanisms.

  14. Eosinophilic venulitis of colon presenting as ileocecal mass.

    Forouhar, Faripour; Rustagi, Tarun; Lamea, Leela


    Reports of eosinophilic infiltration of the colon causing obstruction are few. It is even less common to find associated extensive intestinal venulitis, which is similar to and lumped together with so called Mesenteric Inflammatory Veno-Occlusive Disease (MIVOD) or Self-Limited Intestinal Venulitis. Eosinophilic necrotizing lymphadenitis, such as what we report here, has never been reported in association with this disease. A 41-year-old female presented with cramping lower abdominal pain, hematochezia, nausea, and vomiting. Computed tomography revealed the presence of the mass and thickening of the illeocecal wall. Endoscopy confirmed a cecal mass with surface ulceration suggestive of cecal adenocarcinoma. Patient underwent right hemicolectomy with the clinical and radiologic diagnosis of adenocarcinoma. Microscopic examination of the resected bowel showed an ulcerated mass in the cecum composed of markedly edematous tissue showing transmural eosinophilic infiltration and extensive eosinophilic and lymphocytic venulitis with and without thrombosis. This was associated with a necrotizing lymphadenitis.

  15. Eosinophilic granuloma in the anterior mandible mimicking radicular cyst

    Lee, Byung Do; Lee, Wan; Lee, Jun [College of Dentistry, Wonkwang University, Iksan (Korea, Republic of); Son, Hyun Jin [Dept. of Pathology, School of Medicine, Eulji University, Daejeon (Korea, Republic of)


    Eosinophilic granuloma is a common expression of Langerhans cell histiocytosis and corresponds with typical bone lesions. The radiographic appearance of eosinophilic granuloma in the jaw is variable and not specific. It may resemble periodontitis, radicular cyst, or malignancies. The purpose of this report is to describe the characteristic radiographic features of eosinophilic granuloma of a 39-year-old male. The lesion in the anterior mandible was first diagnosed as radicular cyst because the radiographic findings were ovoid radiolucent lesion with well-defined border. However, careful interpretation revealed a non-corticated border and floating tooth appearance that were the characteristic radiographic features for the differential diagnosis. Early clinical signs of eosinophilic granuloma can occur in the jaw and a bony destructive lesion might be mistaken for periodontitis or an odontogenic cystic lesion; therefore, careful interpretation of radiographs should be emphasized.

  16. Sudden death due to eosinophilic endomyocardial diseases: three case reports.

    Turan, Arzu Akcay; Karayel, Ferah; Akyildiz, Elif U; Ozdes, Taskin; Yilmaz, Eyyup; Pakis, Isil


    Eosinophils are associated with various disorders, such as allergic or hypersensitivity reactions, parasitic diseases, connective tissue diseases, certain neoplastic diseases (Hodgkin's disease, lymphomas, and carcinomas), and various immune deficiency states. Eosinophils can infiltrate any tissue and can cause tissue damage. Heart, has been demonstrated to be the most extensively involved and toxicity of eosinophils is well-established on cardiac tissue. We describe 3 cases with extensive eosinophilic infiltration without endomyocardial fibrosis. All patients died after a short clinical course with rapidly progressive heart failure. Bronchial asthma, hydatid disease and drug reaction were considered as possible etiologies of eosinophilia in case 1 and case 2. Case 3 was considered to fall into the "idiopathic hypereosinophilic syndrome" in which no underlying causes for eosinophilia could be identified.

  17. Herpes Simplex Virus-2 Esophagitis in a Young Immunocompetent Adult

    Deepak K. Kadayakkara


    Full Text Available Herpes simplex esophagitis (HSE is commonly identified in immunosuppressed patients. It is rare among immunocompetent patients and almost all of the reported cases are due to HSV-1 infection. HSV-2 esophagitis is extremely rare. We report the case of a young immunocompetent male who presented with dysphagia, odynophagia, and epigastric pain. Endoscopy showed multitudes of white nummular lesions in the distal esophagus initially suspected to be candida esophagitis. However, classic histopathological findings of multinucleated giant cells with eosinophilic intranuclear inclusions and positive HSV-2 IgM confirmed the diagnosis of HSV-2 esophagitis. The patient rapidly responded to acyclovir treatment. Although HSV-2 is predominantly associated with genital herpes, it can cause infections in other parts of the body previously attributed to only HSV-1 infection.

  18. Eosinophilic ascites: A case report and literature review

    Raed M Alsulaiman


    Full Text Available Eosinophilic gastroenteritis is a rare gastrointestinal (GI disorder characterized by nonspecific GI symptoms, peripheral eosinophilia, and eosinophilic infiltration of the intestinal wall. The disorder is classified into mucosal, muscular, and sub-serosal types, depending on the clinical picture and the depth of eosinophilic infiltration within the GI wall. Sub-serosal disease, which is complicated by ascites, usually results in the most severe clinical form of eosinophilic gastroenteritis and requires early corticosteroid therapy. In such cases, a favorable outcome can be achieved after a short course of corticosteroids. We present the case of a 28-year-old female with diffuse abdominal pain and distention for 2 weeks. Her physical examination was significant for moderate ascites. Initial work-up demonstrated severe peripheral blood eosinophilia, normal liver function tests, and elevated serum immunoglobulin E (IgE. Upper endoscopy, colonoscopy showed a thickening of the stomach and colon, and biopsies showed marked eosinophilic infiltration of the mucosa. Ascitic fluid analysis showed significant eosinophilia. Subsequent treatment with oral prednisone resulted in the normalization of laboratory and radiologic abnormalities 45 days after the start of the treatment. Despite its rarity, eosinophilic gastroenteritis needs to be recognized by the clinician because the disease is treatable, and timely diagnosis and initiation of treatment could be of major importance.

  19. Esophageal Mucormycosis

    Benjamin Boatright


    Full Text Available Mucormycosis is a rare invasive fungal infection with high mortality. It usually affects patients with poorly controlled diabetes, immunosuppression, or hematological malignancies. Gastroenterologists need to be aware of this rare infection because endoscopy can facilitate early diagnosis and prompt appropriate therapy. Here we describe a case of invasive esophageal mucormycosis that developed in a 63-year-old man with diabetes, acute promyelocytic leukemia, and prolonged leukopenia after chemotherapy. Upper endoscopy showed distal circumferential esophageal wall thickening with devitalization. The mucosa did not bleed after endoscopic biopsy. Histopathology confirmed mucormycosis. He was treated with various antifungal agents including echinocandins, fluconazole, and liposomal amphotericin B. Despite aggressive antifungal therapy and supportive care, the patient died 24 days later.

  20. Esophageal stenting for benign and malignant disease : European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

    Spaander, Manon C W; Baron, Todd H; Siersema, Peter D; Fuccio, Lorenzo; Schumacher, Brigitte; Escorsell, Àngels; Garcia-Pagán, Juan-Carlos; Dumonceau, Jean-Marc; Conio, Massimo; de Ceglie, Antonella; Skowronek, Janusz; Nordsmark, Marianne; Seufferlein, Thomas; Van Gossum, André; Hassan, Cesare; Repici, Alessandro; Bruno, Marco J


    This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE), endorsed by the European Society for Radiotherapy and Oncology (ESTRO), the European Society of Digestive Endoscopy (ESDO), and the European Society for Clinical Nutrition and Metabolism (ESPEN). Th

  1. Genes Associated with Food Allergy and Eosinophilic Esophagitis


    JL, Aceves SS. Gastrointestinal manifestations of food allergies. Pediatr Clin North Am 2011;58(2):389-405. 4. Straumann A, Schoepfer AM...acetylglucosamine re- peats [1,2]. Chitin is highly expressed in insects and crustacean exoskeletons, fungal cell walls, and microfilarial nematode ...chitinase [4]. The enzyme is extremely acid stable and its constitutive expression is relatively abundant in the gastrointestinal tract and to a lesser

  2. CXCR3 expression and activation of eosinophils

    Jinquan, T; Jing, C; Jacobi, H H


    that gamma IP-10 and Mig induce an increase in intracellular calcium in eosinophils confirms that CXCR3 exists on eosinophils. Besides induction to chemotaxis, gamma IP-10 and Mig also activate eosinophils to eosinophil cationic protein release. These results indicate that CXCR3-gamma IP-10 and -Mig receptor...

  3. Esophageal motility abnormalities in gastroesophageal reflux disease.

    Martinucci, Irene; de Bortoli, Nicola; Giacchino, Maria; Bodini, Giorgia; Marabotto, Elisa; Marchi, Santino; Savarino, Vincenzo; Savarino, Edoardo


    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophageal motility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from non-erosive reflux disease to erosive reflux disease and Barrett's esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  4. Clinical outcome of lower esophageal sphincter- and vagus-nerve-preserving partial cardiectomy for early gastric cancer of the subcardia.

    Matsumoto, Hideo; Murakami, Haruaki; Kubota, Hisako; Higashida, Masaharu; Nakamura, Masafumi; Hirai, Toshihiro


    No definitive operative method has been established for the treatment of early subcardial gastric cancer. Our newly developed technique involves local resection of the subcardia while preserving the lower esophageal sphincter and vagus nerve. A new fornix is constructed to accept the transposed esophagus. Thirty patients underwent this procedure between July 2003 and December 2010. Continuous gastric pH monitoring was performed immediately after surgery, and esophageal manometry was undertaken 1 month later. Serum total protein, albumin, total cholesterol, cholinesterase, and body mass index (BMI) were recorded every 3 months. Pre- and postoperative oral intake were compared, reflux symptoms were recorded, and reflux esophagitis was assessed by endoscopy after 1 year. Twenty-five patients (86 %) reported no symptoms of reflux, and 27 (92.8 %) patients could eat 70 % or more of what they had eaten before surgery. Lower esophageal pressures were found to be >10 mmHg in 66.7 % of patients, and the fraction of time that pH <4 was <5 % of the 24-h monitoring period in 70 %. Serum parameters and BMI were unchanged. This surgical technique is a useful means of preserving postoperative quality of life after local gastrectomy by preventing reflux and maintaining nutritional status.

  5. Eosinofilia en esputo versus óxido nítrico en aire exhalado: aplicación clínica en el asma Eosinophils in induced sputum versus nitric oxide in exhaled air: clinical utility in bronchial asthma

    M.J. Álvarez


    NO, an easy to measure inflammatory biomarker, with eosinophils in sputum in terms of relationship with clinical and functional parameters. Methods. 106 asthmatic patients (50 in anti-inflammatory therapy [AB+] and 56 without it [AB-] and 15 controls were included. After filling a clinical questionnaire, FeNO measurement, forced spirometry and sputum induction by bronchial challenge with hypertonic saline solution were performed. Results. Adequate measurements of FeNO and eosinophils were obtained in 100% and 81% of the patients, respectively. FE NO w were higher for AB- compared to AB+ and controls. The percentage of eosinophils in sputum was higher in asthmatic patients compared to controls but without differences between both asthmatics groups and was well correlated with the slope of the dose-response curve of bronchial challenge. In the AB- group, FeNO and eosinophils were well correlated with asthma control level. Conclusion. FE NO measurement is readily available and well correlated with clinical and functional markers asthma expression. Anti-inflammatory therapy blunts FeNO levels compromising its utility in the long-term follow-up of asthma patients.

  6. Soft-robotic esophageal swallowing as a clinically-inspired bolus rheometry technique

    Dirven, Steven; Allen, Jacqueline; (Peter Xu, Weiliang; Cheng, Leo K.


    To investigate the impact of viscosity and peristaltic transport parameters on manometric pressure signatures, a reproducible swallowing process is required. Due to inter- and intra-subject variability from swallow to swallow, the human body does not represent an optimal mechanism for such an investigation. A smooth and continuous swallowing soft-robot has been developed to produce biomimetic swallowing trajectories, and is proposed to operate as a bench-top bolus rheometric investigation method. The method compares conventional viscometry and pressure signature findings from robotic swallowing experiments. The robotic aspect of experimentation involved 450 biomimetic swallows (10 repetitions of 45 unique experiments). The method examined swallowing transport in three dimensions: bolus formulation, peristaltic wavelength, and peristaltic velocity, each of which are known to contribute to safe and effective swallowing in vivo. It is found that the pressure gradients and magnitudes are commensurate with clinical reports on biological swallowing, on the order of 100 mmHg peak, however, the relationship between viscosity and pressure signatures is less clear. Bolus transport cannot be predicted as a function of bolus viscosity alone. Traditional viscometric data at 50 s-1, as used in clinical practice, may not be a strong indicator of swallow effort, safety, or efficacy in vivo.

  7. Eosinophilic Granuloma in Jaw Bone


    KEYWORDS: Eosinophilic granuloma, langerhans cell histiocytosis, oral manifestations, ... 1Department of Oral Medicine & Radiology, College of Dentistry, Majmaah University, Saudi Arabia ... the risk of pathological fracture and to facilitate.

  8. Esophago-pleural fistula with multiple esophageal ulcers in human immunodeficiency virus infected patients: A case report

    Kwon, Soo Hee; Lee, Young Kyung; Choi, Jae Phil; Son, Jin Sung [Seoul Medical Center, Seoul(Korea, Republic of)


    Esophagitis is a common complication in patients with human immunodeficiency virus (HIV) infection. Esophagitis in HIV infected patient is caused by candidiasis, cytomegalovirus, herpes simplex virus, or idiopathic esophagitis with no detectable etiology. Esophagitis in HIV infected patient is occasionally combined with esophageal ulcers. We report chest CT findings and clinical manifestation of esophago-pleural fistula with pneumothorax in a HIV infected patient, who was treated for aspiration pneumonia and esophageal ulcers.

  9. Clinical Applications of Successive Spot Radiographs in Esophagography for Diagnosing the Early Esophageal Cancer

    TANGLi-jun; KONGFan-fu; WANGDe-hang


    To introduce primary experience of clinical applications of successive spot radiographs in esophagography for the din mlosis of early esoplmgeal cancer (EEC). Methods: Six patients with EEC were examined and doagnosed dlaarmsed by a digital X-ray machine. According to the routine double contrast study of esophagus, the patient gulped a barimn suspension in the upright position when the successive films were taken by 2 frmnes per second lasting for about 10 seconds. Various phases were obtained including barimn-filled views,mucosal relief views and double contrast views. Results: Functional changes and abnormal mucosal folds of esophagus were present on successive spot radiographs of esophagography in patients with EEC and those patients with EEC were confirmed by endoscopic and pathologic findings. Four patients had mild loss of distensibility, 2 patients had spasmodic contraction and 1 patient had barium retention. Thickened or interrupted folds were found in all cases.Little niches were detected in 5 of 6 patients. Conctusion: Evidence presented in barimn studies of esophagus is more comprehensive and intact for the diagnosis of EEC when successive spot radiographs are employed. Functional changes of esophagus are more evident with this approach.

  10. Primary Colonic Eosinophilia and Eosinophilic Colitis in Adults.

    Turner, Kevin O; Sinkre, Richa A; Neumann, William L; Genta, Robert M


    The normal content of eosinophils in the adult colon and the criteria for the histopathologic diagnosis of eosinophilic colitis remain undefined. This study aimed at: (1) establishing the numbers of eosinophils in the normal adult colon; and (2) proposing a clinicopathologic framework for the diagnosis of primary colonic eosinophilia and eosinophilic colitis. To accomplish these goals, we counted the eosinophils in the right, transverse, and left colon of 159 adults with normal colonic histology. Using a database of 1.2 million patients with colonic biopsies, we extracted all adults with a diagnosis of colonic eosinophilia. We reviewed the slides from all cases and captured demographic, clinical, and pathologic data, including information about eosinophilia in other organs. We then compared the clinical manifestations of the study patients (those with no identifiable cause of eosinophilia) to those of patients with other types of colitis. The normal eosinophil counts (per mm) were 55.7±23.4 in the right, 41.0±18.6 in the transverse, and 28.6±17.2 in the left colon. Of the 194 study patients (eosinophil counts 166-5050/mm), 63 were asymptomatic and had a normal colonoscopy. Diarrhea and abdominal pain were the commonest indications for colonoscopy (38% and 27%, respectively) among the 131 patients who had symptoms, endoscopic abnormalities, or both. Neither clinical manifestations nor endoscopic appearance were sufficiently characteristic to elicit the suspicion of colonic eosinophilia. In conclusion, primary colonic eosinophilia was extremely rare in this series (eosinophilia may result in increased opportunities for clinicopathologic studies that might lead to a better definition of this still elusive entity.

  11. esophageal cancer: preliminary results

    Afsaneh Maddah Safaei


    Full Text Available Purpose: Dysphagia is a common initial presentation in locally advanced esophageal cancer and negatively impacts patient quality of life and treatment compliance. To induce fast relief of dysphagia in patients with potentially operable esophageal cancer high-dose-rate (HDR brachytherapy was applied prior to definitive radiochemotherapy. Material and methods : In this single arm phase II clinical trial between 2013 to 2014 twenty patients with locally advanced esophageal cancer (17 squamous cell and 3 adenocarcinoma were treated with upfront 10 Gy HDR brachytherapy, followed by 50.4 Gy external beam radiotherapy (EBRT and concurrent chemotherapy with cisplatin/5-fluorouracil. Results : Tumor response, as measured by endoscopy and/or computed tomography scan, revealed complete remission in 16 and partial response in 4 patients (overall response rate 100%. Improvement of dysphagia was induced by brachytherapy within a few days and maintained up to the end of treatment in 80% of patients. No differences in either response rate or dysphagia resolution were found between squamous cell and adenocarcinoma histology. The grade 2 and 3 acute pancytopenia or bicytopenia reported in 4 patients, while sub-acute adverse effects with painful ulceration was seen in five patients, occurring after a median of 2 months. A perforation developed in one patient during the procedure of brachytherapy that resolved successfully with immediate surgery. Conclusions : Brachytherapy before EBRT was a safe and effective procedure to induce rapid and durable relief from dysphagia, especially when combined with EBRT.

  12. A clinical analysis of twenty-five cases of eosinophilic lung disease%嗜酸性肺部疾病25例临床资料分析

    梁琼; 陈一强; 孔晋亮; 潘熠平


    目的 通过分析嗜酸性肺部疾病的临床资料,总结诊断和治疗经验,以提高对该类疾病的认识.方法 回顾性分析2004年1月-2012年8月广西医科大学第一附属医院临床诊断为嗜酸性肺部疾病的25例临床资料,包括病因、临床表现、影像、病理特点和诊治等资料.结果 25例嗜酸性肺部疾病者中,慢性嗜酸性粒细胞肺炎(CEP)9例;变应性肉芽肿性血管炎(CSS)6例;10例寄生虫感染所致嗜酸性肺部疾病,其中2例为单纯性肺嗜酸性粒细胞增多症(L(o)ffler综合征).25例患者外周血、支气管肺泡灌洗液(BALF)中嗜酸性粒细胞增多;有不同程度的低氧血症,肺功能呈限制性、阻塞性、混合性通气功能障碍;胸部CT:两肺片状、条索状或弥漫分布片状磨玻璃浸润影和网状影改变浸润影;肺组织病理学检查或皮肤活检见大量嗜酸性粒细胞浸润.糖皮质激素单独或联用免疫抑制剂治疗有效.结论 嗜酸性肺部疾病的主要病因以寄生虫感染最为常见,其次为不明原因的慢性嗜酸性粒细胞性肺炎.除CSS诊断需组织病理学证据外,嗜酸性肺部疾病大部分病例依据临床表现、实验室检查、BALF和胸部影像学资料可做出临床诊断.%Objective To improve the diagnosis and treatment of eosinophilic lung disease.Methods Patients who were diagnosed with eosinophilic lung disease and hospitalized in the First Affiliated Hospital of Guangxi Medical University Hospital were retrospectively analyzed from January 2004 to August 2012.Data of etiology,clinical manifestation,imaging and pathological features,diagnosis and treatment were recorded.Results A total of 25 patients were diagnosed with eosinophilic lung disease including 9 chronic eosinophilic pneumonia,6 churg-strauss syndrome,and 10 cases of parasitic infection of which two patients were the simple pulmonary eosinophilia (L(o)ffler syndrome).Eosinophil counts in peripheral blood and

  13. A sensitive high throughput ELISA for human eosinophil peroxidase: a specific assay to quantify eosinophil degranulation from patient-derived sources.

    Ochkur, Sergei I; Kim, John Dongil; Protheroe, Cheryl A; Colbert, Dana; Condjella, Rachel M; Bersoux, Sophie; Helmers, Richard A; Moqbel, Redwan; Lacy, Paige; Kelly, Elizabeth A; Jarjour, Nizar N; Kern, Robert; Peters, Anju; Schleimer, Robert P; Furuta, Glenn T; Nair, Parameswaran; Lee, James J; Lee, Nancy A


    Quantitative high throughput assays of eosinophil-mediated activities in fluid samples from patients in a clinical setting have been limited to ELISA assessments for the presence of the prominent granule ribonucleases, ECP and EDN. However, the demonstration that these ribonucleases are expressed by leukocytes other than eosinophils, as well as cells of non-hematopoietic origin, limits the usefulness of these assays. Two novel monoclonal antibodies recognizing eosinophil peroxidase (EPX) were used to develop an eosinophil-specific and sensitive sandwich ELISA. The sensitivity of this EPX-based ELISA was shown to be similar to that of the commercially available ELISA kits for ECP and EDN. More importantly, evidence is also presented confirming that among these granule protein detection options, EPX-based ELISA is the only eosinophil-specific assay. The utility of this high throughput assay to detect released EPX was shown in ex vivo degranulation studies with isolated human eosinophils. In addition, EPX-based ELISA was used to detect and quantify eosinophil degranulation in several in vivo patient settings, including bronchoalveolar lavage fluid obtained following segmental allergen challenge of subjects with allergic asthma, induced sputum derived from respiratory subjects following hypotonic saline inhalation, and nasal lavage of chronic rhinosinusitis patients. This unique EPX-based ELISA thus provides an eosinophil-specific assay that is sensitive, reproducible, and quantitative. In addition, this assay is adaptable to high throughput formats (e.g., automated assays utilizing microtiter plates) using the diverse patient fluid samples typically available in research and clinical settings.

  14. Prevalence of Eosinophilic Gastritis, Gastroenteritis, and Colitis: Estimates From a National Administrative Database.

    Jensen, Elizabeth T; Martin, Christopher F; Kappelman, Michael D; Dellon, Evan S


    Eosinophilic esophagitis (EoE) is becoming increasingly more common, but the prevalence of other eosinophilic gastrointestinal disorders (EGIDs) is unknown. Our objective was to estimate the prevalence of eosinophilic gastritis, gastroenteritis, and colitis in the United States. We used the IMS Health LifeLink PharMetrics Plus Claims Database, data representative of a US national commercially insured population containing medical and pharmaceutical claims for > 75 million individuals. We restricted our sample to patients ages 0 to 64 with continuous enrollment between July 1, 2009, and June 30, 2011. We identified patients with eosinophilic gastritis, gastroenteritis, and colitis as defined by ≥ 1 instance of the International Classification of Diseases, Ninth Revision codes 535.70, 558.41, and 558.42, respectively. We calculated the prevalence of the codes in the database and then standardized the estimates to the US population by age and sex. The standardized estimated prevalences of eosinophilic gastritis, gastroenteritis, and colitis were 6.3/100,000, 8.4/100,000, and 3.3/100,000, respectively. The prevalence of eosinophilic gastroenteritis was the highest among children age gastritis was more prevalent among older age groups. We observed no age differences for eosinophilic colitis. Among affected patients, there was a high proportion of coexisting allergic conditions, 38.5% for eosinophilic gastritis, 45.6% for gastroenteritis, and 41.8% for colitis. Concomitant allergic disease was most commonly identified in pediatric patients. The prevalence of non-EoE EGIDs remains rare in the United States, with < 50,000 total patients affected. There appears to be a female predominance and a high co-occurrence of atopic comorbidities.

  15. Risks of Esophageal Cancer Screening

    ... Esophageal Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Screening (PDQ®)–Patient Version What is screening? Go to ... the esophagus and the stomach). Being overweight . Esophageal Cancer Screening Key Points Tests are used to screen for ...

  16. 反流性食管炎临床和内镜分析%Clinical and Endoscopic Analysis of Relfux Esophagitis



    Objective To investigate the clinical characteristics and endoscopic examination of relfux esophagitis.Methods The clinical data of 102 patients with relfux esophagitis diagnosed by endoscopy in our hospital from December 2014 to September 2015 were retrospectively analyzed. The clinical features and endoscopic features of the patients in this group were analyzed.ResultsThe clinical symptoms of the patients in this group is mainly heartburn, acid reflux and upper abdominal pain, followed by substernal chest pain and dysphagia, in complicated with digestive tract diseases in the superifcial gastritis, accounted for 58.8%, and esophageal ifssure hiatal hernia and gastric ulcer and duodenitis, endoscopic grading with gradeⅠaccounted for than the highest, reaching 75.5%. There was a signiifcant difference in the positive rate of Helicobacter pylori in relfux esophagitis, which reached 61.8%, and the negative rate was statistically signiifcant (P<0.05).Conclusion Relfux esophagitis clinical manifestation is mainly heartburn, acid reflux, with a small variety of digestive tract diseases, the disease occurrence and Helicobacter pylori infection exists close relationship.%目的:探讨反流性食管炎的临床特点及内镜检查情况。方法对2014年12月~2015年9月到我院接受内镜检查并确诊为102例反流性食管炎患者的临床资料进行回顾分析,分析本组患者的临床情况及内镜特点。结果本组患者的临床症状主要是烧心、反酸及上腹痛,其次是胸骨后疼痛及吞咽困难;在并发上消化道疾病中以浅表性胃炎为主,占到58.8%,然后为食管裂孔疝、胃溃疡及十二指肠炎;内镜分级中以Ⅰ级占比最高,达到75.5%。反流性食管炎中以幽门螺杆菌阳性为主,达到61.8%,和阴性率相比差异存在统计学意义(P<0.05)。结论反流性食管炎的临床表现主要是烧心、反酸等,合并多种少消化道疾病,该病发生和幽门

  17. Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P).

    Marchand, E; Reynaud-Gaubert, M; Lauque, D; Durieu, J; Tonnel, A B; Cordier, J F


    Idiopathic chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown cause with nonspecific respiratory and systemic symptoms but rather characteristic peripheral alveolar infiltrates on imaging, developing mainly in women and in atopic subjects. The disorder is highly responsive to oral corticosteroid therapy, but relapses are frequent on reducing or stopping treatment. The long-term course of the disease and data regarding outcome, particularly the need for prolonged oral corticosteroid therapy and the development of severe asthma, are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features and, above all, the later course of CEP in a large homogeneous series of 62 stringently selected patients of whom 46 were followed for more than 1 year. The prevalence of smokers was low (6.5%) and about half of our patients (51.6%) had a previous, and often prolonged, history of asthma. The clinical and roentgenographic features were in keeping with previous studies, but we found that computed tomography could disclose ground glass opacities not detected by X-ray, and that migratory infiltrates before treatment were more frequent (25.5%) than reported previously. The bronchoalveolar lavage cellular count always showed a striking eosinophilic pattern, thus allowing distinction between CEP and cryptogenic organizing pneumonia, both syndromes sharing many common clinical and imaging features. About two-thirds of the patients (68%) showed a ventilatory defect in pulmonary function tests, with about one-half of these presenting with an obstructive pattern, sometimes without previous asthma. Along with the submucosal eosinophilic infiltration noted in 2 patients without ventilatory defect, this is strong evidence to confirm that CEP is not only an alveolointerstitial but also an airway disease. The dramatic response to oral corticosteroid therapy was observed in all treated patients. Although only 1

  18. Loss of CADM1/TSLC1 Expression Is Associated with Poor Clinical Outcome in Patients with Esophageal Squamous Cell Carcinoma

    De Zeng


    Full Text Available Aims. We sought to determine the relationship between CADM1/TSLC1 expression and clinicopathological characteristics in patients with esophageal squamous cell carcinoma (ESCC and the correlation with survival. Materials and Methods. Two hundred and ninety-three ESCC tissues and paired adjacent normal esophageal tissues were immunohistochemically assessed in this study. The association of CADM1/TSLC1 with clinicopathological parameters, as well as disease-free survival (DFS and overall survival (OS, was determined based on the Kaplan-Meier method and Cox regression models. Results. CADM1/TSLC1 was detected in 236 (80.5% tumor tissues and 19 (8.0% paired adjacent normal esophageal tissues. Decreased CADM1/TSLC1 expression was correlated with more advanced histological grade. CADM1/TSLC1 negative tumors were more frequently observed in male cases than in female cases. DFS and OS in the CADM1/TSLC1 negative group were significantly shorter than those in the positive group, particularly in male patients with ESCC. Conclusion. Loss or reduction of CADM1/TSLC1 expression is associated with more advanced histological grade and predicts early recurrence and short survival duration. Thus, loss of CADM1/TSLC1 could be a prognostic factor that can be used to assess the risk of recurrence and survival.

  19. Systemic complications of esophageal lichen planus.

    Manna, R; Garcovich, S; Giovinale, M; Marinaro, A; Manganelli, C; Zampetti, A; Feliciani, C


    Lichen planus is an uncommon inflammatory mucocutaneous disorder affecting the skin and its appendages, as well as oral and genital mucosa. Involvement of the esophageal mucosa is rare and causes significant morbidity, with dysphagia and risk of long-term complications, such as esophageal strictures and stenosis. Esophageal lichen planus is an underreported condition in the spectrum of lichenoid tissue reactions, presenting the risk of systemic manifestations. We describe a patient with severe, long-standing esophageal lichen planus, which had led to marked weight-loss, malnutrition syndrome and chronic respiratory distress due to recurrent aspiration pneumonia. Diagnosis was confirmed by the presence of concomitant muco-cutaneous lesions and characteristic endoscopic and histological findings. Systemic therapy with cyclosporine A and micronutrient supplementation led to rapid clinical improvement. Early diagnosis of esophageal lichen planus as well as effective systemic immunosuppressive treatment is crucial in order to prevent short- and long-term complications.

  20. Suppression of Eosinophil Integrins Prevents Remodeling of Airway Smooth Muscle in Asthma

    Januskevicius, Andrius; Gosens, Reinoud; Sakalauskas, Raimundas; Vaitkiene, Simona; Janulaityte, Ieva; Halayko, Andrew J.; Hoppenot, Deimante; Malakauskas, Kestutis


    : Suppression of eosinophil-ASM interaction via RGD-binding integrins attenuates eosinophil-induced ASM remodeling in asthma. Trial Registration: Identifier: NCT02648074. PMID:28119625

  1. Clinical evaluation on cardiac enlargement in patients with esophageal cancer treated by radiotherapy with or without chemotherapy

    Sasamoto, Ryuta [Niigata Univ. (Japan). School of Medicine


    Recent literature on chemoradiotherapy for esophageal cancer report the comparable survival results as surgery, and suggest the importance of management for the late adverse effect of chemoradiotherapy. The aim of this study is to investigate the incidence and risk factors of cardiomegaly after chemoradiotherapy using low dose continuous infusion of 5FU/CDDP+5FU for esophageal cancer. Fifty-one patients with stage I-IVA esophageal cancer who were treated by radiotherapy with more than 50 Gy with or without chemotherapy and followed up for more than 6 months were analyzed. Sixteen patients were treated by radiation alone and 35 patients were treated by chemoradiotherapy. A change of CTR (cardio-thoracic ratio) was defined as the difference between CTR in the pre-treatment X-ray film and CTR in the post-treatment X-ray film with maximum cardiac silhouette. A change of CTR by more than 10% was defined as ''significant cardiomegaly''. In this study cardiac area-dose'', which is the sum of the products of cardiac area within every radiation field and its target dose, was calculated in each patient as a radiation parameter. Significant cardiomegaly was noted in 1 patient (6%) in the radiation alone group, in 8 patients (23%) in the chemoradiotherapy group and in 9 patients (18%) in the total population. In cases with more than 0.4 m{sup 2}{center_dot}Gy in cardiac area-dose, CTR elevation was significantly higher than in cases with less than 0.4m{sup 2}{center_dot}Gy. More than moderate pleural effusion was noted in 5 patients (10%). Chronic pericardial effusion and subsequent cardiac tamponade was considered to be one of the contributing factors for pleural effusion, because increases of pleural effusion coincided with CTR elevations in 3 cases. In addition, the fact that no case had right-sided unilateral pleural effusion suggested the direct effect of radiation to the pleura. Significant cardiomegaly was seen in 18% of 51 patients with

  2. Clinical predictors of abnormal esophageal pH monitoring in preterm infants Preditores clínicos para pHmetria esofágica anormal em prematuros

    Maria Aparecida Mezzacappa


    Full Text Available BACKGROUND: Risk factors for gastroesophageal reflux disease in preterm neonates have not been yet clearly defined. AIM: To identify factors associated with increased esophageal acid exposition in preterm infants during the stay in the neonatal unit. METHODS: A case-control study in preterm infants who had undergone prolonged monitoring of distal esophageal pH, following clinical indication. Eighty-seven preterms with reflux index (percentage of total time of esophageal pHmetry >10% (cases and 87 unpaired preterms were selected with reflux index 10% in preterms were: vomiting, regurgitation, Apnea, female gender. The variables that were associated with a lower frequency of increased reflux index were: volume of enteral intake at the onset of symptoms >147 mL/kg/day, and postnatal corticoid use. CONCLUSIONS: Vomiting, regurgitation, apnea, female gender and acute respiratory distress during the first week of life were variables predictive of increased esophageal acid exposition in preterm infants with birthweight 10%.RACIONAL: Os fatores de risco para a doença pelo refluxo gastroesofágico em recém-nascidos prematuros não foram, até momento, claramente estabelecidos. OBJETIVO: Identificar fatores associados ao aumento da exposição ácida intra-esofágica em prematuros durante o período de internação em unidade neonatal. MÉTODOS: Realizou-se estudo de caso controle com prematuros que realizaram monitorização prolongada do pH esofágico por suspeita clínica de doença do refluxo. Foram selecionados 87 recém-nascidos com valor do índice de refluxo (percentual do tempo total do exame com pH abaixo de 4 >10% (casos e 87 recém-nascidos com índice de refluxo 10% foram: vômitos, regurgitações, apnéia, sexo feminino e insuficiência respiratória na 1ª semana de vida. As variáveis que se associaram a menor freqüência de índice de refluxo 147mL/kg/d e uso de corticóide pós-natal. CONCLUSÕES: Vômitos, regurgitações, apn

  3. Prognostic impact of clinical course-specific mRNA expression profiles in the serum of perioperative patients with esophageal cancer in the ICU: a case control study

    Oshima Yoshiaki


    Full Text Available Abstract Background We previously reported that measuring circulating serum mRNAs using quantitative one-step real-time RT-PCR was clinically useful for detecting malignancies and determining prognosis. The aim of our study was to find crucial serum mRNA biomarkers in esophageal cancer that would provide prognostic information for post-esophagectomy patients in the critical care setting. Methods We measured serum mRNA levels of 11 inflammatory-related genes in 27 post-esophagectomy patients admitted to the intensive care unit (ICU. We tracked these levels chronologically, perioperatively and postoperatively, until the two-week mark, investigating their clinical and prognostic significance as compared with clinical parameters. Furthermore, we investigated whether gene expression can accurately predict clinical outcome and prognosis. Results Circulating mRNAs in postoperative esophagectomy patients had gene-specific expression profiles that varied with the clinical phase of their treatment. Multivariate regression analysis showed that upregulation of IL-6, VWF and TGF-β1 mRNA in the intraoperative phase (p = 0.016, 0.0021 and 0.009 and NAMPT and MUC1 mRNA on postoperative day 3 (p ®, Ono Pharmaceutical Co., Ltd. significantly correlated with MUC1 and NAMPT mRNA expression (p = 0.048 and 0.045. IL-6 mRNA correlated with hypercytokinemia and recovery from hypercytokinemia (sensitivity 80.9% and was a significant biomarker in predicting the onset of severe inflammatory diseases. Conclusion Chronological tracking of postoperative mRNA levels of inflammatory-related genes in esophageal cancer patients may facilitate early institution of pharamacologic therapy, prediction of treatment response, and prognostication during ICU management in the perioperative period.

  4. PET-CT manifestation of Candida esophagitis

    Bahk, Yong Whee [Sung-Ae Hospital, Seoul (Korea, Republic of); O, Joo Hyun [Kangnam St. Mary' s Hospital, Catholic University Medical School, Seoul (Korea, Republic of)


    Candida esophagitis (moniliasis) is the most common infection of the gullet and has generally been attributed to as a complication of immune suppressed state. However, as the current case. Holt found the disease to occur in 3 of his 13 patients without predisposing condition. Predisposing factors other than immune deficient conditions include aplastic anemia, alcoholism and Parkinson's disease and age, diabetes mellitus, and disruption of mucosal integrity. Growing prevalence of Candida esophagitis in recent years is accounted for by an increase in the number of patients with organ transplantation, malignancy and AIDS as well as populrization of endoscopy. Microorganisms that reached the esophagus in oral secretions are rarely cultured from the esophageal surface. Of many species C. albicans is the most common offender although C. tropicalis has also been isolated with high prevalence, particularly in the patients with cancer and disseminated candidiasis. Clinically, the patients with Candida esophagitis seek medical care for esophageal or retrosternal pain, dysphagia or distress. Candida esophagitis may be the extension from oropharyngeal infection but in the majority the esophagus is the sole site of infection. The middle and lower thirds of the esophagus are more typically affected than the upper third. Diagnosis can be indicated by double contrast esophagography or endoscopy and confirmed by potassium hydroxide (KOH) stain or biopsy. It is to be noted that the more presence of Candida in smear or cultured specimen cannot indict Candida as definitive offender. Differential diagnosis includes herpes simplex infection, cytomegalovirus infection, reflux esophagitis or radiation esophagitis.

  5. Esophageal motility abnormalities in gastroesophageal reflux disease

    Irene; Martinucci; Nicola; de; Bortoli; Maria; Giacchino; Giorgia; Bodini; Elisa; Marabotto; Santino; Marchi; Vincenzo; Savarino; Edoardo; Savarino


    Esophageal motility abnormalities are among the main factors implicated in the pathogenesis of gastroesophageal reflux disease. The recent introduction in clinical and research practice of novel esophageal testing has markedly improved our understanding of the mechanisms contributing to the development of gastroesophageal reflux disease, allowing a better management of patients with this disorder. In this context, the present article intends to provide an overview of the current literature about esophageal motility dysfunctions in patients with gastroesophageal reflux disease. Esophageal manometry, by recording intraluminal pressure, represents the gold standard to diagnose esophagealmotility abnormalities. In particular, using novel techniques, such as high resolution manometry with or without concurrent intraluminal impedance monitoring, transient lower esophageal sphincter (LES) relaxations, hypotensive LES, ineffective esophageal peristalsis and bolus transit abnormalities have been better defined and strongly implicated in gastroesophageal reflux disease development. Overall, recent findings suggest that esophageal motility abnormalities are increasingly prevalent with increasing severity of reflux disease, from nonerosive reflux disease to erosive reflux disease and Barrett’s esophagus. Characterizing esophageal dysmotility among different subgroups of patients with reflux disease may represent a fundamental approach to properly diagnose these patients and, thus, to set up the best therapeutic management. Currently, surgery represents the only reliable way to restore the esophagogastric junction integrity and to reduce transient LES relaxations that are considered to be the predominant mechanism by which gastric contents can enter the esophagus. On that ground, more in depth future studies assessing the pathogenetic role of dysmotility in patients with reflux disease are warranted.

  6. Chronic eosinophilic pneumonia within the syndrom of 'pulmonary infiltrates with eosinophilia'

    Heinrich, J.; Schmidt, M.; Kulke, H.; Daemmrich, J.


    Typical diagnostic findings of the chronic eosinophilic pneumonia within the syndrom of 'pulmonary infiltrates with eosinophilia' are described. We demonstrate one case of chronic eosinophilia pneumonia of unknown aetiology investigated clinically, by chest radiography, lung biopsy, bronchial lavage and lung function. The importance of chest radiography in the diagnosis of chronic eosinophilic pneumonia is presented.

  7. PET for Staging of Esophageal Cancer



    FDG-PET is of clinical value especially for detection of distant metastases or recurrent esophageal cancer. For the staging of primary tumor or locoregional lymph node metastasis PET is currently not suitable.

  8. Eosinophilic Colitis: University of Minnesota Experience and Literature Review

    Wolfgang B. Gaertner


    Full Text Available Eosinophilic colitis is a rare form of primary eosinophilic gastrointestinal disease that is poorly understood. Neonates and young adults are more frequently affected. Clinical presentation is highly variable depending on the depth of inflammatory response (mucosal, transmural, or serosal. The pathophysiology of eosinophilic colitis is unclear but is suspected to be related to a hypersensitivity reaction given its correlation with other atopic disorders and clinical response to corticosteroid therapy. Diagnosis is that of exclusion and differential diagnoses are many because colonic tissue eosinophilia may occur with other colitides (parasitic, drug-induced, inflammatory bowel disease, and various connective tissue disorders. Similar to other eosinophilic gastrointestinal disorders, steroid-based therapy and diet modification achieve very good and durable responses. In this paper, we present our experience with this rare pathology. Five patients (3 pediatric and 2 adults presented with diarrhea and hematochezia. Mean age at presentation was 26 years. Mean duration of symptoms before pathologic diagnosis was 8 months. Mean eosinophil count per patient was 31 per high-power field. The pediatric patients responded very well to dietary modifications, with no recurrences. The adult patients were treated with steroids and did not respond. Overall mean followup was 22 (range, 2–48 months.

  9. Eosinophilic Gastroenteritis Presenting as Intestinal Obstruction - A Case Series

    Amita Krishnappa


    Full Text Available Eosinophilic Gastroenteritis is a rare disease characterized by infiltration of the gastrointestinal tract by an increased number of eosinophils as compared to the normal. The anatomic location and intensity of the infiltrate decides the varied clinical symptomatology with which these patients present. The present report deals with four cases, all presenting with clinical signs of intestinal obstruction A laparotomy performed revealed a stricture in the first case, superficial ulcers and adhesions in the second case, an ileocaecal mass in the third case and volvulus formation in the fourth case. Eosinophilic gastroenteritis was confirmed on histopathology in all the four cases. All the four patients experienced relief of symptoms after resection. It is essential to diagnose the disease to differentiate it from other conditions presenting as intestinal obstruction. The cases are presented because of the rarity of occurrence and presentation. Relevant literature has been reviewed.

  10. Brain Abscess after Esophageal Dilatation

    Gaïni, S; Grand, M; Michelsen, J


    with malaise, progressive lethargy, fever, aphasia and hemiparesis. Six days before she had been treated with esophageal dilatation for a stricture caused by accidental ingestion of caustic soda. The brain abscess was treated with surgery and antibiotics. She recovered completely. This clinical case...

  11. Rapid and clinically significant response to masitinib in the treatment of mucosal primary esophageal melanoma with somatic KIT exon 11 mutation involving brain metastases: A case report.

    Prosvicova, Jarmila; Lukesova, Sarka; Kopecky, Jindrich; Grim, Jiri; Papik, Zdenek; Kolarova, Renata; Navratilova, Blanka; Dubreuil, Patrice; Agopian, Julie; Mansfield, Colin; Moussy, Alan; Hermine, Olivier


    Malignant melanoma in the gastrointestinal tract may be primary or metastatic. Mucosal melanoma is a quite rare and aggressive disease, growing hidden and diagnosed with a certain delay which makes treatment difficult. The authors present the first patient with c-kit exon 11 mutated primary esophageal melanoma treated with oral tyrosine kinase inhibitor masitinib. A 55-year-old-man presented with esophageal melanoma metastising into visceral organs and to the brain. The patient showed objective and clinical significant therapeutic response to masitinib. After initiation of masitinib, dysphagia and odynophagia disappeared within 1 week. Following 1 month of treatment, computed tomography showed a regression in the number and size of brain metastatic lesions and regression in visceral lesions. This therapeutic response, despite the aggressive disease on treatment initiation, effectively enabled the patient to have 6 months of quality life. This report corroborates the plausibility of treating advanced melanoma carrying a mutation of KIT with masitinib. It also raises the question of masitinib treatment beyond progression. Additionally, the observed masitinib treatment effect on the brain suggests accumulation of therapeutically relevant concentration of masitinib in the central nervous system. This observation has possible ramifications for treatment of intracranial neoplasms.

  12. [Preliminary clinical evaluation of continuous infusion of 5-FU and low-dose Cisplatin (LFP) therapy alone and combined with radiation therapy for treatment of advanced or recurrent esophageal cancer].

    Itoh, Satoshi; Morita, Sojiro; Ohnishi, Takenao; Tsuji, Akihito; Takamatsu, Masahiro; Horimi, Tadashi


    We evaluated the clinical effect of 5-FU and low-dose Cisplatin (LFP) therapy alone and LFP therapy combined with radiation therapy in patients with advanced or recurrent esophageal cancer. From March 1995 to September 2000, 11 patients with inoperable esophageal cancer, 8 patients with adjuvant chemotherapy post operation, and 14 patients with recurrent esophageal cancer were treated with LFP therapy. 5-FU (160 mg/m2/day) was continuously infused over 24 hours, and CDDP (3-7 mg/m2/day) was infused for 30 minutes. The administration schedule consisted of 5-FU for 7 consecutive days and CDDP for 5 days followed by a 2-day rest, each for four weeks. We combined radiation therapy for the patients with all lesions that could be included in the radiation field. Of 30 patients with measurable lesions the response rates of LFP therapy alone and LFP therapy combined with radiation therapy were 33% and 60%, respectively. Toxicity over grade 3 appeared in 3 of 15 patients with LFP therapy combined with radiation therapy. There was no significant difference between LFP therapy alone and LFP therapy combined with radiation therapy with regard to survival rate of inoperable and recurrent esophageal cancer. In conclusion, LFP therapy alone may be effective for esophageal cancer.

  13. Preliminary clinical evaluation of continuous infusion of 5-FU and low-dose cisplatin (LFP) therapy alone and combined with radiation therapy for treatment of advanced or recurrent esophageal cancer

    Itoh, Satoshi; Morita, Sojiro; Ohnishi, Takenao; Tsuji, Akihito; Takamatsu, Masahiro; Horimi, Tadashi [Kochi Municipal Central Hospital, Nankoku (Japan). Cancer Research Center


    We evaluated the clinical effect of 5-FU and low-dose Cisplatin (LFP) therapy alone and LFP therapy combined with radiation therapy in patients with advanced or recurrent esophageal cancer. From March 1995 to September 2000, 11 patients with inoperable esophageal cancer, 8 patients with adjuvant chemotherapy post operation, and 14 patients with recurrent esophageal cancer were treated with LFP therapy. 5-FU (160 mg/m{sup 2}/day) was continuously infused over 24 hours, and CDDP (3-7 mg/m{sup 2}/day) was infused for 30 minutes. The administration schedule consisted of 5-FU for 7 consecutive days and CDDP for 5 days followed by a 2-day rest, each for four weeks. We combined radiation therapy for the patients with all lesions that could be included in the radiation field. Of 30 patients with measurable lesions the response rates of LFP therapy alone and LFP therapy combined with radiation therapy were 33% and 60%, respectively. Toxicity over grade 3 appeared in 3 of 15 patients with LFP therapy combined with radiation therapy. There was no significant difference between LFP therapy alone and LFP therapy combined with radiation therapy with regard to survival rate of inoperable and recurrent esophageal cancer. In conclusion, LFP therapy alone may be effective for esophageal cancer. (author)

  14. Lower esophageal sphincter pressure in histologic esophagitis.

    Welch, R W; Luckmann, K; Ricks, P; Drake, S T; Bannayan, G; Owensby, L


    The fasting lower esophageal sphincter pressure of 18 normal volunteers was compared to 22 patients with symptoms and objective evidence of gastroesophageal reflux. Lower esophageal sphincter pressure was measured by rapid pull-through using an 8-lumen radially perfused catheter that sampled pressure every45 degrees around the circumference of the sphincter. The 22 reflux patients were subdivided for analysis into two groups, those with an acute inflammatory infiltrate on biopsy and those without inflammation. Those patients without inflammatory esophagitis had normal sphincter pressures. Those with a definite inflammatory infiltrate had pressures significantly less than normal. The least reliable separation between normals and those with inflammatory esophagitis occurred in the anterior orientations. We conclude that while basal lower esophageal sphincter pressure measurement may identify patients with reflux and inflammatory esophagitis, it is of no help in identifying those patients with reflux unassociated with inflammation. Decreased basal fasting LESP does not appear to be the most important primary determinant of gastroesophageal reflux.

  15. Clinicopathological and ultrasonographic features of cats with eosinophilic enteritis.

    Tucker, Samuel; Penninck, Dominique G; Keating, John H; Webster, Cynthia R L


    Eosinophilic enteritis (EE) in cats is poorly characterized. The aim of the current study was to retrospectively evaluate the clinical and ultrasonographic findings in cats with histologic evidence of eosinophilic inflammation on gastrointestinal biopsy. Twenty-five cats with tissue eosinophilia on surgical (10) or endoscopic (15) biopsy of the gastrointestinal tract, having an abdominal ultrasound performed within 48 h of biopsy acquisition, were enrolled. History, clinical presentation, clinical pathology and abdominal ultrasound findings were reviewed. Intestinal biopsies were evaluated by a single pathologist and separated into two groups based on the degree of eosinophilic infiltrate: mild (eosinophils/high-power field [HPF], 11/25 cats), or moderate/marked (>10 eosinophils/HPF, 14/25 cats). The former were considered primary lymphoplasmacytic or lymphocytic inflammatory bowel disease (LPE) with subtle eosinophilic infiltrates, and the latter to have EE. Signalment, history and clinical signs were similar in all cats. Only cats with EE (6/14) had palpably thickened intestines. The only distinguishing clinicopathological feature of cats with EE was the presence of peripheral eosinophilia (6/14). On ultrasound, when compared with cats with LPE, cats with EE had a greater mean jejunal wall thickness (3.34 mm ± 0.72 mm vs 4.07 mm ± 0.58 mm, respectively) and an increased incidence of thickening of the muscularis layer (1/11 and 11/14, respectively). In conclusion, ultrasonographic evidence of a prominent intestinal muscularis layer, palpably thickened intestines and peripheral eosinophilia can serve as biomarkers for the presence of EE in cats with chronic intestinal signs.

  16. Hematopoietic Processes in Eosinophilic Asthma.

    Salter, Brittany M; Sehmi, Roma


    Airway eosinophilia is a hallmark of allergic asthma and understanding mechanisms that promote increases in lung eosinophil numbers is important for effective pharmaco-therapeutic development. It has become evident that expansion of hemopoietic compartments in the bone marrow promotes differentiation and trafficking of mature eosinophils to the airways. Hematopoietic progenitor cells egress the bone marrow and home to the lungs, where in-situ differentiative processes within the tissue provide an ongoing source of pro-inflammatory cells. In addition, hematopoietic progenitor cells in the airways can respond to locally-derived alarmins, to produce a panoply of cytokines thereby themselves acting as effector pro-inflammatory cells that potentiate type 2 responses in eosinophilic asthma. In this review, we will provide evidence for these findings and discuss novel targets for modulating eosinophilopoietic processes, migration and effector function of precursor cells.

  17. Significado clínico y fisiopatológico del eosinófilo Clinical and physiopathological significance of the eosinophil

    José Domingo Torres Hernández


    Full Text Available

    El eosinófilo es una célula con funciones protectoras y beneficiosas especificas pero que en algunas circunstancias Interviene como mediador en diferentes procesos fisiopatológicos. Un recuento aumentado en la sangre periférica (mayor de 500 células/mm cúbico siempre debe investigarse porque puede ser el Indicador precoz de una enfermedad o la guía para llegar a un diagnóstico.

    The eosinophil is a cell with specific protective and beneficial functions but In some circumstances It acts as a mediator in different physiopathologic processes. Increased periphery blood counts (more than 500 cells/cubic mm should always be investigated since they may be the earliest indication of a disease or represent an important diagnostic guide.

  18. [Oesophageal diseases: gastroesophageal reflux disease, Barrett's disease, achalasia and eosinophilic oesophagitis].

    Calvet, Xavier


    The most important novel findings presented on oesophageal disease in DDW 2015 were the following: 1) GERD: a) hypervigilance seems to be a key pathogenic factor in reflux symptoms refractory to PPI; b) post-reflux swallowing-induced peristaltic waves could be an excellent diagnostic criterion for GERD; c) laryngeal pH-metry is not useful in the diagnosis of extra-oesophageal symptoms; d) the recommendation of weight loss adequately recorded in the clinical reports of patients with GERD and obesity or overweight is an excellent quality indicator and is associated with better outcomes. 2) Barrett's oesophagus: a) persistent low-grade dysplasia in more than one endoscopy and a diagnosis of "indefinite for dysplasia" are associated with a high risk of neoplastic progression; b) narrow-band imaging allows areas of dysplasia on Barrett's oesophagus to be identified with high sensitivity and specificity; c) initial endoscopy fails to identify a high percentage of advanced neoplasms in Barrett's oesophagus. Early re-endoscopy should be considered; d) endoscopists specialized in Barret's oesophagus obtain a much higher yield in the diagnosis of advanced lesions. Patients at high risk-men, older patients, smokers and those with long-segment Barrett's oesophagus-could benefit from follow-up in a referral center. 3) Achalasia: POEM seems safe and effective, independently from patient characteristics (age, comorbidity) and the technical variations used. 4) Eosinophilic esophagitis: topical budesonide and exclusion diets are reasonably effective in PPI non-responders.

  19. Esophageal atresia and tracheo-esophageal fistula.

    van der Zee, David C; Tytgat, Stefaan H A; van Herwaarden, Maud Y A


    Management of esophageal atresia has merged from correction of the anomaly to the complete spectrum of management of esophageal atresia and all its sequelae. It is the purpose of this article to give an overview of all aspects involved in taking care of patients with esophageal atresia between January 2011 and June 2016, as well as the patients who were referred from other centers. Esophageal atresia is a complex anomaly that has many aspects that have to be dealt with and complications to be solved. By centralizing these patients in centers of expertise it is believed that the best care can be given. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Eosinophilic meningitis secondary to intravenous vancomycin.

    Kazi, Ruchika; Kazi, Haseeb A; Ruggeri, Cara; Ender, Peter T


    Eosinophilic meningitis may be due to infectious or noninfectious etiologies. Parasitic infections cause this entity most frequently and of the noninfectious causes, medications play an important role. We describe a 32-year-old male who developed eosinophilic meningitis while receiving intravenous vancomycin. No other apparent cause of the eosinophilic meningitis was appreciated. This case represents the first description of eosinophilic meningitis due to systemic vancomycin.

  1. Eosinophil degranulation. An immunologic determinant in the pathogenesis of the Mazzotti reaction in human onchocerciasis.

    Ackerman, S J; Kephart, G M; Francis, H; Awadzi, K; Gleich, G J; Ottesen, E A


    results indicate that eosinophil degranulation is characteristic of the response and that it occurs with a time course suggestive of a role for the eosinophil in determining the clinical and pathologic manifestations of the reaction.

  2. Esophageal Strictures in Children

    Ahmad Bazrafshan


    Conclusion: Anastomotic stricture after surgical repair of esophageal atresia comprised the most common cause of esophageal stricture. Proximal esophagus was the most common site of stricture. Most of the patients recovered with dilatation, surgery, or a combination of the two.

  3. Eosinophilic cholecystitis caused by Ascaris lumbricoides

    Montiel-Jarquín, Alvaro


    Eosinophilic cholecystitis is caused by the accumulation of eosinophils in the gallbladder wall and diagnosis is usually made based on histopathologic studies. The purpose of this paper is to comment on a case report published in World J Gastroenterol 2007 July; 13 (27): 3760-3762, about eosinophilic cholecystitis along with pericarditis without histopathological studies, which are considered necessary for its diagnosis.

  4. Eosinophilic cholecystitis caused by Ascaris lumbricoides

    Montiel-Jarquín Alvaro


    Eosinophilic cholecystitis is caused by the accumulation of eosinophils in the gallbladder wall and diagnosis is usually made based on histopahologic studies.The purpose of this paper is to comment on a case report published in Wodd J Gastroenterol 2007 luly;13 (27):3760-3762,about eosinophilic cholecystitis along with pericarditis without histopathological studies,which are considered necessary for its diagnosis.

  5. Updates on esophageal and gastric cancers

    Amy Gallo; Charles Cha


    Esophageal and gastric cancers are both common and deadly. Patients present most often after disease progression and survival is therefore poor. Due to demographic variability and recent changes in disease incidence, much emphasis has been placed on studying risk factors for both esophageal and gastric cancers.However, with increasing understanding of these diseases, low survival rates persist and continued intensive studies are necessary to optimize treatment plans. This review article discusses updates in the evolving epidemiology, clinical presentation, risk factors,and diagnostic and treatment modalities of esophageal and gastric cancers.

  6. Esophageal tissue engineering: A new approach for esophageal replacement

    Giorgia Totonelli; Panagiotis Maghsoudlou; Jonathan M Fishman; Giuseppe Orlando; Tahera Ansari; Paul Sibbons; Martin A Birchall


    A number of congenital and acquired disorders require esophageal tissue replacement.Various surgical techniques,such as gastric and colonic interposition,are standards of treatment,but frequently complicated by stenosis and other problems.Regenerative medicine approaches facilitate the use of biological constructs to replace or regenerate normal tissue function.We review the literature of esophageal tissue engineering,discuss its implications,compare the methodologies that have been employed and suggest possible directions for the future.Medline,Embase,the Cochrane Library,National Research Register and databases were searched with the following search terms:stem cell and esophagus,esophageal replacement,esophageal tissue engineering,esophageal substitution.Reference lists of papers identified were also examined and experts in this field contacted for further information.All full-text articles in English of all potentially relevant abstracts were reviewed.Tissue engineering has involved acellular scaffolds that were either transplanted with the aim of being repopulated by host cells or seeded prior to transplantation.When acellular scaffolds were used to replace patch and short tubular defects they allowed epithelial and partial muscular migration whereas when employed for long tubular defects the results were poor leading to an increased rate of stenosis and mortality.Stenting has been shown as an effective means to reduce stenotic changes and promote cell migration,whilst omental wrapping to induce vascularization of the construct has an uncertain benefit.Decellularized matrices have been recently suggested as the optimal choice for scaffolds,but smart polymers that will incorporate signalling to promote cell-scaffold interaction may provide a more reproducible and available solution.Results in animal models that have used seeded scaffolds strongly suggest that seeding of both muscle and epithelial cells on scaffolds prior to implantation is a

  7. Clinical Significance of EGFR Expression in Esophageal Squamous Cell Carcinoma%EGFR蛋白在食管鳞癌中的表达及其临床意义

    吴金训; 余英豪; 刘伟


    目的 评价表皮生长因子受体(EGFR)过表达与食管鳞癌患者临床病理参数的相关性及其临床意义.方法 收集2004年1月至2010年6月在南京军区福州总医院手术切除临床资料完整的食管鳞癌标本1034例,采用EliVisionTM plus免疫组织化学染色检测癌组织中EGFR蛋白表达.结果 EGFR在食管鳞癌组织中阳性表达率为74.9%,癌旁非肿瘤性黏膜未见EGFR蛋白过表达;EGFR蛋白表达与患者性别、年龄、肿瘤大小、肉眼分型、TNM分期、浸润深度、淋巴结转移及远处转移均无相关性(P>0.05),而高、中分化胃癌中EGFR的表达显著高于低、未分化胃癌(P<0.05).结论 EGFR蛋白表达与食管鳞癌患者的临床病理参数无明显相关性,不能作为评估食管鳞癌恶性生物学行为的指标,但EGFR过表达为食管鳞癌的靶向治疗研究提供了新思路,EGFR基因可能成为靶向治疗的新靶点.%Objective To evaluate the correlation between EGFR overexpression and esophageal squamous cell carcinoma clinical pathological parameters and the clinical significance. Methods 1034 cases of esophageal squamous cell carcinoma samples with complete clinical data from surgical resection at Fuzhou General Hospital of Nanjing Military Command during Jan. 2004 and Jun. 2010 were collected,EGFR protein expression of which were examined with EliVisionTM plus immunohistochemical staining. Results Out of 1034 esophageal squamous cell carcinoma samples examined by IHC,a total of 774( 74.9% )cases were positive for EGFR overexpression,and no positive cases were observed in adjacent non-neoplastic mucosa. There were no relationship between EGFR overexpression and gender,age,tumor size,gross type differentiation,TNM staging,invasion depth,lymph node metastasis and distant metastasis( P >0. 05 ). The positive rates of EGFR in well differentiated adenocarcinomas was higher than poorly differentiated adenocarcinomas( P < 0. 05 ). Conclusion There are no


    Zhang Jizeng; Chen Jumei; Zhang Chenguang


    Objective: To research the formative mechanism of eosinophilic lymphogranuloma (ELG), investigate its essence, provide morphologic base for treatment.Methods: The biopsies and surgical specimens of 41 cases were studied with the light microscope, fluorescein microscope, electron microscope and immunohistochemical methods. In these cases, 10 cases levels of serum IgE were measured, it was high level, and 11 cases cured with radiotherapy. Results: The lesions mainly included proliferation of both lymph tissues and post-capillary venues and formed many new scattered lymph follicles.Marked hyperplasia of plasmocytes and mast cells and diffusible infiltration of eosinophilic granulocytes were observed in tissues. The eosinophilic granulocytes were obviously degranulated. When stained with fluorescein isothiocyanate (FITC) labeled antiserum IgE, the cells showed yellow-green fluorescence, which showed reticular shape in the germinal center of lymph follicles. The swollen tumor-like masses could disappear with radiotherapy, and the eosinophilic granulocytes count in circulation and level of serum IgE reduced to normal.Conclusion: The serum IgE is high lever and it is positive reaction in the tissues strongly. It is accord with allergic granuloma. The lymphocytes are allergenic ambocepotor cells, the x-ray can kill them and stop allergenic agent, the illness was recovered.

  9. Lack of autologous tissue transmission of eosinophilic plaques in cats.

    Moriello, K A; Kunkle, G; Miller, L M; Crowley, A


    Autologous tissue transmission of spontaneously developing feline eosinophilic plaques was attempted in 5 cats. Macerated tissue from the plaque was vigorously rubbed onto 2 scarified skin sites in each cat. The inoculated areas were observed daily for 30 days. During that time, no clinical or histologic evidence of transmission was found.

  10. Eosinophilic Fasciitis: an Atypical Presentation of a Rare Disease

    Sabrina Poradosu


    Conclusion: The diagnosis of eosinophilic fasciitis is challenging due to the lack of pathognomonic signs and symptoms. As spontaneous resolution has been described, watchful waiting is defendable depending on the clinical presentation. Although magnetic resonance imaging (MRI can be useful in establishing the diagnosis, a deep muscle biopsy remains the gold standard diagnostic tool.

  11. Eosinophils induce airway smooth muscle cell proliferation.

    Halwani, Rabih; Vazquez-Tello, Alejandro; Sumi, Yuki; Pureza, Mary Angeline; Bahammam, Ahmed; Al-Jahdali, Hamdan; Soussi-Gounni, Abdelillah; Mahboub, Bassam; Al-Muhsen, Saleh; Hamid, Qutayba


    Asthma is characterized by eosinophilic airway inflammation and remodeling of the airway wall. Features of airway remodeling include increased airway smooth muscle (ASM) mass. However, little is known about the interaction between inflammatory eosinophils and ASM cells. In this study, we investigated the effect of eosinophils on ASM cell proliferation. Eosinophils were isolated from peripheral blood of mild asthmatics and non-asthmatic subjects and co-cultured with human primary ASM cells. ASM proliferation was estimated using Ki-67 expression assay. The expression of extracellular matrix (ECM) mRNA in ASM cells was measured using quantitative real-time PCR. The role of eosinophil derived Cysteinyl Leukotrienes (CysLTs) in enhancing ASM proliferation was estimated by measuring the release of leukotrienes from eosinophils upon their direct contact with ASM cells using ELISA. This role was confirmed either by blocking eosinophil-ASM contact or co-culturing them in the presence of leukotrienes antagonist. ASM cells co-cultured with eosinophils, isolated from asthmatics, but not non-asthmatics, had a significantly higher rate of proliferation compared to controls. This increase in ASM proliferation was independent of their release of ECM proteins but dependent upon eosinophils release of CysLTs. Eosinophil-ASM cell to cell contact was required for CysLTs release. Preventing eosinophil contact with ASM cells using anti-adhesion molecules antibodies, or blocking the activity of eosinophil derived CysLTs using montelukast inhibited ASM proliferation. Our results indicated that eosinophils contribute to airway remodeling during asthma by enhancing ASM cell proliferation and hence increasing ASM mass. Direct contact of eosinophils with ASM cells triggers their release of CysLTs which enhance ASM proliferation. Eosinophils, and their binding to ASM cells, constitute a potential therapeutic target to interfere with the series of biological events leading to airway remodeling

  12. Distal esophageal spasm: an update.

    Achem, Sami R; Gerson, Lauren B


    Distal esophageal spasm (DES) is an esophageal motility disorder that presents clinically with chest pain and/or dysphagia and is defined manometrically as simultaneous contractions in the distal (smooth muscle) esophagus in ≥20% of wet swallows (and amplitude contraction of ≥30 mmHg) alternating with normal peristalsis. With the introduction of high resolution esophageal pressure topography (EPT) in 2000, the definition of DES was modified. The Chicago classification proposed that the defining criteria for DES using EPT should be the presence of at least two premature contractions (distal latencylong acting), calcium-channel blockers, anticholinergic agents, 5-phosphodiesterase inhibitors, visceral analgesics (tricyclic agents or SSRI), and esophageal dilation. Acid suppression therapy is frequently used, but clinical outcome trials to support this approach are not available. Injection of botulinum toxin in the distal esophagus may be effective, but further data regarding the development of post-injection gastroesophageal reflux need to be assessed. Heller myotomy combined with fundoplication remains an alternative for the rare refractory patient. Preliminary studies suggest that the newly developed endoscopic technique of per oral endoscopic myotomy (POEM) may also be an alternative treatment modality.

  13. Esophageal duplication and congenital esophageal stenosis.

    Trappey, A Francois; Hirose, Shinjiro


    Esophageal duplication and congenital esophageal stenosis (CES) may represent diseases with common embryologic etiologies, namely, faulty tracheoesophageal separation and differentiation. Here, we will re-enforce definitions for these diseases as well as review their embryology, diagnosis, and treatment. Copyright © 2017. Published by Elsevier Inc.

  14. Eosinophil peroxidase in sputum represents a unique biomarker of airway eosinophilia.

    Nair, P; Ochkur, S I; Protheroe, C; Radford, K; Efthimiadis, A; Lee, N A; Lee, J J


    Sputum eosinophilia has been shown to be a predictor of response to anti-eosinophil therapies in patients with airway diseases. However, quantitative cell counts and differentials of sputum are labor intensive. The objective of this study was to validate a novel ELISA-based assay of eosinophil peroxidase (EPX) in sputum as a rapid and reliable marker of airway eosinophils. The utility of EPX-based ELISA as an eosinophil-specific assay was achieved through comparisons with sputum eosinophil differential counts in freshly prepared and archived patient samples from a variety of clinical settings. EPX levels in sputum correlated with eosinophil percentage (r(s) = 0.84) in asthma patients with varying degrees of airway eosinophilia. Significantly, unlike assays of other eosinophil granule proteins (e.g., ECP and EDN), which often detect the presence of these proteins even in asthma patients with neutrophilic bronchitis, EPX-based ELISA levels are not increased in this subset of asthma patients or in COPD patients lacking evidence of an airway eosinophilia. Moreover, sputum EPX was a surrogate marker of airway eosinophilia in other patient studies (e.g., allergen inhalation and treatment trials the anti-(IL-5) therapeutic Mepolizumab™). Finally, EPX levels in cytocentrifuged prepared sputum supernatants correlated with those from rapidly prepared noncentrifuged filtrates of sputum (r(s) = 0.94). EPX-based ELISA is a valid, reliable, repeatable, and specific surrogate marker of eosinophils and/or eosinophil degranulation in the sputum of respiratory patients. The novel EPX assay is a valid and reproducible eosinophil-specific assay that can potentially be developed into a point-of-care assessment of eosinophil activity in airway secretions. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  15. An Interdisciplinary Nutrition Support Team Improves Clinical and Hospitalized Outcomes of Esophageal Cancer Patients with Concurrent Chemoradiotherapy

    Ming-Hua Cong; Shu-Luan Li; Guo-Wei Cheng; Jin-Ying Liu; Chen-Xin Song; Ying-Bing Deng; Wei-Hu Shang


    Background: The prevalence of malnutrition is very high in patients with cancer.The purpose of this study was to investigate whether or not a nutrition support team (NST) could benefit esophageal cancer patients undergoing chemoradiotherapy (CRT).Methods: Between June 2012 and April 2014, 50 esophageal cancer patients undergoing concurrent CRT were randomly assigned into two groups: The NST group and the control group.The nutritional statuses of 25 patients in the NST group were managed by the NST.The other 25 patients in the control group underwent the supervision of radiotherapy practitioners.At the end of the CRT, nutritional status, the incidence of complications, and completion rate of radiotherapy were evaluated.Besides, the length of hospital stay (LOS) and the in-patient cost were also compared between these two groups.Results: At the completion of CRF, the nutritional status in the NST group were much better than those in the control group, as evidenced by prealbumin (ALB), transferrin, andALB parameters (P =0.001, 0.000, and 0.000, respectively).The complication incidences, including bone marrow suppression (20% vs.48%, P =0.037) and complications related infections (12% vs.44%, P=0.012), in the NST group were lower and significantly different from the control group.In addition, only one patient in the NST group did not complete the planned radiotherapy while 6 patients in the control group had interrupted or delayed radiotherapy (96% vs.76%, P =0.103).Furthermore, the average LOS was decreased by 4.5 days (P =0.001) and in-patient cost was reduced to 1.26 4 0.75 thousand US dollars person-times (P ≥ 0.05) in the NST group.Conclusions: A NST could provide positive effects in esophageal cancer patients during concurrent CRT on maintaining their nutrition status and improving the compliance of CRF.Moreover, the NST could be helpful on reducing LOS and in-patient costs.

  16. Acute eosinophilic pneumonia: a case report

    Jung, Gyoo; Sik; Oh, Kyung Seung; Kim, Jong Min; Huh, Jin Do; Joh, Young Duk; Jang, Tae Won; Jung, Man Hong [Kosin Medical College, Busan (Korea, Republic of)


    Acute eosinophilic pneumonia is one of a recently described idiopathic eosinophilic lung disease, which differs from chronic eosinophilic pneumonia. Patients with acute eosinophilic pneumonia develop acute onset of dyspnea, hypoxemia, diffuse pulmonary infiltrates and pleural effusion on chest radiograph, and show an increase in number of eosinophils in bronchoalveolar lavage fluid or lung biopsy specimen. Prompt and complete response to corticosteroid therapy without any recurrence is characteristically seen in patient with this disease. Although the etiology of acute eosinophilic pneumonia is not known, it has been suggested to be related to a hypersensitivity phenomenon to an unidentified inhaled antigen. We report four cases of acute eosinophilic pneumonia presented with acute onset of dyspnea, diffuse pulmonary infiltrates on chest radiograph, and eosinophilia in bronchoalveolar lavage fluid in previously healthy adults.

  17. Herpetic Esophagitis in Immunocompetent Medical Student

    Andréia Vidica Marinho; Vinícius Mendes Bonfim; Luciana Rodrigues De Alencar; Sebastião Alves Pinto; João Alves de Araújo Filho


    Esophagitis caused by herpes simplex virus (HSV) is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV); it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Di...

  18. Clinical Analysis of Acute Renal Failure after Surgery for Esophageal Cancer%食管癌术后急性肾衰竭的临床分析

    徐澄澄; 孙威; 付向宁


    为了探讨食管癌术后急性肾衰竭发生的原因及防治经验,回顾性分析13例术后发生急性肾衰竭食管癌患者的临床资料,并总结防治体会.结果显示患者平均年龄67.5岁,体重50.4千克,皆有严重的吞咽梗阻症状,其中8例术前发现低蛋白血症,3例术前有不同程度的肾功能不全;术后3天内出现急性肾衰竭,治疗纠正肾前性病因、利尿和改善肾血流灌注等,其中4例结合血液净化;10例治愈,3例好转自动出院.就此得出结论食管癌患者术前低容量且营养不良状态是术后急性肾衰竭的重要原因;治疗注意纠正肾前性因素和改善肾灌注,必要时结合血液净化治疗,有助于防治食管癌术后急性肾功能衰竭.%To investigate the causes and experience of treatment for acute renal failure following the surgery for esophageal cancer, the clinical data of 13 patients with acute renal failure after surgery for esophageal cancer were retrospectively reviewed. The average age of patients was 67.5, and the mean weight was 50.4 kg. All patients had severe obstructive symptom, 8 of 13 patients with hypoproteinemia and 3 of 13 patients with renal dysfunction were detected preoperatively.Acute renal failure was followed in three days after operation. Treatment included correction of possible prerenal causes,diuretic drugs and improvement of renal perfusion and so on. Four of 13 patients underwent blood purification. Ten cases were cured and 3 cases improved markedly and were discharged. The conclusions include that hypovolemia and malnutrition are the important causes of acute renal failure following the surgery for esophageal cancer, and correction of possible prerenal causes, improvement of renal perfusion and adequate blood purification can contribute to its treatment.

  19. Glucocorticosteroid-sensitive inflammatory eosinophilic pseudotumor of the bladder in an adolescent: a case report

    Qu Chuangyu


    Full Text Available Abstract Introduction Inflammatory eosinophilic pseudotumor of the bladder is a rare inflammatory bladder disease. The etiology and pathophysiology of this condition are still unclear. Few case reports have described inflammatory eosinophilic pseudotumor of the bladder in adults or children. Although benign, this disease is occasionally clinically aggressive and locally invasive, thus open surgical removal or complete transurethral resection is recommended. Case presentation We present the case of a biopsy-proven inflammatory eosinophilic pseudotumor of the bladder in a previously healthy 16-year-old male adolescent with 2-month history of frequent micturition and dysuria with no significant apparent causative factors. The tumor regressed after a 6-week course of glucocorticosteroids. Conclusion To the best of our knowledge, our case is a rare case of inflammatory eosinophilic pseudotumor of the bladder treated with complete conservative management. Due to its glucocorticosteroid-sensitive nature, we postulate that this disease belongs to a subgroup of eosinophilic disorders.

  20. Expressions and the clinical significances of p53,p57(Kip2) and CD68 in esophageal squamous cell carcinoma

    Geng Su; Zhongming Tang; Qiurong Mo; Wei Wen


    Objective: The aim of our study was to investigate the expression of p53, p57(Kip2) and CD68 in esophageal squamous cell carcinoma (ESCC) and their correlation with the biological behavior of ESCC. Methods: The protein expressions of p53, p57(Kip2) and CD68 were detected in 51 cases of ESCC with S-P immunohistochemical method. Results: The total positive rate of those proteins was p53 64.71%, CD68 58.82% and p57(Kip2) 45.09% respectively in ESCC. The positive expression rate of p57(Kip2) was significantly lower in the positive p53 of ESCC than in the negative p53 (P 0.05). Conclusion: There are significant negative correlations between p57(Kip2) and p53, CD68 protein expression and related to biological behavior. Multy predictors are better guide to patients than single predictor.

  1. Patterns of failure after radical surgery among patients with thoracic esophageal squamous cell carcinoma: implications for the clinical target volume design of postoperative radiotherapy.

    Qi Liu

    Full Text Available BACKGROUND: This study evaluated patterns of treatment failure (especially locoregional failure; LRF after radical esophagectomy and proposes a clinical target volume (CTV for postoperative radiotherapy (PORT among patients with thoracic esophageal squamous cell carcinoma (SCC. METHODS: All patients who were followed up in our center after radical esophagectomy between 2007 and 2011 were retrospectively enrolled. The patterns of first discovered failure were assessed, and LRFs (including anastomotic and regional lymph node recurrences were evaluated to determine whether our proposed PORT CTV encompassed these areas. The clinicopathologic factors predictive of lymphatic recurrence type were analyzed. RESULTS: Of the 414 patients who underwent surgery and were followed up over the study, 207 experienced recurrent or metastatic diseases. The median time to progression was 11.0 months. Of the 173 patients with locoregional recurrence, nodal failure recurred in 160; supraclavicular and superior mediastinal lymph nodes had the highest metastasis rates. All 233 recurrent sites across the 160 patients were located in a standard CTV area, including the bilateral supraclavicular areas, the entire mediastinum, and the left gastric lymphatic drainage region. A total of 203 sites (87.2% were located in either the bilateral supraclavicular areas or the entire mediastinum, and 185 sites (79.4% were located in either the bilateral supraclavicular areas or the upper mediastinum. A multivariate analysis revealed the lymph node metastatic ratio (LNMR and tumor differentiation were risk factors for nodal failure. CONCLUSIONS: Locoregional recurrence (especially lymph node recurrence was the most common and potentially preventable type of initial treatment failure after curative surgery among patients with thoracic esophageal SCC. The proposed PORT CTV covered most LRF sites. The lymphatic drainage regions for PORT are selective, and the supraclavicular and superior

  2. Clinical Significance of Fibrinogen and D-dimer Detection in Esophageal Cancer%食管癌患者纤维蛋白原与D-二聚体检测的临床意义

    刘瑜; 林晓铭; 池闯; 程德志


    目的 检测并研究食管癌患者血浆中纤维蛋白原(FIB)和D-二聚体(D-dimer,DD)的变化及其临床意义.方法 对60例食管癌患者和8例健康人血浆中FIB和D-二聚体进行检测并同临床指标间进行统计学分析.结果 食管癌组血浆中的FIB和D-二聚体水平明显高于正常对照组(P<0.01);同患者的淋巴结转移情况及P-TNM分期有关(P <0.05或P<0.01),而同性别及年龄不相关(P>0.05).结论 食管癌患者的FIB及D-二聚体高于正常,并同淋巴结转移及P-TNM分期相关且与患者的生存期呈明显的负相关.%Objective To explore the clinical significance of fibrinogen and D - dimer detection in esophageal squamous cell cancer. Methods The fibrinogen and D - dimer were detected in 60 esophageal cancer patients and 8 healthy adults, and the data were analyzed with clinical indexes by SPSS. Results Levdel of fibrinogen and D - dimer in esophageal cancer patients were higher than that in healthy group (P 0. 05 ). Conclusion Compared with healthy group, significantly higher serum fibrinogen and D - dimer levels were detected in esophageal cancer patients. There was closely relationship between fibrinogen and D - dimer levels in esophageal cancer patients and lymph node metastases, p - TNM stage,and they were negatively correlated with lifetime.

  3. Asthma, tuberculosis or eosinophilic pneumonia?

    Mitra Subhra


    Full Text Available A 45 year-old male presented with cough and expectoration for 8 months, short-ness of breath and wheeze for 3 months, and fever for 1 month. He remained symptomatic despite repeated courses of antibiotics with partial relief on oral and inhaled bronchodilators. Despite several sputum examinations being negative for acid fast bacilli (AFB, he was put on anti-tubercular drugs (ATD because of bi-lateral infiltrates on his chest radiographs. A mildly raised blood eosinophil count, eosinophilia in broncho-alveolar lavage (BAL fluid and eosinophilic infiltration on CT guided FNAC from his lung lesion raised the suspicion and the dramatic clinico-radiological improvement with oral corticosteroids clinched the diagnosis of CEP.

  4. Impact of simultaneous assay, the PCNA, cyclinD1, and DNA content with specimens before and after preoperative radiotherapy on prognosis of esophageal cancer-possible incorporation into clinical TNM staging system

    Shu-Chai Zhu; Ren Li; Yu-Xiang Wang; Wei Feng; Juan Li; Rong Qiu


    AIM: The aim of the present study is to use immunohistochemical methods to investigate the clinical implications of tumor markers in esophageal squamous cell carcinoma and evaluate their impact on prognosis.METHODS: From November 1990 to December 1996, 47patients were treated with preoperative radiation followed by radical esophagectomy. All patients were confirmed pathologically as suffering from squamous cell carcinoma.Immunohistochemical stain was done for PCNA, cyclinD1 protein expression and DNA content analyzed by image cytometry. Kaplan-Meier method for single prognostic factor and log-rank test was used to test the significant difference. Cox stepwise regression model and prognosis index model were used for survival analysis with multiple prognostic factors.RESULTS: Radio-pathological change, T stage and N stage, as the traditional prognostic factors had statistical difference in 3-, 5- and 10-year survival rates. While, tumor cell proliferating marked PCNA, cyclinD1 and DNA content served as independent prognostic factors of esophageal carcinoma. There was definitely an identity between the single and multiple factor analyses. PI was more accurate to evaluate the prognosis of esophageal carcinoma.CONCLUSION: It is possible that tumor cell proliferating marked PCNA, cyclinD1 and DNA content would become the endpoints for evaluating the prognosis of esophageal carcinoma.

  5. 食管癌患者外周血清中P53表达水平及临床意义%Expression level and clinical significance of P53 in the peripheral serum of patients with esophageal cancer

    方汉刚; 陈建新; 乔健国; 柴国清; 韩劲松


    Objective:To measure the serum P53 protein content of patients with esophageal cancer,to analyze its clinical significance.Methods:86 patients with esophageal disease were selected from September 2010 to August 2014.According to the pathological diagnosis result,the patients were divided into the esophagitis group and the esophageal cancer group.The serum P53 protein contents of two groups were measured,the difference of two groups was analyzed.The esophageal cancer group was given comprehensive treatment,after 2 months,the serum P53 protein content was counterchecked,the differences between before and after treatment were analyzed.The clinical significance of serum P53 protein content in the esophageal cancer group was analyzed under combined with clinical pathological characteristics.Results:P53 protein content in the peripheral serum:the esophagitis group was (0.726 ± 0.531)μg/mL,the esophageal cancer group before treatment was (2.381 ± 1.412)μg/mL,after treatment was (1.096 ± 0.689)μg/mL.The two groups comparison had statistical significant difference.Before and after treatment of esophageal cancer were compared with statistical significant difference(P<0.05).The serum P53 protein content of patients with esophageal carcinoma had correlation with cell differentiation,local infiltration, lymph node metastasis.Conclusion:The serum P53 protein content of patients with esophagus cancer has certain guiding significance for diagnosis and prognosis of esophagus cancer.%目的:测定食管癌患者血清中P53蛋白含量,分析其临床意义。方法:2010年9月-2014年8月收治食管疾病患者86例,根据病理组织学诊断结果,分为食管炎组和食管癌组,测定两组血清中P53蛋白含量,对比分析两组的差异性。食管癌组给予综合治疗2个月后,复查血清中P53蛋白含量,对比分析治疗前后的差异性。结合临床病理特征分析食管癌组血清中P53蛋白含量的

  6. Esophageal transit scintigraphy in systemic sclerosis.

    Chojnowski, Marek; Kobylecka, Małgorzata; Olesińska, Marzena


    Systemic sclerosis is a rare connective tissue disease, distinctive features of which are fibrosis and microangiopathy. The esophagus is one of the most commonly involved internal organs. Most patients experience dysphagia, difficulties in swallowing and gastro-esophageal reflux. However, in up to one third of cases, the initial onset of esophageal disease may be clinically silent. There are several diagnostic modalities available for assessing both morphological and functional abnormalities of the esophagus. If structural abnormalities are suspected, endoscopy is the method of choice. Functional evaluation is best achieved with manometry. Both endoscopy and manometry are invasive techniques, with low patient acceptance. Barium-contrast study is well tolerated, but qualitative assessment of functional abnormalities is imprecise. Esophageal scintigraphy is an easy, non-invasive, sensitive and specific diagnostic modality. It can detect esophageal dysfunction even in asymptomatic patients. In patients already diagnosed with systemic sclerosis, scintigraphy is useful in evaluating severity and progression of the disease.

  7. 腹腔镜下治疗食管裂孔疝55例报告%Clinical Experience of Laparoscopic Repair of Esophageal Hiatal Hernia

    梁明强; 朱勇; 郑炜; 郭朝晖; 康明强; 陈椿


    Objective To explore the feasibility and effectiveness of laparoscopic repair of esophageal hiatal hernia . Methods We retrospectively analyzed clinical data of 55 patients with esophageal hiatal hernia who underwent laparoscopic surgery in our hospital between March 2008 and March 2013.After laparoscopic repair of esophageal hiatal hernia , different types of fundoplication were carried out including Nisse fundoplication in 17 cases, Toupet fundoplication in 19 cases, Dor fundoplication in 19 cases. Results All the operations were successfully completed under laparoscope .Different fundoplication included 17 cases of Nissen fundoplication, 19 cases of Toupet fundoplication, and 19 cases of Dor fundoplication.The operative time was (69.6 ±13.0) min for Nissen operation, (68.0 ±8.2) min for Toupet operation, and (63.8 ±10.1) min for Dor, respectively.The intraoperative blood loss was (20.0 ±5.8) ml for Nissen operation, (20.6 ±9.5) ml for Toupet, and (21.7 ±5.0) ml for Dor, respectively.No blood transfusion was needed .The postoperative extubation time was (3.1 ±1.1) d for Nissen operation, (2.7 ±0.7) d for Toupet, and (2.3 ±1.1) d for Dor, respectively.The postoperative hospital stay was (9.1 ±4.9) d for Nissen operation, (8.4 ±2.6) d for Toupet, and (7.6 ±1.5) d for Dor, respectively.Clinical symptoms had been alleviated effectively after operation , without deaths. However, 3 patients (5.5%) had developed postoperative complications , including 2 cases of delayed gastric emptying and 1 case of dysphagia, which were relieved after treatment.The median follow-up time was 45 months (range, 6-60 months).Oral barium meal and endoscopic examinations showed no recurrence of hiatal hernia , esophageal stenosis , or esophageal diverticula . Conclusion Laparoscopic repair of esophageal hiatal hernia is safe and effective , and different fundoplications can be chosen according to conditions of patients .%目的:探讨腹腔镜下治疗食管裂孔疝的

  8. Denture mis-swallowing in the sliding esophageal hiatal hernia mimics esophageal perforation.

    Chen, Chao-Yang; Lee, Shih-Chun; Chen, Chun-Wen; Chen, Jen-Chih


    Mis-swallowing of a foreign body in the esophagus coexisting with sliding hernia might be misdiagnosed as esophageal perforation with mediastinal abscess. We report an 89-year-old woman, bedridden for a long period in a nursing home after a previous cerebrovascular accident, who was sent to our emergency department in a state of sepsis because she had swallowed a radio-opaque partial denture. The retention of the denture as an esophageal foreign body was complicated with mediastinitis and bilateral pleural effusion. The inability of the patient to give a reliable clinical history delayed the diagnosis. This report highlights the difficulty in precisely locating a partial denture because of conflicting radiologic findings and the coexistence of esophageal sliding hernia, all of which led to a misdiagnosis of possible esophageal perforation. A right posterolateral thoracotomy with gastrostomy was performed to remove the lower esophageal foreign body after esophagoscopy failed. The surgical finding of a coincidental sliding esophageal hiatal hernia correlated well with the clinical presentation. Managing such a complicated esophageal foreign body in this elderly patient was challenging.

  9. Epidemiologic differences in esophageal cancer between Asian and Western populations

    Han-Ze Zhang; Guang-Fu Jin; Hong-Bing Shen


    Esophageal cancer is a common cancer worldwide and has a poor prognosis.The incidence of esophageal squamous cell cancer has been decreasing,whereas the incidence of esophageal adenocarcinoma has been increasing rapidly,particularly in Western men.Squamous cell cancer continues to be the major type of esophageal cancer in Asia,and the main risk factors include tobacco smoking,alcohol consumption,hot beverage drinking,and poor nutrition.In contrast,esophageal adenocarcinoma predominately affects the whites,and the risk factors include smoking,obesity,and gastroesophageal reflux disease.In addition,Asians and Caucasians may have different susceptibilities to esophageal cancer due to different heritage backgrounds.However,comparison studies between these two populations are limited and need to be addressed in the near future.Ethnic differences should he taken into account in preventive and clinical practices.

  10. TU-C-12A-09: Modeling Pathologic Response of Locally Advanced Esophageal Cancer to Chemo-Radiotherapy Using Quantitative PET/CT Features, Clinical Parameters and Demographics

    Zhang, H; Chen, W; Kligerman, S; D’Souza, W; Suntharalingam, M; Lu, W [University of Maryland School of Medicine, Baltimore, MD (United States); Tan, S [Huazhong University of Science and Technology, Wuhan (China); Kim, G [Duke University, High Point, NC (United States)


    Purpose: To develop predictive models using quantitative PET/CT features for the evaluation of tumor response to neoadjuvant chemo-radiotherapy (CRT) in patients with locally advanced esophageal cancer. Methods: This study included 20 patients who underwent tri-modality therapy (CRT + surgery) and had {sup 18}F-FDG PET/CT scans before initiation of CRT and 4-6 weeks after completion of CRT but prior to surgery. Four groups of tumor features were examined: (1) conventional PET/CT response measures (SUVmax, tumor diameter, etc.); (2) clinical parameters (TNM stage, histology, etc.) and demographics; (3) spatial-temporal PET features, which characterize tumor SUV intensity distribution, spatial patterns, geometry, and associated changes resulting from CRT; and (4) all features combined. An optimal feature set was identified with recursive feature selection and cross-validations. Support vector machine (SVM) and logistic regression (LR) models were constructed for prediction of pathologic tumor response to CRT, using cross-validations to avoid model over-fitting. Prediction accuracy was assessed via area under the receiver operating characteristic curve (AUC), and precision was evaluated via confidence intervals (CIs) of AUC. Results: When applied to the 4 groups of tumor features, the LR model achieved AUCs (95% CI) of 0.57 (0.10), 0.73 (0.07), 0.90 (0.06), and 0.90 (0.06). The SVM model achieved AUCs (95% CI) of 0.56 (0.07), 0.60 (0.06), 0.94 (0.02), and 1.00 (no misclassifications). Using spatial-temporal PET features combined with conventional PET/CT measures and clinical parameters, the SVM model achieved very high accuracy (AUC 1.00) and precision (no misclassifications), significantly better than using conventional PET/CT measures or clinical parameters and demographics alone. For groups with a large number of tumor features (groups 3 and 4), the SVM model achieved significantly higher accuracy than the LR model. Conclusion: The SVM model using all features

  11. The Use of Esophageal Radiography in the Location of Atrial-Septal Puncture: Clinical Analysis of 486 Cases

    Wu Tongguo; Wang Lexing; Chen Siwei; Lin Ziqing; Yang Chengjun; Huang Liping


    Objectives To determine the safety and value of esophageal radiography as a means of locating transseptal puncture. Methods 486 patients who underwent transseptal puncture were randomized into two groups. An esophagus radiographic method of locating tansseptal puncture site was applied in the study group( n = 243 ) and modified-Ross locating method was used in the control group ( n = 243 ). After successful location, transseptal puncture was made. We observed the success rate and incidence complications in the 2 groups.Results Left atrium impression in the study group was clearly seen. Nonetheless in 120 cases of control group,the left atria silhouette was not clearly visualised. The success rate of locating transseptal puncture site in the study group and control group were 100% and 50.6% respectively ( P<0.001 ). The success rate of transseptal puncture in the study group and control group was 99.6% and 45.7% respectively ( P<0.001 ). There were no complications associated with puncture in the study group and pericardial tamponade occurred in 1 control patient. Conclusions The esophagus radiographic method of locating transseptal puncture site is accurate,safe and simple to perform. Transseptal puncture has a high success rate with few complications.

  12. Application and clinical significance of minimally Invasive treatment for patients with esophageal carcinoma%微创外科技术在食管癌治疗中的应用及临床意义

    徐文鑫; 徐广全


    食管癌是我国常见的消化道恶性肿瘤之一,尽管食管癌的药物及放射治疗水平不断提高,目前手术切除仍是公认的最为有效的治疗方法.随着食管外科技术的不断发展,国内外相继开展了以减少并发症、降低病死率以及提高生命质量为目的的食管癌微创治疗技术.本文就食管癌微创手术的适应证、手术方式选择、手术并发症及预后情况与传统手术进行比较,以探讨微创外科技术在食管癌治疗中的应用及临床意义.%Esophageal cancer is one of the most common alimentary malignancy.Although drugs and radiation treatments for esophageal cancer are constantly improved,surgical resection is still recognized as the most effective treatment method at present.With the continuous development of esophageal surgical techniques,minimally invasive treatment of esophageal cancer surgery technology has bcen performed at home and abroad,for the purpose of reducing the complications or mortality and improving the post-operative quality of life.Minimally invasive surgical indications,surgical procedure selection,complications and prognosis compared with traditional surgery are reviewed in this article to explore the application and clinical significance of minimally invasive treatment in patients with esophageal carcinoma.

  13. Eosinophil secretion of granule-derived cytokines

    Lisa A Spencer


    Full Text Available Eosinophils are tissue-dwelling leukocytes, present in the thymus, and gastrointestinal and genitourinary tracts of healthy individuals at baseline, and recruited, often in large numbers, to allergic inflammatory foci and sites of active tissue repair. The biological significance of eosinophils is vast and varied. In health, eosinophils support uterine and mammary gland development, and maintain bone marrow plasma cells and adipose tissue alternatively activated macrophages, while in response to tissue insult eosinophils function as inflammatory effector cells, and, in the wake of an inflammatory response, promote tissue regeneration and wound healing. One common mechanism driving many of the diverse eosinophil functions is the regulated and differential secretion of a vast array of eosinophil-derived cytokines. Eosinophils are distinguished from most other leukocytes in that many, if not all, of the over three dozen eosinophil-derived cytokines are pre-synthesized and stored within intracellular granules, poised for very rapid, stimulus-induced secretion. Eosinophils engaged in cytokine secretion in situ utilize distinct pathways of cytokine release that include: classical exocytosis, whereby granules themselves fuse with the plasma membrane and release their entire contents extracellularly; piecemeal degranulation, whereby granule-derived cytokines are selectively mobilized into vesicles that emerge from granules, traverse the cytoplasm and fuse with the plasma membrane to release discrete packets of cytokines; and eosinophil cytolysis, whereby intact granules are extruded from eosinophils, and deposited within tissues. In this latter scenario, extracellular granules can themselves function as stimulus-responsive secretory-competent organelles within the tissue. Here we review the distinctive processes of differential secretion of eosinophil granule-derived cytokines.

  14. Eosinophilic gastroenteritis with ascites and hepatic dysfunction

    Hai-Bo Zhou; Jin-Ming Chen; Qin Du


    Eosinophilic gastroenteritis is a rare gastrointestinal disorder with eosinophilic infiltration of the gastrointestinal wall and various gastrointestinal dysfunctions. Diagnosis requires a high index of suspicion and exclusion of various disorders that are associated with peripheral eosinophilia.We report a case of eosinophilic gastroenteritis, which had features of the predominant subserosal type presenting with ascites and hepatic dysfunction, and which responded to a course of low-dose steroid.

  15. Esophageal lichen planus

    Oliveira,Janine Pichler de; Uribe, Natalia Caballero; Abulafia,Luna Azulay; Quintella, Leonardo Pereira


    Abstract Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen ...

  16. “Layer-to-Layer” Esophagogastric Anastomosis Combined with Intrathoracic Esophageal Mucosal Extention in Patients with Esophageal and Cardia Cancer

    SHIZhongqi; CAIPing; YANYu; CHENYinchun; LIUJunhua; YOUQinshen; CAIJixiang; XIZhongxia


    Objective: To evaluate the clinical value of intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosa extended varied in plane and to study the effective methods to prevent anastomotic leaking or stricture postoperatively. Methods: From May 1985 to December 2002, 2 240 esophageal and stomach cardia cancer patients treated by intrathoracic esophagogastric “layer-to-layer”anastomosis with esophageal mucosa extended varied in plane were retrospectively analyzed. Results:There was no anastomotic leaking and severe stricture in all above cases. Conclusion: Intrathoracic esophagogastric “layer-to-layer” anastomosis with esophageal mucosal extended varied in plane is an effective method to prevent anastomotic leaking and stricture postoperatively.

  17. Esophageal lichen planus.

    Oliveira, Janine Pichler de; Uribe, Natalia Caballero; Abulafia, Luna Azulay; Quintella, Leonardo Pereira


    Lichen planus is a chronic inflammatory disease that affects the skin, mucous membranes, nails and scalp. Esophageal lichen planus is a rarely reported manifestation of lichen planus, presenting itself commonly in middle-aged women, with symptoms such as dysphagia. We report a case of esophageal lichen planus in a 54-year-old woman associated with oral, cutaneous and ungual lichen planus. Although lichen planus is a disorder well known by dermatologists, reports of esophageal lichen planus are rare in dermatologic literature. The esophageal lichen planus is little known and underdiagnosed, with a significant delay between the onset of symptoms and diagnosis.

  18. Esophageal capsule endoscopy

    Ignacio Fernandez-Urien; Cristina Carretero; Raul Armendariz; Miguel Mu(n)oz-Navas


    Capsule endoscopy is now considered as the first imaging tool for small bowel examination.Recently,new capsule endoscopy applications have been developed,such as esophageal capsule endoscopy and colon capsule endoscopy.Esophageal capsule endoscopy in patients with suspected esophageal disorders is feasible and safe,and could be also an alternative procedure in those patients refusing upper endoscopy.Although large-scale studies are needed to confirm its utility in GERD and cirrhotic patients,current results are encouraging and open a new era in esophageal examination.

  19. Chronic eosinophilic pneumonia: a case report

    Heo, Tae Haeng; Park, Jeong Hee; Lim, Jong Nam; Shin, Hyun Jun; Jeon, Hae Jeong [College of Medicine, Kon-Kuk University, Seoul (Korea, Republic of)


    Chronic eosinophilic pneumonia is a rare disease characterized by chronic infiltration of the lung with eosinophils, usually associated with peripheral eosinophilia. In 65% of cases, the chest radiograph shows typical nonsegmental air-space consolidation confined to the outer third of the lung, and in 25% of cases, the 'photographic negative of pulmonary edema' Typical lung manifestations with peripheral eosinophilia are characteristic of chronic eosinophilic pneumonia. In the remaining cases, radiographic findings are nonspecific and require lung biopsy for confirmation. We report a case of chronic eosinophilic pneumonia in which chest radiograph and CT scans revealed bilateral patchy or diffuse opacity with nodules scattered throughout the lungs.

  20. Tropical Pulmonary Eosinophilia with Eosinophilic Leukemoid Reaction

    Manish Kumar


    Full Text Available A 7 year-old male presented with recurrent fever, cough and respiratory distress for over last 2 years. Based on extremely high eosinophil count, high Immunoglobulin E, increase in eosinophilic precursors in bone marrow, and positive antigen test for Wuchereria bancrofti, a diagnosis of Tropical Pulmonary Eosinophilia with Eosinophilic Leukemoid Reaction was made. Complete recovery was achieved with Diethylcarbamazine for 3 weeks. We are reporting this case as the first case of Tropical pulmonary eosinophilia with eosinophilic leukemoid reaction in a child.

  1. Eosinophilic granuloma of the capital femoral epiphysis.

    Goto, Takahiro; Nemoto, Tetsuo; Ogura, Koichi; Imanishi, Jungo; Hozumi, Takahiro; Funata, Nobuaki


    Eosinophilic granuloma occurs almost exclusively in the diaphysis or metaphysis, when tubular bones are affected. The investigators present an extremely rare case of eosinophilic granuloma arising at the epiphysis of the femoral head in an 8-year-old boy. Plain radiographs and computed tomography showed a well-circumscribed radiolucent lesion, suggesting chondroblastoma or Brodie's abscess. However, the findings on magnetic resonance images were different from typical features of chondroblastoma or Brodie's abscess. The lesion was curetted. Histological diagnosis was eosinophilic granuloma. Differential diagnoses of a radiolucent lesion at the epiphysis in a child should include, though quite rare, eosinophilic granuloma.

  2. Clinical application of high resolution manometry for examining esophageal function in neonates%新生儿食管高分辨测压的临床应用

    李正红; 王丹华; 董梅; 柯美云; 王智凤


    Objective To examine the esophageal function of neonates by high resolution manometry ( HRM) , and to provide preliminary data for research on the esophageal function of neonates. Methods Esophageal HRM was performed on neonates using a solid-state pressure measurement system with 36 circumference sensors arranged at intervals of 0. 75 cm, and ManoView software was used to analyze esophageal peristalsis pattern. Results Esophageal HRM was performed successfully in 11 neonates, and 126 occurrences of complete esophageal peristalsis were recorded. Complete esophageal peristalsis with pressure increase was recorded in some neonates but most neonates showed a different esophageal peristalsis pattern compared with adults. Some neonates had no relaxation of the upper esophageal sphincter ( UES) when pharyngeal muscles contracted in swallowing, some neonates had multiple swallowing without esophageal peristalsis and some neonate9 had relatively low pressure of esophageal peristalsis. Full-term infants could have relatively low UES pressure and esophageal sphincter ( LES) pressure but some preterm infants showed relatively high UKS pressure and LES pressure. Longitudinal contraction of the whole esophagus and elevation of LES after swallowing were recorded in some neonates. Conclusions Esophageal HRM is safe and tolerable for neonates. HRM shows that esophageal peristalsis after swallowing may not occur or may be incomplete in neonates. The esophageal function of neonates has not yet been developed completely, with large individual differences in esophageal peristalsis. Urge sample data are needed for further analysis and research on the esophageal function of neonates.%目的 应用食管高分辨测压(HRM)对新生儿食管功能进行检测,为研究新生儿食管功能提供初步依据.方法 应用具有间隔0.75 cm的36个圆周传感器的固态压力测量系统进行新生儿食管HRM,应用ManoView软件对食管蠕动形式进行分析.结果 为11例新生


    张力建; 叶国经; 黄信孚; 谢玉泉


    A case of esophageal Crohn's disease in a 52-year-old man is described.The patient was treated successfully by surgical excision of the esophagus.Because esophageal Crohn's disease is uncommon,we would like to discuss its clinical characteristics and to teview theliterature.

  4. Presence of Eosinophils in Nasal Secretion during Acute Respiratory Tract Infection in Young Children Predicts Subsequent Wheezing within Two Months

    Miwa Shinohara


    Conclusions: Our findings not only suggest that nasal eosinophil testing may serve as a convenient clinical marker for identifying young children at risk for subsequent wheezing, but also shed new light on the role of eosinophils in the onset of wheezing in young children.

  5. Esophageal Cancer

    ... Resources Conducting Clinical Trials Statistical Tools and Data Terminology Resources NCI Data Catalog Cryo-EM NCI's Role ... Contacts Other Funding Find NCI funding for small business innovation, technology transfer, and contracts Training Cancer Training ...

  6. Expression of Wnt11 and Rock2 protein with clinical characteristics of esophageal squamous cell carcinoma in Kazakh and Han patients

    LIU Dong; Zhou, Keming; Li, Qiaoxin; Deng, Feiyan; Ma, Yuqing


    Background: Esophageal squamous cell carcinoma (ESCC) is one of the most malignancies with a very poor outcome in China. Wnt11 and Rock2, new identified proteins highly associated with metastasis of many cancers, which were never reported in esophageal squamous cell carcinoma (ESCC). Here we measured the expression levels of Wnt11 and Rock2 in tissues from 265 patients with ESCC. Immunohistochemical staining was employed to detect the correlation of Wnt11 and Rock2 expression with clinicopath...

  7. Preliminary clinical evaluation of continuous infusion of 5-FU and low dose cisplatin (LFP) combined with radiation therapy for the treatment of advanced or recurrent esophageal cancer

    Itoh, Satoshi; Morita, Soujiro; Hisa, Nobuaki; Tsuji, Akihito; Takamatsu, Masahiro; Takasaki, Motohiro; Horimi, Tadashi [Kochi Municipal Central Hospital (Japan)


    We evaluated the LFP combined with radiation therapy for the treatment of advanced or recurrent esophageal cancer. The patients consisted of 4 inoperable cases, 4 cases in combination with operation, and 5 cases with recurrent tumor. The response rate was 80% (CR2, PR6, NC1 and PD1). We conclude that the LFP combined with radiation therapy was effective and useful for the treatment of advanced or recurrent esophageal cancer. (author)

  8. IgE, mast cells, and eosinophils in atopic dermatitis.

    Liu, Fu-Tong; Goodarzi, Heidi; Chen, Huan-Yuan


    Atopic dermatitis (AD) is a chronic inflammatory skin disease with specific immune and inflammatory mechanisms. Atopy is among the major features of the diagnosis criteria for AD but is not an essential feature. Thus, patients diagnosed with AD can be atopic or non-atopic. This review focuses on the role of IgE, mast cells, and eosinophils in the pathogenesis of AD. The known functions of IgE in allergic inflammation suggest that IgE and IgE-mediated mast cell and eosinophil activation contribute to AD, but direct evidence supporting this is scarce. The level of IgE (thus the degree of allergic sensitization) is associated with severity of AD and contributed by abnormality of skin barrier, a key feature of AD. The function of IgE in development of AD is supported by the beneficial effect of anti-IgE therapy in a number of clinical studies. The role of mast cells in AD is suggested by the increase in the mast cell number and mast cell activation in AD lesions and the association between mast cell activation and AD. It is further suggested by their role in mouse models of AD as well as by the effect of therapeutic agents for AD that can affect mast cells. The role of eosinophils in AD is suggested by the presence of eosinophilia in AD patients and eosinophil infiltrates in AD lesions. It is further supported by information that links AD to cytokines and chemokines associated with production, recruitment, and activation of eosinophils.

  9. The clinical experience of laparoscopic repair of esophageal hiatal hernia%腹腔镜治疗食管裂孔疝56例临床分析

    王玉楼; 王骥; 马东伟; 马红钦; 赵文星; 刘斌


    Objective The aim of the present study was to evaluate the safety and efficacy of laparoscopic repair of esophageal hiatal hernia at our hospital. Methods Between August 2010 and August 2014,56 patients at our department underwent laparoscopic repair and Nissen fundoplication of esophageal hiatal hernia,the clinical data from these cases were retrospectively analyzed. Results The mean operation time was(117.4 ±39.9)minutes,intraoperative blood loss was(47.3 ±21.8)ml,the time to first flatus was (35. 7 ± 13. 9)hours and the time of postoperative hospital stay was(5. 4 ± 2. 2)days. There were statistically significant reductions(P<0. 005)in visual analog scores(VAS)for all post-operative time points(1month and 6 months postoperatively). All cases were followed up,no hernia recurrence was found. Conclusion Laparoscopic repair and Nissen fundoplication is a technically safe and feasible surgical procedure for the treatment of esophageal hiatal hernia.%目的:探讨腹腔镜食管裂孔疝修补联合胃底折叠手术治疗食管裂孔疝的安全性和实用性。方法回顾性分析2010年8月至2014年8月在徐州医学院附属医院接受腹腔镜食管裂孔疝修补联合Nissen胃底折叠手术56例患者的围手术期及术后随访的临床资料。结果56例手术均顺利完成。平均手术时间(117.4±39.9) min,术中出血量(47.3±21.8) ml,术后胃肠功能恢复时间(35.7±13.9)h,术后住院时间(5.4±2.2)d。围手术期无严重并发症及死亡。胃食管反流综合症状VAS评分术后1个月、6个月与术前比较,差异有统计学意义( P<0.05)。术后随访均未见复发。结论腹腔镜食管裂孔疝修补联合胃底折叠手术是治疗食管裂孔疝的有效方法。

  10. Eosinophilic pleural effusion and giardiasis: A causal or a casual relationship?

    Singh, Urvinderpal; Garg, Nishi; Chopra, Vishal


    A case of bilateral eosinophilic pleural effusion with coincidental intestinal infestation of giardia lamblia is being reported. After reviewing the possible causes of this type of pleural effusion, no clinical or laboratory data were obtained which could explain this condition except giardiasis. Moreover the clearance of pleural effusion with the treatment of giardia with metronidazole suggests giardia as the probable cause of bilateral eosinophilic pleural effusion.

  11. Eosinophilic Enteritis with Ascites in a Patient with Overlap Syndrome

    Spyros Aslanidis


    Full Text Available Gastrointestinal involvement is frequent in patients with systemic lupus erythematosus (SLE. Eosinophilic gastroenteritis, however, has only rarely been described in rheumatological conditions, despite its reported connection to autoimmune diseases, such as hypereosinophilic syndrome, vasculitides, and systemic mastoidosis. It presents typically with abdominal pain and diarrhea and is only exceptionally associated with ascites. Diagnosis can be problematic, as several other clinical conditions (malignancies, infection/tuberculosis, and inflammatory bowel diseases have to be ruled out. It is basically a nonsurgical disease, with excellent recovery on conservative treatment. We report the rare case of a young woman with overlap syndrome who presented with abdominal pain and ascites. The diagnosis of eosinophilic enteritis was made based on clinical, radiological, and laboratory criteria. The patient was treated with corticosteroids with excellent response.

  12. Eosinophilic Otitis Media: CT and MRI Findings and Literature Review

    Chung, Won Jung; Lee, Jeong Hyun; Lim, Hyun Kyung; Yoon, Tae Hyun; Cho, Kyung Ja; Baek, Jung Hwan [Asan Medical Center, Ulsan University College of Medicine, Seoul (Korea, Republic of)


    Eosinophilic otitis media (EOM) is a relatively rare, intractable, middle ear disease with extremely viscous mucoid effusion containing eosinophils. EOM is associated with adult bronchial asthma and nasal allergies. Conventional treatments for otitis media with effusion (OME) or for chronic otitis media (COM), like tympanoplasty or mastoidectomy, when performed for the treatment of EOM, can induce severe complications such as deafness. Therefore, it should be differentiated from the usual type of OME or COM. To our knowledge, the clinical and imaging findings of EOM of temporal bone are not well-known to radiologists. We report here the CT and MRI findings of two EOM cases and review the clinical and histopathologic findings of this recently described disease entity.

  13. Brain metastasis from esophageal carcinoma

    Almasi Saeid


    Full Text Available Brain metastasis from esophageal carcinoma is rare. In our center, among 301 cases of esophageal cancer referred for radiotherapy during a 14-year period, brain metastasis from esophageal carcinoma was detected in one case. An unusual case of esophageal carcinoma that presented with brain metastasis is reported.


    Balasubramanian Thiagarajan


    Full Text Available Eosinophilic otitis media is actually a recent introduction. These patients may manifest with sudden hearing loss. There may be associated bronchial asthma and allergic rhinitis. Diagnostic criteria of this condition are rather vague. A review of literature shows that demonstration of eosinophils in the middle ear secretion of these patients could be considered to be pathognomonic of this condition

  15. Eosinophilic Mucin Otomastoiditis and Otopolyposis: A Progressive Form of Eosinophilic Otitis Media.

    Azadarmaki, Roya; Westra, William; Prasad, Sanjay


    The purpose of this study is to introduce and define a disease entity on a continuum of eosinophilic otitis media: eosinophilic mucin otomastoiditis and otopolyposis. A case of a 66-year-old woman with complicated chronic otitis media is reported. A literature review of the National Library of Medicine's online database, with a focus on eosinophilic otitis media and eosinophilic mucin rhinosinusitis, was performed. The authors report the case of a 66-year-old woman with a history of asthma, chronic rhinosinusitis, nasal polyposis, and chronic otitis media who presented with allergic middle ear mucin and otic polyps. Treatment involved a tympanomastoidectomy with removal of otic polyps and steroid therapy. Eosinophilic mucin otomastoiditis with otopolyposis is a disease entity on a continuum of eosinophilic otitis media. This disease process shares similarities with eosinophilic mucin rhinosinusitis. Otic polypectomy and steroids are suggested therapeutic measures. © The Author(s) 2015.

  16. Feline gastrointestinal eosinophilic sclerosing fibroplasia.

    Craig, L E; Hardam, E E; Hertzke, D M; Flatland, B; Rohrbach, B W; Moore, R R


    A retrospective study of cases of a unique intramural inflammatory mass within the feline gastrointestinal tract was performed in order to describe and characterize the lesion. Twenty-five cases were identified from archival surgical and postmortem tissues. The lesion most often occurred as an ulcerated intramural mass at the pyloric sphincter (n = 12) or the ileocecocolic junction or colon (n = 9); the remaining cases were in the small intestine. Seven cases also had lymph node involvement. The lesions were characterized by eosinophilic inflammation, large reactive fibroblasts, and trabeculae of dense collagen. Intralesional bacteria were identified in 56% of the cases overall and all of the ileocecocolic junction and colon lesions. Fifty-eight percent of cats tested had peripheral eosinophilia. Cats treated with prednisone had a significantly longer survival time than those receiving other treatments. We propose that this is a unique fibroblastic response of the feline gastrointestinal tract to eosinophilic inflammation that in some cases is associated with bacteria. The lesion is often grossly and sometimes histologically mistaken for neoplasia.

  17. Coccidioidomycosis Masquerading as Eosinophilic Ascites

    Kourosh Alavi


    Full Text Available Endemic to the southwestern parts of the United States, coccidioidomycosis, also known as “Valley Fever,” is a common fungal infection that primarily affects the lungs in both acute and chronic forms. Disseminated coccidioidomycosis is the most severe but very uncommon and usually occurs in immunocompromised individuals. It can affect the central nervous system, bones, joints, skin, and, very rarely, the abdomen. This is the first case report of a patient with coccidioidal dissemination to the peritoneum presenting as eosinophilic ascites (EA. A 27-year-old male presented with acute abdominal pain and distention from ascites. He had eosinophilia of 11.1% with negative testing for stool studies, HIV, and tuberculosis infection. Ascitic fluid exam was remarkable for low serum-ascites albumin gradient (SAAG, PMN count >250/mm3, and eosinophils of 62%. Abdominal imaging showed thickened small bowel and endoscopic testing negative for gastric and small bowel biopsies. He was treated empirically for spontaneous bacterial peritonitis, but no definitive diagnosis could be made until coccidioidal serology returned positive. We noted complete resolution of symptoms with oral fluconazole during outpatient follow-up. Disseminated coccidioidomycosis can present in an atypical fashion and may manifest as peritonitis with low SAAG EA. The finding of EA in an endemic area should raise the suspicion of coccidioidal dissemination.

  18. Lansap in treatment of esophagitis in patients with systemic sclerosis

    R T Alekperov


    Full Text Available Objective. To study the efficacy of Lansap (Lansoprasole in treatment of esophagitis in pts with systemic sclerosis (SS. Methods. 30 SS pts with clinical manifestations and endoscopic signs of esophagitis received lansap 30 or 60 mg/day during two weeks. All pts had a standard endoscopic examination before and after the treatment. Results. Clinical symptoms of esophagitis were reduced significantly in most pts during the first day of treatment and resolved completely to the eleventh day. Endoscopic examination after two weeks revealed decrease of esophagitis severity in all pts. Esophagial erosions were healed in 16 from 18 pts. Conclusion. Lansap is an effective drug for treatment of reflux esophagitis in pts with SS.

  19. Association of the blood eosinophil count with hematological malignancies and mortality.

    Andersen, Christen L; Siersma, Volkert D; Hasselbalch, Hans C; Vestergaard, Hanne; Mesa, Ruben; Felding, Peter; Olivarius, Niels D F; Bjerrum, Ole W


    Blood eosinophilia (≥0.5 × 10(9) /l) may be an early sign of hematological malignancy. We investigated associations between levels of blood eosinophils and risks of hematological malignancies and mortality in order to provide clinically derived cut-offs for referral to specialist hematology care. From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count encompassing the eosinophil count during 2000-2007 and matched these laboratory data with Danish nationwide health registers. We used multivariable logistic regression to calculate odds ratios (ORs) for the 4-year incidences of hematological malignancies and mortality between the eosinophil counts and a reference count of 0.16 × 10(9) /l which was the median eosinophil count in our data. Risks of hematological malignancies and mortality increased above the median eosinophil count. At the 99th percentile, corresponding to an eosinophil count of 0.75 × 10(9) /l, risks of hematological malignancies were increased more than twofold with OR (95% C.I.) of 2.39 (1.91-2.99). Interestingly, risks reached a plateau around an eosinophil count of 1.0 × 10(9) /l. Risks also increased when the eosinophil count approached zero. Here, counts associated relatively more with acute myeloid leukemia and myelodysplastic syndromes whereas counts above 0.16 × 10(9) /l associated more with myeloproliferative neoplasms. Eosinophil counts associate with hematological malignancies and mortality even below the definition of eosinophilia. The observed plateau of risks around 1.0 × 10(9) /l is important for physicians encountering patients with eosinophilia since even mild-to-moderate eosinophilia according to traditional definitions confers maximally increased risks of subsequent/subclinical hematological malignancy.

  20. Eosinophil resistance to glucocorticoid-induced apoptosis is mediated by the transcription factor NFIL3.

    Pazdrak, Konrad; Moon, Young; Straub, Christof; Stafford, Susan; Kurosky, Alexander


    The mainstay of asthma therapy, glucocorticoids (GCs) exert their therapeutic effects through the inhibition of inflammatory signaling and induction of eosinophil apoptosis. However, laboratory and clinical observations of GC-resistant asthma suggest that GCs' effects on eosinophil viability may depend on the state of eosinophil activation. In the present study we demonstrate that eosinophils stimulated with IL-5 show impaired pro-apoptotic response to GCs. We sought to determine the contribution of GC-mediated transactivating (TA) and transrepressing (TR) pathways in modulation of activated eosinophils' response to GC by comparing their response to the selective GC receptor (GR) agonist Compound A (CpdA) devoid of TA activity to that upon treatment with Dexamethasone (Dex). IL-5-activated eosinophils showed contrasting responses to CpdA and Dex, as IL-5-treated eosinophils showed no increase in apoptosis compared to cells treated with Dex alone, while CpdA elicited an apoptotic response regardless of IL-5 stimulation. Proteomic analysis revealed that both Nuclear Factor IL-3 (NFIL3) and Map Kinase Phosphatase 1 (MKP1) were inducible by IL-5 and enhanced by Dex; however, CpdA had no effect on NFIL3 and MKP1 expression. We found that inhibiting NFIL3 with specific siRNA or by blocking the IL-5-inducible Pim-1 kinase abrogated the protective effect of IL-5 on Dex-induced apoptosis, indicating crosstalk between IL-5 anti-apoptotic pathways and GR-mediated TA signaling occurring via the NFIL3 molecule. Collectively, these results indicate that (1) GCs' TA pathway may support eosinophil viability in IL-5-stimulated cells through synergistic upregulation of NFIL3; and (2) functional inhibition of IL-5 signaling (anti-Pim1) or the use of selective GR agonists that don't upregulate NFIL3 may be effective strategies for the restoring pro-apoptotic effect of GCs on IL-5-activated eosinophils.

  1. Relationship between the positive rates of the results of the tumor markers six of esopha-geal carcinoma preoperativly and the esophageal clinical parameters postoperativly%食管癌术前血浆肿瘤标志物检测的临床意义

    孙宝林; 余守强; 甄福喜


    目的:探讨术前检测食管癌血浆六项肿瘤标志物的临床意义。方法:回顾手术治疗的食管癌临床资料138例,分析术前 NSE、AFP、CEA、CA72-4、CA19-9、C19六项肿瘤标志物与术后病理特征的关系。结果:138例患者年龄43~81(63.46±6.787)岁,男105例,女33例;鳞癌114例,腺癌24例;位于贲门16例;六项肿瘤标志物含量最高者为 NSE 占26.1%(36/138),最低者为 CA19-9占2.2%(3/138)。食管鳞癌中 NSE阳性率高;食管腺癌、贲门癌中 AFP、CEA 阳性率高,CA72-4阳性率在 Tis -T2组中升高,均有统计学意义;而 CA19-9和 C19阳性率在各病例组均无显著增高。结论:六项肿瘤标志物在食管癌患者术前血浆中阳性率较低。仅显示 AFP、CEA 在食管腺癌、贲门癌中,CA72-4在 Tis -T2期中,NSE 在食管鳞癌略高。%Objective:To investigate the clinical application value of the preoperative levels of six tumor markers for patients with esophageal cancer underwent esophagogectomy.Methods:The records of 138 cases with esophageal cancer underwent esophagogectomy were reviewed and the relationship between the results of preoperative esophageal six tumor markers and the pathological characteristics after esophagectomy was assessed.Results:The characteristics of 138 caes were as follow:Aged 43 ~81(63.46 ±6.787),105 male and 33 female,114 cases of squamous carcino-ma,24 cases of adenocarcinoma and 16 cases of cardia carcinoma.The positive rate of NSE was 26.1%(36 /138),the highest rate in six tumor markers and CA19 -9 was only 2.2%(3 /138),the lowest.The positive rate of AFP in the lower esophagus and cardia cancer and adenocarcinoma group,CEA in the esophageal adenocarcinoma group,CA72-4 in Tis -T2 group and NSE in the esophageal squamous cell carcinoma group was statistically increased (P<0.05).Whereas,the CA19 -9 and C19 in each group had no statistical significance

  2. Role of Adhesion Molecules in Eosinophil Activation: A Comparative Study on the Effect of Adhesion Molecules on Eosinophil Survival

    Kazutoshi Yamaguchi


    Conclusions: The regulation of adhesion molecules, by not only preventing eosinophil adhesion but also eosinophil activation, may be a potential target in the treatment of allergic inflammatory disorders.

  3. Whole greater than the parts: integrated esophageal centers (IEC) and advanced training in esophageal diseases.

    Triadafilopoulos, G; Clarke, J; Hawn, M


    An integrated esophageal center (IEC) is a multidisciplinary team with expertise, skill, range, and facilities necessary to achieve optimal outcomes in patients with esophageal diseases efficiently and expeditiously. Within IEC, patients presenting with esophageal symptoms undergo a detailed clinical, functional and structural evaluation of their esophagus prior to implementation of tailored medical, endoscopic or surgical therapy. Serving as a core, the IEC clinical practice also supports research and innovation in esophageal diseases as well as public and physician education. Referrals to the unit may be primary, either from primary care or self-initiated, or secondary from other specialty practices, to reassess patients who have previously failed therapies and to manage complex or complicated cases. The fundamental goals of the IEC are to provide value for patients with esophageal diseases, streamlining complex diagnostic investigations and expediting therapies aiming at reducing costs while improving clinical outcomes, and to accelerate knowledge generation through robust interaction and cross-training across disciplines. The organization of the IEC goes beyond traditional academic and clinical silos and involves a director and administrative team coordinating faculty and fellows from both medical and surgical disciplines and supported by other clinical lines, such as radiology, pathology, etc., while it interfaces with physicians, the public, basic, translational and clinical research groups, and related industry partners. © The Authors 2017. Published by Oxford University Press on behalf of International Society for Diseases of the Esophagus. All rights reserved. For permissions, please e-mail:

  4. 58例早期食道癌患者的内镜诊断分析及临床研究%Endoscopic diagnosis analysis and clinical research of 58 cases of early esophageal cancer patients



    Objective: To explore endoscopic diagnosis analysis and clinical research of early esophageal cancer patients.Methods: Select 58 cases of early esophageal cancer patients in our treatment from January 2011 to June 2012, all patients were given endoscopic lugo liquid - methylene blue double staining examination ,after diagnosis of early esophageal cancer, the patients agreed to conduct endoscopic surgery treatment. Results: Endoscopic lugo liquid - methylene blue double dyeing diagnosis rate as high as 96.5, after endoscopic resection, overall survival rate of 1, 3, 5 year were 94.8, 84.4, 72.4%.Conclusion: The important methods of early diagnosis of esophageal cancer were endoscopic examination and tissue biopsies, endoscopic lugo liquid - methylene blue double staining can specific inspect early esophageal cancer, and can significantly improve detection rate of the early esophageal cancer.%目的探讨早期食道癌患者的内镜诊断分析及临床研究。方法 选取2007年1月~2008年6月来我院收治的早期食道癌患者58例,所有患者进行内镜下卢戈液-美蓝双重染色法检查和病理检查,确诊为早期食道癌后,经患者同意进行内镜下切除手术治疗。结果 内镜卢戈液-美蓝双重染色的诊断率高达96.5,经过内镜切除治疗,1、3、5年总生存率达94.8、84.4、72.4%。结论 食管癌的早期诊断重要方法有内镜检查和组织活检,内镜下卢戈液-美蓝双重染色可特异性的检查早期食道癌,且显著提高了早期食道癌的检出率。

  5. Herpetic Esophagitis in Immunocompetent Medical Student

    Andréia Vidica Marinho


    Full Text Available Esophagitis caused by herpes simplex virus (HSV is often documented during periods of immunosuppression in patients infected with human immunodeficiency virus (HIV; it is rare in immunocompetent diagnosed patients. Case reports of herpetic esophagitis in students of health sciences are extremely rare. The disease presents with a clinical picture characterized by acute odynophagia and retrosternal pain without obvious causes and ulcers, evidenced endoscopically in the middistal esophagus. Diagnosis depends on endoscopy, biopsies for pathology studies, and immunohistochemistry techniques. The disease course is often benign; however, treatment with acyclovir speeds the disappearance of symptoms and limits the severity of infection. In this report, we present a case of herpetic esophagitis in an immunocompetent medical student, with reference to its clinical features, diagnosis, and treatment. The disease may have manifested as a result of emotional stress experienced by the patient.

  6. 嗜酸性膀胱炎:CT征象和临床诊断分析%Analysis of eosinophilic cystitis on CT signs and clinical manifestations

    孙晓忠; 刘彩云


    Purpose:To explore the potential etiology ,clinical and radiological presentation with EC .Materials and Methods:A pooled ten patients diagnosed with EC were retrospectively studied in our hospital to assess clinical presentation symptoms , radiological and patho-logical diagnosis between 1998 and 2012.Results:The ratio of females to male was 2:3,with mean age was 16.4 years(range 4 to 68 years) at presentation.9 patients presented with irritative urinary symptoms , including dysuria, hematuria.,urinary frequency, lower abdominal pain,one patient was symptomless and found occasionally during routine cystoscopy owing to bladder tumor .Allergic or similar family history were found in 2 patients, bladder mass was detected in all patients and confirmed by radiologic tests or cystoscopy .Radiology revealed diffuse thickening of bladder wall in 7 cases among which one with bilateral hydroureteronephrosis ,solitary tumor-like lesion in other 3 cases.Ele-vated serum leukocytes was evident in 4 cases while elevated peripheral eosinophilia were observed in 3 cases.urine cultures and cytology were negative in all patients ,The final diagnosis of EC was made by cystoscopic ,transurethral resection or open operation biopsy .Conclu-sion:EC should be a rare condition without specific clinical and radiological characters .Final diagnosis might be based on pathology .%目的:探讨嗜酸性膀胱炎( EC)潜在的病因,临床和影像学表现。方法:回顾性的分析1998~2012年间我院诊断的10例EC,以评估该病的临床表现,影像学征象,病理诊断。结果:男女发病比例为3:2,平均年龄16.4岁(4~68岁)。9例出现尿路刺激症状,包括排尿困难,血尿,尿频,下腹疼痛,1例无症状,是在常规膀胱镜检查时偶然发现膀胱肿瘤。2例有过敏史或类似的家族史。通过影像学检查或膀胱镜检查,所有的患者都发现了膀胱肿块。有7例膀胱壁弥漫性增厚,其中的1

  7. Blood eosinophil count and exacerbations in severe chronic obstructive pulmonary disease after withdrawal of inhaled corticosteroids

    Watz, Henrik; Tetzlaff, Kay; Wouters, Emiel F M


    BACKGROUND: Blood eosinophil counts might predict response to inhaled corticosteroids (ICS) in patients with chronic obstructive pulmonary disease (COPD) and a history of exacerbations. We used data from the WISDOM trial to assess whether patients with COPD with higher blood eosinophil counts would...... to receive either continued or reduced ICS over 12 weeks. We did a post-hoc analysis after complete ICS withdrawal (months 3-12) to compare rate of exacerbations and time to exacerbation outcomes on the basis of blood eosinophil subgroups of increasing cutoff levels. The WISDOM trial is registered...... at, number NCT00975195. FINDINGS: In the 2296 patients receiving treatment after ICS withdrawal, moderate or severe exacerbation rate was higher in the ICS-withdrawal group versus the ICS-continuation group in patients with eosinophil counts (out of total white blood cell count) of 2...

  8. Association of the blood eosinophil count with hematological malignancies and mortality

    Andersen, Christen L; Siersma, Volkert D; Hasselbalch, Hans C;


    Blood eosinophilia (≥0.5x10(9) /l) may be an early sign of hematological malignancy. We investigated associations between levels of blood eosinophils and risks of hematological malignancies and mortality in order to provide clinically derived cut-offs for referral to specialist hematology care....... From the Copenhagen Primary Care Differential Count (CopDiff) Database, we identified 356,196 individuals with at least one differential cell count encompassing the eosinophil count during 2000-2007 and matched these laboratory data with Danish nationwide health registers. We used multivariable...... logistic regression to calculate odds ratios (ORs) for the 4-year incidences of hematological malignancies and mortality between the eosinophil counts and a reference count of 0.16x10(9) /l which was the median eosinophil count in our data. Risks of hematological malignancies and mortality increased above...

  9. Clinical Value of Endoscopic Esophageal Iodine Staining in the Early Diagnosis and Treatment of Esophageal Cancer and Precan-cerous Lesions%内镜下食管碘染在早期食管癌及癌前病变诊治中的临床应用价值



    Objective To analyze the clinical value of endoscopic iodine dye in the early diagnosis and treatment of esophageal cancer and precancerous lesions .Methods Selecting 180 cases as the object , doing iodine endoscopic inspection process dyed checks on esopha-geal lesions in 50 cases, doing detailed records under the lesion morphology , location and size, and doing analysis and comparison on multi-ple biopsies and the esophageal squamous epithelium colored concrete results with the corresponding clinical and pathological examination . Results In 50 patients before receiving iodine dye check , 63 lesions points are suspected .In 40 cases after iodine staining dye -free area and lightly staining , a total of 58 points are found , which is about 1/3 of cases have ≥2 points with no staining area and lightly stained area . Conclusion Early diagnosis and treatment of esophageal cancer and precancerous lesions appear within the application in endoscopic has i -deal iodine dye detection results , with higher rate of clinical examination .So it is worth promotion and application .%目的:分析内镜下食管碘染在早期食管癌及癌前病变诊治中的临床应用价值。方法选取180例患者作为此次的研究对象,对50例经内镜检查有食管黏膜可能病变者给予碘染色检查,详细记录病灶的形态、位置以及大小等,行多处活检并把食管鳞状上皮组织具体的着色结果同相应的病理临床检查相互对比分析。结果50例患者接受碘染检查前怀疑病变点共63处,行碘染后40例出现无染色区以及淡染区共58处,约1/3病例出现≥2处无染色区以及淡染区。结论对早期食管癌以及癌前出现病变患者应用内镜下食管碘染色检查,可获得较为理想的检出效果,临床检诊率较高,值得在临床推广和应用。

  10. Radiation Therapy, Paclitaxel, and Carboplatin With or Without Trastuzumab in Treating Patients With Esophageal Cancer


    Adenocarcinoma of the Gastroesophageal Junction; Esophageal Adenocarcinoma; Stage IB Esophageal Cancer; Stage IIA Esophageal Cancer; Stage IIB Esophageal Cancer; Stage IIIA Esophageal Cancer; Stage IIIB Esophageal Cancer

  11. Eosinophilic pleuritis due to sparganum: a case report.

    Oh, Youngmin; Kim, Jeong-Tae; Kim, Mi-Kyeong; Chang, You-Jin; Eom, Keeseon; Park, Jung-Gi; Lee, Ki-Man; Choe, Kang-Hyeon; An, Jin-Young


    Sparganosis is a rare parasitic disease caused by migrating plerocercoid tapeworm larva of the genus Spirometra. Infection in humans is mainly caused by the ingestion of raw or inadequately cooked flesh of infected frogs, snakes, and chickens. Here, we report a rare case of a 45-year-old man who was admitted to our hospital with left lower chest pain. The chest radiograph and computed tomography (CT) scan revealed localized pleural effusion in the left lower lobe; further, peripheral blood eosinophilia and eosinophilic pleural effusion were present. Percutaneous catheter drainage was performed, which revealed long worm-shaped material that was identified as a sparganum by DNA sequencing. The patient showed clinical improvement after drainage of the sparganum. This study demonstrates the importance of considering parasitic diseases in the differential diagnosis of eosinophilic pleural effusion.

  12. Use of AN Eosinophil Specific Monoclonal Antibody in Assessing Eosinophil Function.

    Minkoff, Marjorie Sue

    A monoclonal antibody to an eosinophil specific determinant is very important in assessing eosinophil function during helminthic infection. Eosinophils induced by Schistosoma mansoni infection in BALB/c mice were used to induce C57B1/6 immunocytes for production of hybridomas secreting eosinophil monoclonal antibodies. These antibodies were shown to react with an eosinophil surface epitope but not with neutrophils or macrophages as determined by ELISA, immunodiffusion, immunofluorescence, and immunoblot assay. Affinity chromatography with eosinophil chemotactic factor-sepharose consistently selected out a { rm M_ R} 67,000 protein from solubilized eosinophil membrane antigens but not from neutrophil and macrophage antigens. In vitro studies showed that the eosinophil-specific monoclonal antibodies abrogated antibody-dependent eosinophil -mediated killing of S. mansoni schistosomula using mouse, rat or human eosinophils. Neutrophil and macrophage killing activities were unaffected. The monoclonal antibodies effected complement-dependent lysis of mouse and rat eosinophils but not of human eosinophils. ECF-treated eosinophils showed enhanced killing of schistosomula which was blocked by the monoclonal antibody. Murine and human eosinophils preincubated with monoclonal antibody exhibited decreased chemotaxis to ECF at optimal chemotactic concentrations. The monoclonal antibody also blocked eosinophil binding to ECF- sepharose beads. In vivo induction of peripheral blood eosinophilia by injection of S. mansoni eggs was suppressed by injections of monoclonal antibodies 2CD13 and 2QD45 in mouse and rat experimental models. Eosinophilia induced by keyhole limpet hemocyanin- cyclophosphamide treatment was also suppressed by monoclonal antibody in both murine and rat systems. Pulmonary granulomas in mice given egg injection and monoclonal antibody were smaller and contained fewer eosinophils than those granulomas from mice given eggs only. In immuno-biochemical studies, the

  13. Unusual presentations of eosinophilic gastroenteritis: Case series and review of literature

    Rafiq A Sheikh; Thomas P Prindiville; R Erick Pecha; Boris H Ruebner


    Eosinophilic gastroenteritis (EG) is an uncommon disease characterized by focal or diffuse eosinophilic infiltration of the gastrointestinal tract, and is usually associated with dyspepsia, diarrhea and peripheral eosinophilia. Diffuse gastrointestinal tract and colonic involvement are uncommon. The endoscopic appearance may vary from normal to mucosal nodularity and ulceration. Gastrointestinal obstruction is unusual and is associated with predominantly muscular disease. We present five unusual cases of EG associated with gastric outlet and duodenal obstruction. Two cases presented with acute pancreatitis and one had a history of pancreatitis. Four cases responded well to medical therapy and one had recurrent gastric outlet obstruction that required surgery. Four out of the five cases had endoscopic and histological evidence of esophagitis and two had colitis. Two patients had ascites. These cases reaffirm that EG is a disorder with protean manifestations and may involve the entire gastrointestinal tract. Gastric outlet and/or small bowel obstruction is an important though uncommon presentation of EG. It may also present as esophagitis, gastritis with polypoid lesions, ulcers or erosions, colitis and pancreatitis and may mimic malignancy.

  14. Clinical experience of laparoscopy for treating esophageal hiatal hernia in 16 cases%腹腔镜治疗食管裂孔疝16例临床体会



    目的 探讨腹腔镜在食管裂孔疝修补术中应用的疗效及安全性.方法 应用腹腔镜对16例食管裂孔疝患者行食管裂孔疝修补术,同时将行Nissen胃底折叠术.结果 16例均顺利完成疝修补术,无中转开腹,未出现并发症.手术时间78~125 min,平均102.8 min.术后平均住院时间为4.3 d.术中失血量为40~180 mL,平均95 mL,均无输血.术后3个月行胃镜复查,显示患者的食道炎均已明显好转,未见消化性溃疡或糜烂性胃炎,术后随访3~30个月,无复发.结论 腹腔镜手术用以治疗食管裂孔疝是安全可行的,有手术损伤小、出血少、患者恢复快、住院时间短等优点,值得临床推广应用.%Objective To explore the effect and safety of the clinical application of laparoscopic repair in esophageal hi-atal hernia. Methods The esophageal hiatal repair was performed in 16 patients with esophageal hiatal hernia by laparoscopy. Meanwhile Nissen fundoplication was performed. Results Hermiorrhaphy in 16 cases were smoothly completed without convert-ing to laparotomy and complications occurrence. The average operation time was 117 min , the intraoperative bleeding amount was 40-180 mL(average 95 mL),without blood transfusion. The gastroscopic examination after postoperative 3 months showed that esophagitis was improved significantly and no peptic ulcers and erosive gastritis were found. No recurrence occurred by 3-30 months follow up. Conclusion Treating esophageal hiatal hernia by laparoscopy is safe and feasible ,has the advantages of little injury,less bleeding,rapid recovery and short hospitalization duration,which is worth clinical popularization and application.

  15. Risk Factors for Esophageal Fistula Associated With Chemoradiotherapy for Locally Advanced Unresectable Esophageal Cancer: A Supplementary Analysis of JCOG0303.

    Tsushima, Takahiro; Mizusawa, Junki; Sudo, Kazuki; Honma, Yoshitaka; Kato, Ken; Igaki, Hiroyasu; Tsubosa, Yasuhiro; Shinoda, Masayuki; Nakamura, Kenichi; Fukuda, Haruhiko; Kitagawa, Yuko


    Esophageal fistula is a critical adverse event in patients treated with chemoradiotherapy (CRT) for locally advanced esophageal cancer. However, risk factors associated with esophageal fistula formation in patients receiving CRT have not yet been elucidated.We retrospectively analyzed data obtained from 140 patients who were enrolled in a phase II/III trial comparing low-dose cisplatin with standard-dose cisplatin administered in combination with 5-flurouracil and concomitant radiotherapy. Inclusion criteria were performance status (PS) 0 to 2 and histologically proven thoracic esophageal cancer clinically diagnosed as T4 and/or unresectable lymph node metastasis for which definitive CRT was applicable. Risk factors for esophageal fistula were examined with univariate analysis using Fisher exact test and multivariate analysis using logistic regression models.Esophageal fistula was observed in 31 patients (22%). Of these, 6 patients developed fistula during CRT. Median time interval between the date of CRT initiation and that of fistula diagnosis was 100 days (inter quartile range, 45-171). Esophageal stenosis was the only significant risk factor for esophageal fistula formation both in univariate (P = 0.026) and in multivariate analyses (odds ratio, 2.59; 95% confidence interval, 1.13-5.92, P = 0.025). Other clinicopathological factors, namely treatment arm, age, sex, PS, primary tumor location, T stage, lymph node invasion to adjacent organs, blood cell count, albumin level, and body mass index, were not risk factors fistula formation.Esophageal stenosis was a significant risk factor for esophageal fistula formation in patients treated with CRT for unresectable locally advanced thoracic esophageal squamous cell carcinoma.

  16. Acute Esophageal Necrosis: An Uncommon Cause of Hematemesis

    George Sarin Zacharia


    Full Text Available Acute esophageal necrosis or black esophagus is an uncommon clinical entity, diagnosed at the upper gastrointestinal endoscopy with the presence of strikingly black necrotic esophagus. Very often no definite etiology will be identified even though a large list of potential associations has been postulated. Upper gastrointestinal bleeding is the most common clinical presentation, others being epigastric pain, retrosternal chest discomfort and dysphagia. Only about a hundred cases of acute esophageal necrosis have been described in medical literature till this date. We report a case of acute esophageal necrosis in an elderly female who had presented with hematemesis.

  17. Challenges of correlating pH change with relief of clinical symptoms in gastro esophageal reflux disease: a phase III, randomized study of Zegerid versus Losec.

    Dave Walker

    Full Text Available Zegerid (on demand immediate-release omeprazole and sodium bicarbonate combination therapy has demonstrated earlier absorption and more rapid pH change compared with Losec (standard enteric coated omeprazole, suggesting more rapid clinical relief of heartburn. This Phase III, multicenter, double-blind, double-dummy, randomized study assessed the clinical superiority of Zegerid versus Losec for rapid relief of heartburn associated with gastro-esophageal reflux disease (GERD.Patients with a history of frequent (2 3 days/week uncomplicated GERD, were randomized to receive Zegerid (20 mg or Losec (20 mg with corresponding placebo. Study medication was self-administered on the first episode of heartburn, and could be taken for up to 3 days within a 14 day study period. Heartburn severity was self assessed up to 180 minutes post dose (9 point Likert scale. Primary endpoint was median time to sustained response (≥3 point reduction in heartburn severity for ≥45 minutes.Of patients randomized to Zegerid (N=122 or Losec (N=117, 228/239 had recorded ≥1 evaluable heartburn episodes and were included in the modified intent-to-treat population. No significant between-group differences were observed for median time to sustained response (60.0 vs. 52.2 minutes, Zegerid [N=117] and Losec [N=111], respectively, sustained partial response (both, 37.5 minutes and sustained total relief (both, 105 minutes. Significantly more patients treated with Zegerid reached sustained total relief within 0-30 minutes post dose in all analysis sets (p<0.05. Both treatments were well tolerated and did not raise any safety concerns.Superiority of Zegerid over Losec for rapid heartburn relief was not demonstrated; both treatments were equally effective however the rapid onset of action of Losec was unexpected. Factors, including aspects of study design may have contributed to this. This study supports previously reported difficulty in correlating intra-gastric pH change with

  18. Eosinophilic follicular reaction induced by Demodex folliculorum mite: a different disease from eosinophilic folliculitis.

    Sabater-Marco, V; Escutia-Muñoz, B; Botella-Estrada, R


    Eosinophilic folliculitis (EF) is an idiopathic dermatitis included in the spectrum of eosinophilic pustular follicular reactions. Demodex folliculorum has been implicated as contributing to the pathogenesis of human immunodeficiency virus-associated EF, but it has not been described outside this context. We present an immunocompetent 65-year-old white man with a 5-year history of recurrent pruritic erythematous and oedematous lesions on his face, neck and scalp. Histopathologically, an eosinophilic microabcess with Demodex folliculorum mite within a pilosebaceous follicle was seen, and considered the causal agent. There were also accumulations of eosinophil granules on collagen bundles, and flame figure formations in the dermis. We believe that 'eosinophilic follicular reaction' is an appropriate term to describe this case of EF induced by D. folliculorum and thus distinguish it from the idiopathic form of EF. Moreover, this case suggests that D. folliculorum can sometimes induce an eosinophilic immune reaction.

  19. Esophageal surgery in minimally invasive era


    The widespread popularity of new surgical technologiessuch as laparoscopy, thoracoscopy and robotics has ledmany surgeons to treat esophageal diseases with thesemethods. The expected benefits of minimally invasive surgery (MIS) mainly include reductions of postoperativecomplications, length of hospital stay, and pain andbetter cosmetic results. All of these benefits couldpotentially be of great interest when dealing with theesophagus due to the potentially severe complicationsthat can occur after conventional surgery. Moreover,robotic platforms are expected to reduce many of thedifficulties encountered during advanced laparoscopicand thoracoscopic procedures such as anastomoticreconstructions,accurate lymphadenectomies, andvascular sutures. Almost all esophageal diseases areapproachable in a minimally invasive way, includingdiverticula, gastro-esophageal reflux disease, achalasia,perforations and cancer. Nevertheless, while the limitsof MIS for benign esophageal diseases are mainlytechnical issues and costs, oncologic outcomes remainthe cornerstone of any procedure to cure malignancies,for which the long-term results are critical. Furthermore,many of the minimally invasive esophageal operationsshould be compared to pharmacologic interventionsand advanced pure endoscopic procedures; such acomparison requires a difficult literature analysis andleads to some confounding results of clinical trials. Thisreview aims to examine the evidence for the use of MISin both malignancies and more common benign diseaseof the esophagus, with a particular emphasis on futuredevelopments and ongoing areas of research.

  20. Acute esophageal necrosis and liver pathology, a rare combination

    Amir Maqbul Khan; Rangit Hundal; Vijaya Ramaswamy; Mark Korsten; Sunil Dhuper


    Acute esophageal necrosis (AEN) or "black esophagus" is a clinical condition found at endoscopy. It is a rare entity the exact etiology of which remains unknown. We describe of liver cirrhosis and hepatic encephalopathy.

  1. Preoperative Chemotherapy, Radiation Improve Survival in Esophageal Cancer (Updated)

    Patients with esophageal cancer who received chemotherapy and radiation before surgery survived, on average, nearly twice as long as patients treated with surgery alone, according to results of a randomized clinical trial published May 31, 2012, in NEJM.

  2. Clinical observation of the middle-late patients with esophageal cancer to perform esophageal stent placement and radiation therapy%覆膜支架置入联合放射治疗在中晚期食管癌治疗中的临床观察

    胥雄阳; 赵平宗; 蒋丽琳; 杨兴平; 郭凤英; 贾碧慧


    Objective To study the clinical value of esophageal stent placement with radiation therapy for the middle-late pa-tients with esophageal cancer.Methods To perform esophageal stent placement and radiation therapy for the middle-late 35 pa-tients,and to perform radiation therapy for the middle-late 37 patients,then observe the clinical curative effects.Results The treat-ment group were significantly alleviated with dysphagia symptom after operation,which 32 cases sticked the entire radiation,ac-counting for 91.4%,no one can′t complete the treatment because of nutritional status reason.Survival time of one month after ra-diotherapy was up to 100.0%,and survival time of six months was 85.7% (30/35).But the contrast group with dysphagia symp-tom were aggravated or no relief,and needed parenteral nutrition.There were 23 cases to complete the entire radiation,accounting for 62.2%,and 5 cases happened esophageal tracheal fistula.Survival time of one month after radiotherapy was 83.8%(31/37),and survival time of six months was 62.2% (23/37).Two groups of cases in radiotherapy resistance difference was statistically signifi-cant,one month and six months of survival time were statistically significant (all P <0.05 ).Conclusion Esophageal stent place-ment with radiotherapy is more efficient than only radiation therapy to the middle-late patients with esophageal cancer.%目的:探讨食管覆膜支架置入联合放射治疗对中晚期食管癌治疗的临床价值。方法对35例中晚期食管癌患者进行覆膜支架置入术并放射治疗(治疗组),对37例中晚期食管癌患者进行单纯放射治疗(对照组),并进行临床疗效对比观察。结果治疗组术后患者吞咽困难症状均明显缓解,坚持完成全程放射治疗32例(91.4%),无因营养状况原因导致治疗情况不能完成;放射治疗后1个月以上生存期达100.0%,6个月生存期为85.7%(30/35)。对照组放射治疗开始1周内吞咽困难症状加重或无缓解,需

  3. [Ambulatory esophageal pH monitoring: critical review of methodology: (equipment, reproducibility, standards), clinical importance and personal experience].

    Jonard, P; Fiasse, R; Tomé, G; Dive, C


    The authors review the recent literature about the methodology of oesophageal pH monitoring, which has a high sensitivity and a high specificity for assessing gastro-oesophageal reflux. Combined electrodes offer most advantages. Ambulatory recording should be done in hospital under standard conditions (meals), particularly for clinical studies. The best clinical indication is to detect pathological reflux in case of atypical symptoms with negative oesophagoscopy. The authors give their normal values in a series of measurements with two systems as well as their results in a series of cases of oesophagitis of various grades.

  4. Methylation in esophageal carcinogenesis

    Da-Long Wu; Feng-Ying Sui; Xiao-Ming Jiang; Xiao-Hong Jiang


    Genetic abnormalities of proto-oncogenes and tumor suppressor genes have been demonstrated to be changes that are frequently involved in esophageal cancer pathogenesis. However, hypermethylation of CpG islands, an epigenetic event, is coming more and more into focus in carcinogenesis of the esophagus. Recent studies have proved that promoter hypermethylation of tumor suppressor genes is frequently observed in esophageal carcinomas and seems to play an important role in the pathogenesis of this tumor type. In this review, we will discuss current research on genes that are hypermethylated in human esophageal cancer and precancerous lesions of the esophagus. We will also discuss the potential use of hypermethylated genes as targets for detection, prognosis and treatment of esophageal cancer.

  5. Bleeding esophageal varices

    ... this page: // Bleeding esophageal varices To use the sharing features on ... veins in the esophagus to balloon outward. Heavy bleeding can occur if the veins break open. Any ...

  6. Herpetic esophagitis: a diagnosis to remember

    Marina Pinheiro


    Full Text Available Introduction: Herpetic esophagitis is a well-recognized infection in immunocompromised hosts, having been rarely described in immunocompetent individuals. Case report: The authors describe a case of a 16-year-old female adolescent admitted to the emergency room with a threeday history of fever, odynophagia, dysphagia for liquid and solid food and retrosternal pain. The upper endoscopy revealed linear and round erosions in the distal esophagus and the histologic findings were compatible with herpetic esophagitis. Discussion/conclusion: Herpetic esophagitis is an underdiagnosed condition in immunocompetent children and adolescents, but it should not be overlooked. An esophagoscopy is required to make a definitive diagnosis. It is usually a selflimited infection and the mainstay of treatment is supportive care. The use of acyclovir is still controversial but its early initiation may shorten the clinical course of the disease.

  7. Integrative topological analysis of mass spectrometry data reveals molecular features with clinical relevance in esophageal squamous cell carcinoma.

    Gao, She-Gan; Liu, Rui-Min; Zhao, Yun-Gang; Wang, Pei; Ward, Douglas G; Wang, Guang-Chao; Guo, Xiang-Qian; Gu, Juan; Niu, Wan-Bin; Zhang, Tian; Martin, Ashley; Guo, Zhi-Peng; Feng, Xiao-Shan; Qi, Yi-Jun; Ma, Yuan-Fang


    Combining MS-based proteomic data with network and topological features of such network would identify more clinically relevant molecules and meaningfully expand the repertoire of proteins derived from MS analysis. The integrative topological indexes representing 95.96% information of seven individual topological measures of node proteins were calculated within a protein-protein interaction (PPI) network, built using 244 differentially expressed proteins (DEPs) identified by iTRAQ 2D-LC-MS/MS. Compared with DEPs, differentially expressed genes (DEGs) and comprehensive features (CFs), structurally dominant nodes (SDNs) based on integrative topological index distribution produced comparable classification performance in three different clinical settings using five independent gene expression data sets. The signature molecules of SDN-based classifier for distinction of early from late clinical TNM stages were enriched in biological traits of protein synthesis, intracellular localization and ribosome biogenesis, which suggests that ribosome biogenesis represents a promising therapeutic target for treating ESCC. In addition, ITGB1 expression selected exclusively by integrative topological measures correlated with clinical stages and prognosis, which was further validated with two independent cohorts of ESCC samples. Thus the integrative topological analysis of PPI networks proposed in this study provides an alternative approach to identify potential biomarkers and therapeutic targets from MS/MS data with functional insights in ESCC.

  8. Oral and esophageal disorders.

    Noyer, C M; Simon, D


    This article focused on the approach to oral and esophageal disorders in patients with AIDS. Most of these disorders respond to various therapeutic regimens. Some of the oral complications can be prevented with dental prophylaxis, whereas recurrent esophageal disease in some patients may require long-term suppressive therapy. As patients with AIDS live longer with lower CD4 counts, gastroenterologists need to become familiar with the approach to and management of the more common lesions of the mouth and esophagus.

  9. [Eosinophilic pneumonia revealing B-cell non-Hodgkin lymphoma].

    Fikal, Siham; Sajiai, Hafsa; Serhane, Hind; Aitbatahar, Salma; Amro, Lamyae


    The diagnosis of eosinophilic pneumonia is rare and malignant etiology remains exceptional. Eosinophilic pneumonia etiology varies and is mainly dominated by allergic and drug causes. We report the case of a 61-year-old patient with B-cell non-Hodgkin lymphoma revealed by eosinophilic pneumonia. The diagnosis of eosinophilic pneumonia was confirmed by eosinophil count of 56% in bronchoalveolar lavage. Immunohistochemical examination of bone marrow biopsy revealed malignant Small B cells non-Hodgkin lymphoma.

  10. Acute esophageal necrosis: a rare syndrome.

    Gurvits, Grigoriy E; Shapsis, Alexander; Lau, Nancy; Gualtieri, Nicholas; Robilotti, James G


    Acute esophageal necrosis, which presents as a black esophagus on endoscopy, is a rare disorder that is poorly described in the medical literature. In this study, we analyze all cases reported to date to define risk factors, clinical presentation, endoscopic features, histologic appearance, treatment, complications, outcome and etiopathogenesis of the disease and to describe a distinct medical syndrome and propose a staging system. We searched Medline and PubMed from January 1965 to February 2006 for English-language articles using the key words "acute esophageal necrosis," "necrotizing esophagitis," and "black esophagus." A total of 88 patients were reported in the literature during the 40 years, 70 men and 16 women with an average age of 67 years. Patients were generally admitted for gastrointestinal bleeding and cardiovascular event/shock. Patients presented with hematemesis and melena in more than 70% of the cases. Upper endoscopy showed black, diffusely necrotic esophageal mucosa predominantly affecting the distal third of the organ. Necrosis was confirmed histologically in most cases. Complications included strictures or stenoses, mediastinitis/abscesses, and perforations. Overall mortality was 31.8%. This study provides a structured approach to identifying risk factors, diagnosis, and pathogenesis of the acute esophageal necrosis. Risk factors include age, male sex, cardiovascular disease, hemodynamic compromise, gastric outlet obstruction, alcohol ingestion, malnutrition, diabetes, renal insufficiency, hypoxemia, hypercoagulable state, and trauma. Mechanism of damage is usually multifactorial secondary to ischemic compromise, acute gastric outlet obstruction, and malnutrition. Overall, acute esophageal necrosis should be viewed as a poor prognostic factor, associated with high mortality from the underlying clinical disease.

  11. Esophageal Motor Disorders in Terms of High-Resolution Esophageal Pressure Topography: What Has Changed?

    Kahrilas, Peter J.


    The concept of high-resolution manometry (HRM) is to use sufficient pressure sensors such that intraluminal pressure can be monitored as a continuum along luminal length much as time is viewed as a continuum in conventional manometry. When HRM is coupled with pressure topography plots, pressure amplitude is transformed into spectral colors with isobaric conditions indicated by same-colored regions on the display. Together, these technologies are called high-resolution esophageal pressure topography (HREPT). HREPT has several advantages compared with conventional manometry, the technology that it was designed to replace. (i) The contractility of the entire esophagus can be viewed simultaneously in a uniform format, (ii) standardized objective metrics can be systematically applied for interpretation, and (iii) topographic patterns of contractility are more easily recognized and have greater reproducibility than with conventional manometry. Compared with conventional manometry, HREPT has improved sensitivity for detecting achalasia, largely due to the objectivity and accuracy with which it identifies impaired esophagogastric junction (EGJ) relaxation. In addition, it has led to the subcategorization of achalasia into three clinically relevant subtypes based on the contractile function of the esophageal body: classic achalasia, achalasia with esophageal compression, and spastic achalasia. Headway has also been made in understanding hypercontractile conditions, including diffuse esophageal spasm and a newly described entity, spastic nutcracker. Ultimately, clinical experience will be the judge, but it seems likely that HREPT data, along with its well-defined functional implications, will improve the clinical management of esophageal motility disorders. PMID:20179690

  12. Effect of anti-IgE therapy on food allergen specific T cell responses in eosinophil associated gastrointestinal disorders

    Foster, Barbara; Foroughi, Shabnam; Yin, Yuzhi; Prussin, Calman


    .... To test this hypothesis, food allergen specific T cell responses were examined during a 16-week clinical trial of omalizumab in nine subjects with eosinophilic gastroenteritis and food sensitization...

  13. 嗜酸粒细胞性胃肠炎致血性腹水1例%Eosinophilic gastroenteritis with bloody ascites: a case report

    黄颖秋; 韩春丽; 刘旭妍


    嗜酸粒细胞性胃肠炎(eosinophilic gastroentertis,EG)是一种不明原因的罕见疾病,以周围血中嗜酸粒细胞增高及胃肠道局部或弥漫性嗜酸粒细胞浸润为特征.本文报道EG致血性腹水1例.患者,男,15岁,以恶心、呕吐、乏力、间断腹泻10d入院.化验检查显示血WBC 18.28×109/L,嗜酸粒细胞57.61%.腹水血性,蛋白46 g/L,白细胞7040×106/L,嗜酸性粒细胞68%,李凡它试验(+).彩超和CT示腹水和右半结肠管壁增厚.胃镜示重度多灶性红斑渗出性食管炎、胃炎和十二指肠炎,食管下段黏膜色泽晦暗,呈环形色素沉着和颗粒样增生.结肠镜示回肠末段、阑尾开口处及升结肠黏膜呈显著的水肿、肥厚、渗出、颗粒样增生和管腔狭窄等炎性改变.内镜活检病理示大量的嗜酸粒细胞浸润.该患者经强的松治疗症状明显缓解.%Eosinophilic gastroentertis (EG) is a very rare disease of unknown cause, characterized by peripheral eosinophilia and focal or difuse eosinophilic infiltration of the gastrointestinal tract. Here we report a case of eosinophilic gastroenteritis with bloody ascites in a 15-year-old male patient who presented to our hospital with nausea, vomiting, debilitation, and intermittent diarrhea for 10 d. Laboratory data showed that his WBC count was 18.28 ×109/L and his eo-sinophil percentage was 57.61%. He developed bloody ascitic fluid, in which the protein level was 46 g/L, WBC count was 7 040 ×106/L, and eosinophil percentage was 68%. The Rivalta test was positive. Ultrasound and CT demonstrated bowel wall thickness in the right colon and ascites. Gastroendoscopy showed severe multifocal erythematous esophagitis, gastritis and duodenitis, and a ring-like discoloration with mucosal particle hyperplasia in the lower esophagus. Colonoscopy revealed severe inflammation in the lower ileum, the opening of vermiform appendix, and right colon, with erosions, thickening, exudates, mucosal particle

  14. The influence of Helicobacter pylori on the ethnic distribution of esophageal eosinophilia.

    Sonnenberg, Amnon; Dellon, Evan S; Turner, Kevin O; Genta, Robert M


    Environmental factors associated with ethnicity may contribute to the occurrence of eosinophilic esophagitis. Our study aimed to investigate the influence of Helicobacter pylori on the ethnic variation of esophageal eosinophilia in a large national sample of patients undergoing esophago-gastro-duodenoscopy. The Miraca Life Sciences Database is an electronic repository of histopathologic patient records. A case-control study evaluated the influence of ethnicity on the occurrence of esophageal eosinophilia and how age, gender, and histologic diagnosis of H. pylori modify this relationship. The total study population comprised 596 479 subjects, of whom 25 969 harbored a diagnosis of esophageal eosinophilia. Young age, male sex, and H. pylori infection in declining order exerted the strongest influence on the occurrence of esophageal eosinophilia. In comparison with the population comprising of Caucasians and African-Americans, esophageal eosinophilia was less common among patients of African (OR=0.10, 95% CI=0.01-0.46), Middle Eastern (0.22, 0.15-0.31), East Asian (0.32, 0.26-0.38), Indian (0.28, 0.21-0.37), Hispanic (0.40, 0.37-0.43), or Jewish descent (0.58, 0.51-0.66), but more common among patients of Northern European descent (1.25, 1.07-1.45). With the exception of Northern Europeans, all ethnic subgroups were characterized by a higher prevalence of H. pylori than the comparison group. A low prevalence of H. pylori was significantly associated with a high prevalence of esophageal eosinophilia (R(2) =0.90, Ppylori and esophageal eosinophilia, H. pylori infection may be in part responsible for the observed ethnic distribution of esophageal eosinophilia. © 2016 John Wiley & Sons Ltd.

  15. Adult eosinophilic gastroenteritis and hypereosinophilic syndromes

    Hugh James Freeman


    Eosinophilic gastroenteritJs (EGE) in the adult is a distinctive pathologically-based disorder characterized by an eosinophil-predominant mucosal inflammatory process. Most often, the disorder is detected during endoscopic investigation for abdominal pain or diarrhea. Other causes of gastric and intestinal mucosal eosinophilia require exclusion, including parasitic infections and drug-induced causes. Occasionally, the muscle wall or serosal surface may be involved. EGE appears to be more readily recognized, in large part, due to an evolution in the imaging methods used to evaluate abdominal pain and diarrhea, in particular, endoscopic imaging and mucosal biopsies. Definition of EGE, however, may be difficult, as the normal ranges of eosinophil numbers in normal and abnormal gastric and intestinal mucosa are not well standardized. Also, the eosinophilic inflammatory process may be either patchy or diffuse and the detection of the eosinophilic infiltrates may vary depending on the method of biopsy fixation. Treatment has traditionally focused on resolution of symptoms, and, in some instances, eosinophil quantification in pre-treatment and post-treatment biopsies. Future evaluation and treatment of EGE may depend on precise serological biomarkers to aid in definition of the long-term natural history of the disorder and its response to pharmacological or biological forms of therapy.

  16. Evidence for eosinophil degranulation in acute appendicitis

    Santosh G


    Full Text Available Finding of increased numbers of eosinophils in the muscle in cases of acute appendicitis has led to the hypothesis that it may have an allergic origin. This study aimed to measure the eosinophil degranulation resulting in a rise in the serum of eosinophil granule proteins that would be expected in such cases. The levels of serum eosinophil cationic protein (ECP measured by chemiluminescence assay in acute appendicitis were compared, with those of appropriate controls. Mean (95% CI serum ECP (µg/L levels were: acute appendicitis 45.3 (27.7-63.0; normal appendix 22.7 (16.0-29.3; asthma 24.2 (4.6-43.8; and healthy volunteers 13.2 (8.3-18.1. In cases of acute appendicitis, there is an inverse relationship between duration of symptoms and serum ECP. However, this was not statistically significant. Significant local eosinophil activation and degranulation occurs in acute appendicitis, enough to cause a rise in serum levels of eosinophil chemotactic protein

  17. Myeloprolipherative disorder type chronic myeloid leukemia--eosinophilic form.

    Arnautovic-Custovic, Aida; Hasic, Samira; Kopic, Emina; Jahic, Azra; Jovic, Svetlana


    Chronic eosinophilic leukemia (CEL) is a very rare form of leucemia in the western world. Adequate response is seldomly achieved after treatment with corticosteroids, interferon-alfa (INF-alfa) and medications containing hydroxi-urea (Litalir). The study presents a patient with CEL with no initial therapeutic response to the use of corticosteroids, INF-alfa and hydroxy-urea, and with neither clinical nor hematological response. After setting a diagnosis of CEL, patient was ordinated Imatinib (Glivec tabbletes) in a daily dose of 200 mg. Two days afterwards there was an evident withdrawal of subjective and clinical symptoms of disease, and the complete blood count showed significant amendment.

  18. Eosinophils increase in animals that received biotherapic

    Pedro Gilberto Silva Morais


    Full Text Available Dairy industry is an important Brazilian economic activity participating of income generation. European breeds cattle aren’t adapted to parasites found in the tropics, like the Rhipicephalus microplus tick. Parasites can acquire resistance to allopathic products, but not to homeopathic products. We evaluate the efficacy of an antiparasiticide biotherapic against the R. microplus tick. The biotherapic was prepared according to the homeopathic pharmacopoeia recommendations from vegetable (Abrotanum and animal products (Rhipicephalus microplus, Amblyomma cajenennense, Haematobia irritans, Musca domestica, Dermatobia hominis, all diluted and vigorous shaken (dynamized in water or alcohol at a ratio of 1:99, in the 12th Centesimal Hahnemann (CH12, with limestone as the carrier. This homeophatic product found in veterinary pharmacies of Ituiutaba’s region, Minas Gerais State, is registered at Ministério da Agricultura, Pecuária e Abastecimento (MAPA. Natural tick infestation was accessed in thirty Girolando (Gir x Holstein cows with 7 to 13 year-old, by monthly counting of tick female bigger than 6 mm, from October/2009 to July/2011. Cows were divided in three groups of 10 similar animals. The treated group (T1 received roughage, concentrate and biotherapic. The placebo group (T2 received roughage, concentrate and limestone and the control group (T3 received only roughage and concentrate. T1 and T2 groups were managed together and remained in the same paddock. T3 group was separed from T1 and T2 by a wire fence. From October 2009 to September 2010 blood cell counts and serum biochemical tests were performed monthly only in T1 and T2, but visual clinical observations were made in all animals. Any group was treated with acaricide when the count’s average reached 50 or more ticks. It was necessary 7 baths with acaricide in T1 and T2, while in T3 group (control group it was necessary 19 acaricide baths to control the cattle tick. We verified

  19. Lichenoid esophagitis: clinicopathologic overlap with established esophageal lichen planus.

    Salaria, Safia N; Abu Alfa, Amer K; Cruise, Michael W; Wood, Laura D; Montgomery, Elizabeth A


    Lichen planus (LP) affects mucocutaneous surfaces and is characterized by intraepithelial and lamina propria lymphocytosis and squamous cell apoptosis (Civatte bodies). Lichen planus esophagitis (LPE) is underrecognized; concurrent cutaneous disease is present in some patients, but LPE alone is more common. We diagnose patients with characteristic pathologic findings of LPE and known correlation with skin disease or immunofluorescence (IF) results as LPE but use descriptive terminology ("lichenoid esophagitis pattern" [LEP]) when confirmation is unavailable. We reviewed clinicopathologic features of patients diagnosed at our institution with LPE or LEP. There were 88 specimens with LPE or LEP from 65 patients. Most patients were female. Seventeen patients had LPE confirmed by IF. Five patients had both esophageal (1 with IF) and skin LP. Strictures were a prominent presenting feature in LPE patients, with disease distribution more frequent in the upper and lower esophagus. Dysphagia was a common reason for endoscopy in LEP patients. Rheumatologic diseases are more common in patients with LPE compared with LEP. Viral hepatitides and human immunodeficiency virus (HIV) infections are associated with LEP. We defined polypharmacy as patients taking >3 medications; this finding was present in both LPE and LEP cohorts; however, this is a prominent feature in those with established LPE. Progression to dysplasia was noted in both cohorts. About 5% of LPE patients have tandem skin manifestations. LPE is more likely than LEP to arise in women, result in stricture formation, and be associated with rheumatologic disorders and polypharmacy, whereas LEP is associated with viral hepatitis and HIV. Both can progress to neoplasia. As the risk of stricture formation is high in patients with LPE, it is worth performing pertinent IF studies to confirm LPE, although knowledge of the clinical association of LEP with viral hepatitis, HIV, and use of multiple medications is of value in

  20. Analysing the eosinophil cationic protein - a clue to the function of the eosinophil granulocyte

    Bishop-Bailey David


    Full Text Available Abstract Eosinophil granulocytes reside in respiratory mucosa including lungs, in the gastro-intestinal tract, and in lymphocyte associated organs, the thymus, lymph nodes and the spleen. In parasitic infections, atopic diseases such as atopic dermatitis and asthma, the numbers of the circulating eosinophils are frequently elevated. In conditions such as Hypereosinophilic Syndrome (HES circulating eosinophil levels are even further raised. Although, eosinophils were identified more than hundred years ago, their roles in homeostasis and in disease still remain unclear. The most prominent feature of the eosinophils are their large secondary granules, each containing four basic proteins, the best known being the eosinophil cationic protein (ECP. This protein has been developed as a marker for eosinophilic disease and quantified in biological fluids including serum, bronchoalveolar lavage and nasal secretions. Elevated ECP levels are found in T helper lymphocyte type 2 (atopic diseases such as allergic asthma and allergic rhinitis but also occasionally in other diseases such as bacterial sinusitis. ECP is a ribonuclease which has been attributed with cytotoxic, neurotoxic, fibrosis promoting and immune-regulatory functions. ECP regulates mucosal and immune cells and may directly act against helminth, bacterial and viral infections. The levels of ECP measured in disease in combination with the catalogue of known functions of the protein and its polymorphisms presented here will build a foundation for further speculations of the role of ECP, and ultimately the role of the eosinophil.

  1. Long-Term Loss of Response in Proton Pump Inhibitor-Responsive Esophageal Eosinophilia Is Uncommon and Influenced by CYP2C19 Genotype and Rhinoconjunctivitis.

    Molina-Infante, Javier; Rodriguez-Sanchez, Joaquin; Martinek, Jan; van Rhijn, Bram D; Krajciova, Jana; Rivas, Maria D; Barrio, Jesus; Moawad, Fouad J; Martinez-Alcalá, Carmen; Bredenoord, Albert J; Zamorano, Jose; Dellon, Evan S


    Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is diagnosed in at least one-third of patients with suspected eosinophilic esophagitis (EoE). We aimed to evaluate the durability and factors influencing long-term efficacy of PPI therapy. Retrospective multicenter cohort study of patients with PPI-REE who had at least 12 months of follow-up. PPI therapy was tapered to the lowest dose, which maintained clinical remission. Primary outcomes were the proportion of patients with loss of histological response (eosinophilia was limited to the distal esophagus in 14/20 (70%). Nine of ten relapsers, with distal eosinophilia, all showing a CYP2C19 rapid metabolizer genotype, regained histological remission after PPI dose intensification. Most PPI-REE patients remain in long-term remission on low-dose PPI therapy. CYP2C19 rapid metabolizer genotypes and rhinoconjunctivitis were independent predictors of loss of response to PPI, but patients frequently responded to PPI dose escalation.

  2. Expression and clinical significance of eosinophil cationic protein in nasal secretion from chronic rhinosinusitis%慢性鼻窦炎鼻分泌物中嗜酸粒细胞阳离子蛋白的表达及临床意义

    章锦秀; 史剑波


    Aim:To study the Expression and clinical significance of eosinophil cationic protein in nasal secretion from chronic rhinosinusitis.Methods: Thirty-six nasal secretion collection from CRS patients and twenty nasal collection samples from health people used as control, Eosinophilic cationic protein in nasal secretion were measured by fluoroimmunoassay.Results: The ECP level in the nasal secretion from CRS patients is at 2 154.42 μg/L,it was obviously higher than that of obtaining from the control's,185.02 μg/L( P < 0.05 ).Conclusion:This study may indicate that the ECP in nasal secretion involvs in the monitoring of CRS nasal inflammation.%目的:探讨慢性鼻窦炎(chronic rhinosinusitis,CRS)患者鼻分泌物中嗜酸粒细胞阳离子蛋白(eosinophilic cationic protein,ECP)的表达及临床意义.方法:取36例CRS患者及20例健康人鼻分泌物,用免疫荧光分析法定量检测其ECP含量.结果:CRS患者鼻分泌物ECP质量浓度平均为2 154.42μg/L较对照组平均185.02μg/L明显增高(P<0.05).结论:鼻分泌物ECP可能成为CRS黏膜炎症严重程度的检测指标之一.

  3. Esophageal lichen planus: a case report and review of the literature.

    Nielsen, Jennifer A; Law, Robert M; Fiman, Keith H; Roberts, Cory A


    Esophageal involvement by lichen planus (ELP), previously thought to be quite rare, is a disease much more common in women and frequently the initial manifestation of mucocutaneous lichen planus (LP). Considering that the symptoms of ELP do not present in a predictable manner, ELP is perhaps more under-recognized than rare. To date, four cases of squamous cell carcinoma in association with ELP have been reported, suggesting that timely and accurate diagnosis of ELP is of importance for appropriate follow-up. In this case report, a 69-year-old female presented with dysphagia and odynophagia. She reported a history of oral LP but had no active oral or skin lesions. Endoscopic examination revealed severe strictures and web-like areas in the esophagus. Histologic examination demonstrated extensive denudation of the squamous epithelium, scattered intraepithelial lymphocytes, rare eosinophils and dyskeratotic cells. Direct immunofluorescence showed rare cytoid bodies and was used to exclude other primary immunobullous disorders. By using clinical, endoscopic, and histologic data, a broad list of differential diagnoses can be narrowed, and the accurate diagnosis of ELP can be made, which is essential for proper treatment and subsequent follow-up.

  4. Percutaneous endoscopic gastrostomy for nutritional palliation of upper esophageal cancer unsuitable for esophageal stenting

    Ana Grilo


    Full Text Available CONTEXT: Esophageal cancer is often diagnosed at an advanced stage and has a poor prognosis. Most patients with advanced esophageal cancer have significant dysphagia that contributes to weight loss and malnutrition. Esophageal stenting is a widespread palliation approach, but unsuitable for cancers near the upper esophageal sphincter, were stents are poorly tolerated. Generally, guidelines do not support endoscopic gastrostomy in this clinical setting, but it may be the best option for nutritional support. OBJECTIVE: Retrospective evaluation of patients with dysphagia caused advanced esophageal cancer, no expectation of resuming oral intake and with percutaneous endoscopic gastrostomy for comfort palliative nutrition. METHOD: We selected adult patients with unresecable esophageal cancer histological confirmed, in whom stenting was impossible due to proximal location, and chemotherapy or radiotherapy were palliative, using gastrostomy for enteral nutrition. Clinical and nutritional data were evaluated, including success of gastrostomy, procedure complications and survival after percutaneous endoscopic gastrostomy, and evolution of body mass index, albumin, transferrin and cholesterol. RESULTS: Seventeen males with stage III or IV squamous cell carcinoma fulfilled the inclusion criteria. Mean age was 60.9 years. Most of the patients had toxic habits. All underwent palliative chemotherapy or radiotherapy. Gastrostomy was successfully performed in all, but nine required prior dilatation. Most had the gastrostomy within 2 months after diagnosis. There was a buried bumper syndrome treated with tube replacement and four minor complications. There were no cases of implantation metastases or procedure related mortality. Two patients were lost and 12 died. Mean survival of deceased patients was 5.9 months. Three patients are alive 6, 14 and 17 months after the gastrostomy procedure, still increasing the mean survival. Mean body mass index and laboratory

  5. Clinical study of non-specific cell mediated immunity in the patients with esophageal cancer. Influence of preoperative irradiation and surgical intervention

    Nakata, Yoshitaka


    Few data are available to elucidate the influence of combined preoperative irradiation and surgery on the non-specific cell mediated immunity of patients with esophageal cancer. In vitro and in vivo examinations of the non-specific cell mediated immunity were made before and after irradiation and surgery in 108 patients with esophageal cancer. Decreased immune competence was noticeable one month after surgery in the irradiated group, as compared with the non-irradiated group. Simultaneously, the ratio of concanavalin A to phytohemagglutinin was significantly higher in the irradiated group than the non-irradiated group (p < 0.01). Two months later, both findings in the two groups were similar. There was no consistent tendency toward altered immune competence between the group with curative surgery and the group with non-curative surgery. (Namekawa, K.).

  6. Does bee pollen cause to eosinophilic gastroenteropathy?

    Güç, Belgin Usta; Asilsoy, Suna; Canan, Oğuz; Kayaselçuk, Fazilet


    Bee pollen is given to children by mothers in order to strengthen their immune systems. There are no studies related with the side effects of bee polen in the literature. In this article, the literature was reviewed by presenting a case of allergic eosinophilic gastropathy related with bee polen. A 5-year old child was admitted due to abdominal pain. Edema was detected on the eyelids and pretibial region. In laboratory investigations, pathology was not detected in terms of hepatic and renal causes that would explain the protein loss of the patient diagnosed with hypoproteinemia and hypoalbuminemia. Urticaria was detected during the follow-up visit. When the history of the patient was deepened, it was learned that bee pollen was given to the patient every day. The total eosinophil count was found to be 1 800/mm(3). Allergic gastroenteropathy was considered because of hypereosinophilia and severe abdominal pain and endoscopy was performed. Biopsy revealed abundant eosinophils in the whole gastric mucosa. A diagnosis of allergic eosinophilic gastropathy was made. Bee polen was discontinued. Abdominal pain and edema disappeared in five days. Four weeks later, the levels of serum albumin and total eosinophil returned to normal.

  7. [Eosinophilic gastroenteritis caused by bee pollen sensitization].

    Puente, S; Iñíguez, A; Subirats, M; Alonso, M J; Polo, F; Moneo, I


    A 34-year-old Spanish woman with a lifelong history of seasonal rhinoconjunctivitis and honey intolerance (pyrosis and abdominal pain) developed, 3 weeks after starting ingestion of bee pollen, astenia, anorexia, abdominal pain, diarrhoea, peripheral blood hypereosinophilia and elevated serum total IgE levels. A duodenal biopsy showed eosinophilic infiltration of the mucosal layer. Other causes of hypereosinophilia were not found. Repeated parasitological stool studies, as well as a duodenal aspirate showed negative results. Symptoms, hypereosinophilia and elevated IgE levels resolved after bee pollen ingestion was stopped. This is a typical case of eosinophilic gastroenteritis by ingestion of bee pollen in a woman with intolerance to honey bee, because the patient fulfilled the usual diagnostic criteria: gastrointestinal symptoms were present, eosinophilic infiltration of the digestive tract was demonstrated by biopsy, no eosinophilic infiltration of other organs was found and the presence of parasites was excluded. Honey intolerance and/or bee pollen administration should be considered as a cause of eosinophilic gastroenteritis.

  8. High EGFR and low p-Akt expression is associated with better outcome after nimotuzumab-containing treatment in esophageal cancer patients: preliminary clinical result and testable hypothesis

    Wang, Chun-Yu; Deng, Jia-ying; Cai, Xu-Wei; Fu, Xiao-Long; Li, Yuan; Zhou, Xiao-Yan; Wu, Xiang-Hua; Hu, Xi-Chun; Fan, Min; Xiang, Jia-Qing; Zhang, Ya-Wei; Chen, Hai-quan; Perez, Rolando; Jiang, Guo-Liang; Zhao, Kuai-Le


    The epidermal growth factor receptor (EGFR) is widely overexpressed in esophageal squamous cell carcinoma (ESCC) and it results is associated with a poor prognosis. Identifying the subgroup of ESCC patients who are sensitive to EGFR-targeted therapy is a key point to facilitate its medical use. We retrospectively analyzed 32 ESCC patients treated with the combination of nimotuzumab (h-R3) and radiotherapy (RT) or chemoradiotherapy (CRT). Expression of EGFR and phosphorylated proteins associat...

  9. Asymmetric sweating and flushing in infants with esophageal atresia.

    Cozzi, Denis A; Mele, Ermelinda; Totonelli, Giorgia; Ceccanti, Silvia; Frediani, Simone; Cozzi, Francesco


    Of 136 infants with repaired esophageal atresia, one presented an unilateral facial flushing and 2 presented a flushing and sweating of one half of the body. The topography of these disorders and/or the associated clinical manifestations suggest that the asymmetry may be related to an instability of unilateral autonomic centers more than to a surgical injury of upper thoracic sympathetic chain during esophageal repair.

  10. 覆膜食管支架的临床疗效评价%Clinical Application of the Membrana Tectoria Esophageal Stent in ETF Patients

    何山; 王德林; 曹玉娟; 杜芳; 曹凤; 郝龙英; 赵聪; 侯东东


    目的:评价覆膜食管支架的临床疗效。方法在血管造影机的引导下对25例患者置入覆膜食管支架。结果术后25例患者呛咳、吞咽困难等症状得到改善,生活质量明显提高,未见严重并发症。结论置入覆膜食管支架可以安全、有效地治疗食管气管瘘。%Objective To investigate the effectiveness of application of the membrana tectoria esophageal stent in ETF (Esophago-Tracheal Fistula) patients.Methods The membrana tectoria esophageal stent was implanted in 25 patients under the guidance of angiography equipment.Results The life quality was obviously improved post-operatively in 25 ETF patients without the symptoms such as dysphagia and cough as well as serious adverse complications.Conclusion Design of the membrana tectoria esophageal stent could effectively ensure the occurrence of closed ifstula and restenosis.

  11. The Prevalence, Risk Factors, and Clinical Correlates of Erosive Esophagitis and Barrett’s Esophagus in Iranian Patients with Reflux Symptoms

    Alireza Sharifi


    Full Text Available Background. Erosive esophagitis (EE and Barrett’s esophagus (BE are the two important complications of gastroesophageal reflux disease. We aimed to investigate the prevalence of and the risk factors for EE and BE in an Iranian group of patients with reflux symptoms. We also examined the relationship between reflux symptoms and endoscopic findings. Methods. A total of 736 patients with gastroesophageal reflux disease (GERD symptoms were enrolled and all underwent upper gastrointestinal endoscopy. Diagnosis of Barrett’s esophagus was confirmed by pathologic examination and Helicobacter pylori (H. pylori infection was demonstrated by rapid urease test. Results. Two hundred eighty-three and 34 patients were found to have EE and BE, respectively. Multivariate analysis showed that hiatal hernia (P<0.001 and H. pylori infection (P<0.002 were the two significantly related risk factors for esophagitis. Only age was related to BE, with BE patients being more likely to be older (P<0.001 than others. Conclusions. Prevalence of EE and BE in Iranian reflux patients is similar to that seen in western countries. H. pylori infection and the presence of hiatal hernia may be strong risk factors for esophagitis as does older age for Barrett’s esophagus. Finally, reflux symptoms have no significant relationship with endoscopic findings.

  12. Eosinophilic pneumonia due to toxocariasis: an adult case report.

    Demirci, Mustafa; Unlü, Mehmet; Fidan, Fatma; Kaya, Selçuk


    Toxocara is a roundworm, a common parasite of dogs (T. canis) and cats (T. cati). Toxocariasis or Visceral larva migrans (VLM) are diseases caused by the larvae of Toxocara sp., which may involve many organs, but pulmonary symptoms such as coughing and wheezing and allergic symptoms are seen in more than 80% of patients. It is known that, although the risk of infection is present, the worldwide diagnosis of toxocariasis is difficult since clinical and laboratory data provide insufficient evidence for the diagnosis. Nowadays, the diagnosis of toxocariasis is performed by serologic methods. We describe herein a case of toxocariasis with eosinophilic pneumonia that was diagnosed using serologic methods.

  13. Salbutamol delays human eosinophil apoptosis via a cAMP-dependent mechanism.

    Kankaanranta, Hannu; Parkkonen, Jouni; Ilmarinen-Salo, Pinja; Giembycz, Mark A; Moilanen, Eeva


    Eosinophils play a major role in asthma. One described mechanism leading to the impaired clearance of these cells from the lung is the delay in their programmed cell death (apoptosis). β(2)-Adrenoceptor agonists have been shown to prolong survival and delay apoptosis of eosinophils. The aim of the present study was to evaluate the mechanisms, especially the role of cAMP pathway, in the prolongation of human eosinophil survival by a selective β(2)-agonist salbutamol. Isolated human peripheral blood eosinophils were cultured in the absence or presence of a β(2)-agonist salbutamol and the indicated antagonists/inhibitors under sterile conditions. Apoptosis was measured by using the relative DNA fragmentation assay and Annexin-V binding. Salbutamol prolonged survival of human eosinophils and it was inhibited by a β-receptor antagonist propranolol and mimicked by cell-permeant cAMP analogues dibutyryl- and 8-bromo-cAMP. Pharmacological inhibitors of adenylyl cyclase (SQ-22,536) and protein kinase A (Rp-8-CPT-cAMPS) antagonized the effects of salbutamol. The survival-prolonging action of salbutamol was potentiated by a phosphodiesterase inhibitor rolipram (EC(50) for the salbutamol effect was 13.6 ± 4.0 and 8.1 ± 3.1 nM in the absence and presence of rolipram, respectively; p=0.0142, n=10). In contrast, inhibition of Ca(2+)-activated K(+)-channels by apamin, charybdotoxin, iberiotoxin or paxilline did not affect the ability of salbutamol to prolong eosinophil survival. Taken together, the present results suggest that salbutamol at clinically relevant concentrations decreases apoptosis in human eosinophils by activating the cannonical β(2)-receptor-adenylyl cyclase-cAMP-protein kinase A pathway.

  14. Eosinophilic leukemoid reaction associated with carbamazepine hypersensitivity

    Laad Gaurish


    Full Text Available Carbamazepine is widely used in the treatment of epilepsy, neuralgic pain, and bipolar affective disorders. Several adverse drug reactions have been described during the course of carbamazepine administration, including exanthemata and hematological reactions. Carbamazepine is one of the common drugs that have been implicated in the etiology of drug hypersensitivity syndrome. A 50-year-old male presented with generalized erythroderma following 10 weeks of ingestion of carbamazepine 200 mg daily for idiopathic epilepsy. His systemic examination was within normal limits. Blood counts revealed marked eosinophilia of 52% (absolute eosinophil count of 10,400 per mm3. Bone marrow aspiration revealed a moderate increase in the eosinophilic series with cells showing normal morphology. The eosinophil counts returned to normal after 2 weeks of oral prednisolone therapy. This case is reported because of its rarity in the Indian medical literature.

  15. Effect of inhaled corticosteroids on blood eosinophil count in steroid-naïve patients with COPD

    Kreindler, James L.; Watkins, Michael L; Lettis, Sally; Tal-Singer, Ruth; Locantore, Nicholas


    Introduction Sputum and blood eosinophil counts have attracted attention as potential biomarkers in chronic obstructive pulmonary disease (COPD). One question regarding the use of blood eosinophils as a biomarker in COPD is whether their levels are affected by the use of inhaled corticosteroids (ICS), which are commonly prescribed for COPD. Methods We performed a retrospective analysis of peripheral blood leucocytes from a previously completed clinical trial that examined effects of ICS in st...

  16. Esophageal testing: What we have so far


    Gastroesophageal reflux disease (GERD) is a commondisorder of the gastrointestinal tract. In the last fewdecades, new technologies have evolved and havebeen applied to the functional study of the esophagus,allowing for the improvement of our knowledge of thepathophysiology of GERD. High-resolution manometry(HRM) permits greater understanding of the function ofthe esophagogastric junction and the risks associatedwith hiatal hernia. Moreover, HRM has been found tobe more reproducible and sensitive than conventionalwater-perfused manometry to detect the presenceof transient lower esophageal sphincter relaxation.Esophageal 24-h pH-metry with or without combinedimpedance is usually performed in patients withnegative endoscopy and reflux symptoms who havea poor response to anti-reflux medical therapy toassess esophageal acid exposure and symptom-refluxcorrelations. In particular, esophageal 24-h impedanceand pH monitoring can detect acid and non-acid refluxevents. EndoFLIP is a recent technique poorly appliedin clinical practice, although it provides a large amountof information about the esophagogastric junction.In the coming years, laryngopharyngeal symptomscould be evaluated with up and coming non-invasive orminimally invasive techniques, such as pepsin detectionin saliva or pharyngeal pH-metry. Future studies arerequired of these techniques to evaluate their diagnostic accuracy and usefulness, although the available dataare promising.

  17. Esophageal testing: What we have so far.

    de Bortoli, Nicola; Martinucci, Irene; Bertani, Lorenzo; Russo, Salvatore; Franchi, Riccardo; Furnari, Manuele; Tolone, Salvatore; Bodini, Giorgia; Bolognesi, Valeria; Bellini, Massimo; Savarino, Vincenzo; Marchi, Santino; Savarino, Edoardo Vincenzo


    Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract. In the last few decades, new technologies have evolved and have been applied to the functional study of the esophagus, allowing for the improvement of our knowledge of the pathophysiology of GERD. High-resolution manometry (HRM) permits greater understanding of the function of the esophagogastric junction and the risks associated with hiatal hernia. Moreover, HRM has been found to be more reproducible and sensitive than conventional water-perfused manometry to detect the presence of transient lower esophageal sphincter relaxation. Esophageal 24-h pH-metry with or without combined impedance is usually performed in patients with negative endoscopy and reflux symptoms who have a poor response to anti-reflux medical therapy to assess esophageal acid exposure and symptom-reflux correlations. In particular, esophageal 24-h impedance and pH monitoring can detect acid and non-acid reflux events. EndoFLIP is a recent technique poorly applied in clinical practice, although it provides a large amount of information about the esophagogastric junction. In the coming years, laryngopharyngeal symptoms could be evaluated with up and coming non-invasive or minimally invasive techniques, such as pepsin detection in saliva or pharyngeal pH-metry. Future studies are required of these techniques to evaluate their diagnostic accuracy and usefulness, although the available data are promising.

  18. Genetics Home Reference: PDGFRA-associated chronic eosinophilic leukemia

    ... eosinophilic leukemia is a form of blood cell cancer characterized by an elevated number of cells called eosinophils in the blood. These cells help fight infections by certain parasites and are involved in the inflammation associated with ...

  19. Eosinophilic Granulomatosis with Polyangiitis, formerly Churg-Strauss Syndrome (EGPA)

    ... Lotte Strauss as a syndrome consisting of “asthma, eosinophilia [an excessive number of eosinophils in the blood], ... phase of the disease is often marked by eosinophilia, the finding of an excessive number of eosinophils ...

  20. Saiboku-to, a Kampo herbal medicine, inhibits LTC4 release from eosinophils

    Koichi Hirai


    Full Text Available Saiboku-to (TJ-96, a traditional Kampo herbal formation, has been used in the treatment of bronchial asthma in Japan as an anti-allergy herbal medicine. We investigated the effect of TJ-96 on leukotriene (LTC4 release from eosinophils and basophils isolated from healthy volunteers. Pre-incubation of eosinophils with TJ-96 inhibited ionophore- or formyl-methionyl-leucyl-phenylalanine (FMLP-induced LTC4 generation by eosinophils in a dose-dependent fashion. The TJ-96 was more potent in the release by ionophore (IC50 = 60 mg/mL than the release induced by FMLP (IC50 = 300 mg/mL. Maximal inhibition was observed when eosinophils were pretreated with TJ-96 for 5 min. Although TJ-96 at high concentrations inhibited IgE-mediated histamine release from human basophils, inhibition of IgE-mediated LTC4 release was not statistically significant. The potent inhibitory activity was found in the extract of Glycyrrhiza root, one of the herbal components of TJ-96, but the inhibitory effects were not due to either glycyrrhizin or liquiritin, the main elements of the Glycyrrhiza root. These results raise the possibility that the clinical efficacy of TJ-96 is derived, at least in part, from its potent inhibitory effect on LTC4 release from eosinophils.

  1. Immunohistological evaluation of feline herpesvirus-1 infection in feline eosinophilic dermatoses or stomatitis.

    Lee, Meichet; Bosward, Katrina L; Norris, Jacqueline M


    This study used immunohistochemistry (IHC) and histopathology to evaluate the presence of feline herpesvirus-1 (FHV-1) in feline cases of 'eosinophilic granuloma complex' (EGC) or other eosinophilic dermatoses or stomatitis, diagnosed at the Veterinary Pathology Diagnostic Service, University of Sydney between January 1996 and June 2008. Two of the 30 cases (6.6%) examined showed positive immunoreactivity to FHV-1 using IHC. Intranuclear inclusion bodies were also detected on histopathological examination of haematoxylin and eosin stained sections of both cases but were very difficult to find. Therefore, FHV-1 is uncommonly associated with EGC or other eosinophilic dermatoses or stomatitis in Sydney. However, misdiagnosis as an EGC lesion or other eosinophilic dermatoses may occur if inclusion bodies are overlooked or absent on histopathology and this may significantly decrease the chance of a favourable treatment outcome. FHV-1 should be considered in cats with severe ulcerative cutaneous or oral lesions, unresponsive to corticosteroid treatment, with or without concurrent or historical signs of upper respiratory tract or ocular disease more typical of FHV-1. IHC may be helpful in differentiating FHV-1 dermatitis or stomatitis from other eosinophilic lesions, which is of vital clinical and therapeutic importance.

  2. [Management of the esophageal candidiasis by the primary care physician].

    Behrens, Garance; Bocherens, Astrid; Senn, Nicolas


    Esophageal candidiasis is one of the most common opportunistic infections in patients infected by human immunodeficiency virus (HIV). This pathology is also found in patients without overt immunodeficiency. Other risk factors are known to be associated with this disease like inhaled or systemic corticosteroid treatment or proton-pump inhibitors and H2 receptor antagonists. In the absence of identified risk factors, a primary immune deficiency should be sought. Prevention of esophageal candidiasis is based primarily on the identification of risk factors, and a better control of them. This article presents a review of the physiopathology, clinical presentation and management of esophageal candidiasis by primary care physicians. We will also discuss ways of preventing esophageal candidiasis when necessary.

  3. Antiepithelial autoantibodies associated with the feline eosinophilic granuloma complex.

    Gelberg, H B; Lewis, R M; Felsburg, P J; Smith, C A


    A retrospective study of banked sera from 19 cats with the eosinophilic granuloma complex revealed that 68% of affected cats had circulating antibodies to components of normal cat epithelium. Seemingly, the eosinophilic granuloma complex of cats may be an autoimmune disease; however, epidermal damage caused by the eosinophilic granuloma complex may release altered self-antigens to which the cat's immune system responds.

  4. Chronic Eosinophilic Meningoencephalitis by Prototheca Wickerhamii in an Immunocompetent Boy.

    Ahn, Ari; Choe, Yong-Joon; Chang, Jeonghyun; Kim, Duckhee; Sung, Heungsup; Kim, Mi-Na; Hong, Seok Ho; Lee, Jina; Yum, Mi-Sun; Ko, Tae-Sung


    Human protothecosis is mainly a cutaneous infection caused by the Prototheca species. Prototheca wickerhamii is an established pathogen of eosinophilic meningoencephalitis in dogs, but no eosinophilic pleocytosis of the cerebrospinal fluid has been reported in human cases of meningitis. Herein, we report a case of chronic protothecosis manifesting eosinophilic meningoencephalitis in an immunocompetent boy.

  5. Treatment Options by Stage (Esophageal Cancer)

    ... Cancer Prevention Esophageal Cancer Screening Research Esophageal Cancer Treatment (PDQ®)–Patient Version General Information About Esophageal Cancer ... Certain factors affect prognosis (chance of recovery) and treatment options. The prognosis (chance of recovery ) and treatment ...

  6. Detection of eosinophilic myocarditis using contrast-enhanced magnetic resonance imaging: case report

    Takahashi, N.; Murakami, Y.; Shimada, T.; Kashima, Y.; Nakamura, K.; Inoue, S.-I.; Sugamori, T.; Katoh, H.; Ishibashi, Y. [Shimane Medical Univ., The Fourth Dept. of Internal Medicine, Izumo City, Shimane (Japan); Maruyama, R. [Shimane Medical Univ., Dept. of Laboratory Medicine, Izumo City, Shimane (Japan)


    Hypereosinophilic syndrome is characterized by idiopathic eosinophilia in the peripheral blood and multiorgan dysfunction secondary to mature eosinophil infiltration. It is essential to diagnose myocardial involvement in the early stage of the disease when active myocarditis due to cardiotoxic substances from eosinophils is still taking place, but clinical tools for the diagnosis of myocardial lesions in patients without overt cardiac dysfunction are not yet available. We present a case of successful detection of myocarditis due to hypereosinophilic syndrome by gadolinium-diethylenetriaminepentaascetic acid (Gd-DTPA) enhanced magnetic resonance imaging (MRI). (author)

  7. [Can eosinophilic bronchitis be considered as an occupational disease? Medical certification aspects].

    Kleniewska, Aneta; Wiszniewska, Marta; Walusiak-Skorupa, Jolanta


    Eosinophilic bronchitis (EB) is a condition which can be associated with occupational exposure to low, as well as to high molecular weight allergens. The prevalence of occupational eosinophilic bronchitis is unknown and the data concerning its work-related etiology are available only from the case reports. However, there is a need to establish the principles, especially in the context of medical certification among workers occupationally exposed to allergens. This paper reviews current knowledge on the etiology, clinical features, and diagnostic procedures in the eosinophilic bronchitis. The importance of EB, especially in view of the problems emerging in the prophylactic care taken by occupational health services and the principles of medical certification when occupational etiology is suspected are also presented.

  8. Can eosinophilic bronchitis be considered as an occupational disease? Medical certification aspects

    Aneta Kleniewska


    Full Text Available Eosinophilic bronchitis (EB is a condition which can be associated with occupational exposure to low, as well as to high molecular weight allergens. The prevalence of occupational eosinophilic bronchitis is unknown and the data concerning its work-related etiology are available only from the case reports. However, there is a need to establish the principles, especially in the context of medical certification among workers occupationally exposed to allergens. This paper reviews current knowledge on the etiology, clinical features, and diagnostic procedures in the eosinophilic bronchitis. The importance of EB, especially in view of the problems emerging in the prophylactic care taken by occupational health services and the principles of medical certification when occupational etiology is suspected are also presented. Med Pr 2013;64(4:569–578

  9. 数字胃肠X线造影与内镜检查对真菌性食管炎诊断的对照研究%The value of radiography classificatory criteria for fungal esophagitis in clinical application

    李峰; 赵慧娟; 王玲; 李琳; 李芸芸; 尹成方


    Objective The purpose of this report is to evaluate the role of digital gastrointestinal radiography in the diagnosis of the fungal esophagitis compared with endoscopy , and to explore the clinical application of the X-ray grading scale of fungal esophagitis for digital radiography . Methods 45 cases were conformed by endoscopy and cytology. The roentgenographic features of these fungal esophagitis cases were analyzed respectively, regarding the endoscopy findings as standard . Results The fungal esophagitis' features of esophagography in different grades were compared with that of endoscopy . DR was relatively consistent with endoscopy (the value of Kappa is 0. 543 ). The lesions, which diameter of plaques were less than 1 mm or similar as military, could be observed more clearly at the mucosal phase (9/13) than double-contrast phase(4/13)and filling phase(0/13). Conclusions For miliary-like lesions,we should pay more attention to the use of dynamic monitoring technique. The grading scale for X-ray findings of fungal esophagitis has a good clinical value ,but its operability should be further improved .%目的 通过与内镜分级表现相对照,探讨数字胃肠造影技术对真菌性食管炎的诊断价值,并对真菌性食管炎X线分度标准的临床应用进行评价.方法 选取45例经内镜和涂片病原学检查确诊的病例,对数字胃肠造影和内镜检查中真菌性食管炎的分度/分级表现进行分析.结果 在确定真菌性食管炎的分度/分级表现时,数字胃肠造影检查与内镜检查相比,Kappa值为0.543,具有中高度的一致性.对其中13例病灶很小(直径≤1 mm或病灶呈粟粒样)的真菌性食管炎病例,其在黏膜相中的显示情况(9/13)优于在双对比相(4/13)和钡剂充盈相(0/13)中的显示情况.结论 对于粟粒样的病灶,数字胃肠造影检查的动态黏膜图像往往更易发现病变.真菌性食管炎X线分度标准具有较好的临床应用价值,但在其可操作性上还可以进一步改进.

  10. Randomized clinical trial on seven-day-per-week continuous accelerated irradiation for patients with esophageal carcinoma:Preliminary report on tumor response and acute toxicity

    Su-Ping Sun; Ya-Zhou Liu; Tao Ye; Wen Zhang; Wen-Bin Shen; Jing-Lei Shi; Hai-Ting Xu; Wei-Dong Wang


    AIM: Tumor response and normal tissue toxicity of seven-day-per-week continuous accelerated irradiation (CAIR) for patients with esophageal carcinoma were evaluated and compared to conventional irradiation (CR).METHODS: Sixty patients with squamous cell carcinoma of the esophagus were randomized into two groups:the CAIR group (30 patients) and the CR group (30 pa(RT) with 2 Gy/fraction per day at 7 d/wk with a total dose of 50-70 Gy (average dose 64.2 Gy). The overall time of irradiation was 3.6-5.0 wk (average 4.6 wk). RT in the CR group was 2 Gy/fraction per day at 5 d/wk with a total dose of 40-70 Gy (average dose 61.7 Gy).The overall time of irradiation was 4.0-7.0 wk (average 6.4wk).RESULTS: The data showed that the immediate tumor response to RT was better in the CAIR group than in the CR group. Efficiency rates (CR plus PR) were 82.8%(24/29) and 58.6% (17/29), respectively (P = 0.047). In both groups the incidences of esophagitis and tracheitis were insignificant (P = 0.376, 0.959), and no patient received toxicity that could not be tolerated.CONCLUSION: CAIR shortens overall treatment time and is well tolerated by patients. It may be superior to CR in enhancing the local response of tumor, but its remote effect for esophageal carcinoma awaits further follow-up.

  11. Application of clinical nursing path to the perioperative patients with esophageal cancer%临床护理路径在食管癌患者围术期中的应用

    谢玉珠; 陈羡香


    目的:探讨临床护理路径在食管癌患者围术期中的应用效果.方法:将2007年9月~2008年5月收治的32例食管癌患者作为观察组,实施围术期临床护理路径;将2006年9月~2007年5月收治的38例食管癌患者作为对照组,实施常规护理.比较两组患者满意度及健康教育达标率.结果:观察组患者对入院宣教、服务态度、疾病知识教育、处理问题及时性的满意度及健康教育达标率均高于对照组(P<0.01,P<0.05).结论:临床护理路径作为一种新型护理模式,体现出了以患者为中心的服务宗旨,提高了患者满意度和健康教育达标率.%Objective: To investigate the application effect of clinical nursing path to the perioperative patients with esophageal cancer. Methods:32 esophageal cancer patients admitted from September 2007 to May 2008 were taken as the observation group and other 38 e-sophageal cancer patients admitted from September 2006 to May 2007 were taken as the control group. The perioperative clinical nursing path was implemented in the observation group and routine nursing care; was taken in the control group. The patients'satisfaction and the rate which was up to the standard of health education were compared between the two groups. Residts:The patients'satisfaction with health education on admission,service attitude,teaching of related knowledge of disease,timely solution of problems and the rate up to the standard of health education were higher in the observation group than the control group( P <0. 01 ,P <0. 05 ). Conclusion:The clinical nursing path can improve patients'satisfaction and the rate up to the standard of health education.

  12. Eosinophil: central mediator of allergic asthma?

    SHEN Hua-hao


    @@ Allergic asthma is a chronic disorder characterized by chronic airway inflammation, airway hyperresponsiveness, reversible airway obstruction, airway remodelling and mucus hypersecretion. It has been widely recognized that the infiltration of the lung with increased number of eosinophils is a hallmark of this disease.1

  13. Mechanism of nitrite oxidation by eosinophil peroxidase: implications for oxidant production and nitration by eosinophils.

    van Dalen, Christine J; Winterbourn, Christine C; Kettle, Anthony J


    Eosinophil peroxidase is a haem enzyme of eosinophils that is implicated in oxidative tissue injury in asthma. It uses hydrogen peroxide to oxidize thiocyanate and bromide to their respective hypohalous acids. Nitrite is also a substrate for eosinophil peroxidase. We have investigated the mechanisms by which the enzyme oxidizes nitrite. Nitrite was very effective at inhibiting hypothiocyanous acid ('cyanosulphenic acid') and hypobromous acid production. Spectral studies showed that nitrite reduced the enzyme to its compound II form, which is a redox intermediate containing Fe(IV) in the haem active site. Compound II does not oxidize thiocyanate or bromide. These results demonstrate that nitrite is readily oxidized by compound I, which contains Fe(V) at the active site. However, it reacts more slowly with compound II. The observed rate constant for reduction of compound II by nitrite was determined to be 5.6x10(3) M(-1) x s(-1). Eosinophils were at least 4-fold more effective at promoting nitration of a heptapeptide than neutrophils. This result is explained by our finding that nitrite reacts 10-fold faster with compound II of eosinophil peroxidase than with the analogous redox intermediate of myeloperoxidase. Nitration by eosinophils was increased 3-fold by superoxide dismutase, which indicates that superoxide interferes with nitration. We propose that at sites of eosinophilic inflammation, low concentrations of nitrite will retard oxidant production by eosinophil peroxidase, whereas at higher concentrations nitrogen dioxide will be a major oxidant formed by these cells. The efficiency of protein nitration will be decreased by the diffusion-controlled reaction of superoxide with nitrogen dioxide.

  14. Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm.

    Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro


    Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm. The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation. In this case, the patient's symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  15. Esophageal epiphrenic diverticulum associated with diffuse esophageal spasm

    Matsumoto, Hideo; Kubota, Hisako; Higashida, Masaharu; Manabe, Noriaki; Haruma, Ken; Hirai, Toshihiro


    Introduction Esophageal diverticulum, a relatively rare condition, has been considered to be associated with motor abnormalities such as conditions that cause a lack of coordination between the distal esophagus and lower esophageal sphincter. Presentation of case We herein report a case of esophageal epiphrenic diverticulum associated with diffuse esophageal spasm. A 73-year-old woman presented with dysphagia and regurgitation. Imaging examinations revealed a right-sided esophageal diverticulum located about 10 cm above the esophagogastric junction. High-resolution manometry revealed normal esophageal motility. However, 24-h pH monitoring revealed continuous acidity due to pooling of residue in the diverticulum. An esophageal epiphrenic diverticulum was diagnosed and resected thoracoscopically. Her dysphagia recurred 2 years later. High-resolution manometry revealed diffuse esophageal spasm. Discussion The diverticulum in the present case was considered to have been associated with diffuse esophageal spasm. The motility disorder was likely not identified at the first evaluation. Conclusion In this case, the patient’s symptoms spontaneously resolved without any treatment; however, longer-term follow-up is needed. PMID:26143577

  16. Eosinophilic Chronic Rhinosinusitis in Japan

    Junichi Ishitoya


    ECRS is different from non-ECRS in terms of many clinical features: symptom appearance, occurrence site of nasal polyps, CT scan findings, the histology of nasal polyps, blood examination findings, clinical course after surgery, and co-morbid asthma, etc. In this review, we describe these clinical features and mention how to make a clinical diagnosis of ECRS as well as how to treat it. Finally, we discuss the pathophysiology of ECRS. The concept of ECRS in Japan would be applicable for CRSwNP in other countries including Europe and the United States.

  17. Velopharyngeal incompetence in a patient with multifocal eosinophilic granuloma (Hand-Schüller-Christian disease).

    Cohn, E R; Garver, K L; Metz, H C; McWilliams, B J; Skolnick, M L; Garrett, W S


    The diagnosis and management of velopharyngeal insufficiency in a 16-year-old boy with multifocal eosinophilic granuloma (Hand-Schüller-Christian disease) is described. Medical history, speech and velopharyngeal valving information, and the results of clinical management are presented.

  18. Eosinophilic ulcer of the lateral tongue: case report

    Ana Myriam Costa de Medeiros


    Full Text Available Introduction: Eosinophilic ulcer of the oral mucosa (EUOM is a lesion manifesting as ulcer with elevated margins. The lesion is self-limiting and develops rapidly usually disappearing after several weeks. The exact pathogenetic mechanisms implicated in its development are poorly understood, however, the possibility that trauma may play a role has been often postulated. Case report: A 63 year-old male patient had presented whit a chief complaint of painful ulcerated nodule on the tongue. Oral examination revealed a firm, raised and indurated erythematous nodule with a central ulcer that had a yellow fibrinous base. Clinical diagnosis hypothesis was either traumatic ulcer or oral squamous cell carcinoma. Histopathologic analysis revealed an ulcerated lesion with a dense mixed infiltrate of eosinophils, variably sized lymphocytes and epithelioid cells extending into submucosa. These cells exhibited pleomorphism, voluminous cytoplasm and nucleus with prominent nucleolus and were identified by immunohistochemical method as CD68+ cells. The histological diagnosis was EUOM. At 1-year follow-up there was no recurrence. Conclusion: Our case provides useful information on clinical and pathological features, diagnosis, treatment, and prognosis of EUOM, as suggesting the possible etiology of this uncommon lesion because it is poorly described in the literature.

  19. Black esophagus: Acute esophageal necrosis syndrome

    Grigoriy; E; Gurvits


    Acute esophageal necrosis (AEN), commonly referred to as "black esophagus", is a rare clinical entity arising from a combination of ischemic insult seen in hemodynamic compromise and low-flow states, corrosive injury from gastric contents in the setting of esophago-gastroparesis and gastric outlet obstruction, and decreased function of mucosal barrier systems and reparative mechanisms present in malnourished and debilitated physical states. AEN may arise in the setting of multiorgan dysfunction, hypoperfusi...

  20. Eosinophilic granulomatosis with polyangiitis: an overview

    Andrea eGioffredi


    Full Text Available Eosinophilic granulomatosis with polyangiitis (EGPA is a multisystemic disorder, belonging to the small vessel ANCA-associated vasculitis, defined as a eosinophil-rich and necrotizing granulomatous inflammation often involving the respiratory tract, and necrotizing vasculitis predominantly affecting small to medium-sized vessels, associated with asthma and eosinophilia. EGPA pathogenesis is not well known: HLA-DRB1*04 and *07, HLA-DRB4 and IL10.2 haplotype of the IL-10 promoter gene are the most studied genetic determinants. Among the acquired pathogenetic factors, the exposure to different allergens, infections, vaccinations, drugs and silica exposure have been involved.Eosinophils are the most characteristic cells in EGPA and different studies have demonstrated their role as effector and immunoregulatory cells.EGPA is considered a disease with a prevalent activation of the Th2 cellular-mediated inflammatory response but also humoral immunity plays an important role. A link between B and T inflammatory responses may explain different disease features. EGPA typically develops into three sequential phases: the allergic phase, distinguished by the occurrence of asthma, allergic rhinitis and sinusitis, the eosinophilic phase, in which the main pathological finding is the eosinophilic organ infiltrations (e.g. lungs, heart and gastrointestinal system and the vasculitic phase, characterized by purpura, peripheral neuropathy and constitutional symptoms.ANCA (especially pANCA anti-MPO are present in 40-60% of the patients. An elevation of IgG4 is frequently found. Corticosteroids and cyclophosphamide are classically used for remission induction, while azathioprine and methotrexate are the therapeutic options for remission maintenance. B-cell depletion with rituximab has shown promising results for remission induction.

  1. Atrio-esophageal fistula complicating esophageal achalasia.

    Achouh, Paul; Pouly, Julia; Azarine, Arshid; Fabiani, Jean-Noël


    A 75-year-old male, known to have achalasia, was admitted to the intensive care unit with massive upper gastrointestinal bleeding and sepsis. He had a history of purulent pericarditis 18 months earlier. He also presented with atrial fibrillation associated with a cerebral transient ischemic accident two months earlier. A contrast computed tomography scan showed an atrio-esophageal fistula with active extravasation of contrast. He was operated on via a median sternotomy, and the defects in the atrial wall, inferior vena cava and diaphragm were closed using pericardial patches. An esophagectomy was to be performed 24 hours later, but the patient died from septic shock and multiple organ failure before his second procedure.

  2. 食管癌放疗后复发再程调强放疗的临床观察%Clinical efficacy of intensity modulated radiation therapy for loco-regionally recurrent e-sophageal cancer after initial radiotherapy

    彭雷; 卢鑫; 朱兆峰


    目的:探讨调强放疗(intensity modulater radiation therapy,IMRT)在食管癌首程放疗后局部复发患者中的应用及临床观察。方法:37例首程放疗后局部复发的食管鳞癌患者,采用调强放疗技术进行二程放疗,处方剂量为(50-60)Gy/[2Gy·(25-30)f]。结果:37例患者中完全缓解(complete response,CR)7例,部分缓解(partial response,PR)20例,有效率(response rate,RR)为73.0%(27/37)。本组患者1、2、3年生存率分别为59.5%、32.4%、21.1%。放射性食管炎、骨髓抑制、胃肠道反应的发生率较高。全部病例随访资料完整。截止2012年12月,25例患者已经死亡,其中死于局部复发11例、远处转移8例、食管气管瘘2例、大出血2例、其他疾病1例、自杀1例。结论:调强放疗对于食管癌首程放疗后局部复发患者是一种较好的有效的治疗方法,能取得较好的局部控制率。%Objective:To evaluate the applications and clinical effect of intensity modulated radiation therapy (IMRT)for loco-regionally recurrent esophageal cancer after initial radiotherapy.Methods:All 37 patients with loco-regionally recurrent esophageal cancer after initial radiotherapy were treated with IMRT,with a total dose of (50-60)Gy/[2Gy·(25 -30)f].Results:Of 37 patients,7 patients achieved completed remission,20 patients achieved partial remission,the effective rate was 73.0%(27/37).The overall 1 -,2 -,3 -year survival rates were 59.5%, 32.4%,21.1%.In the radiation therapy,the incidence rates of radiation esophagitis and arrest of bone marrow were high.In followed up,until December 2012,25 patients died,1 1 from local recurrence,8 from distant metastases,2 from esophageal leak,2 from haemorrhage,1 from other disease,1 from suicide.Conclusion:To patients with loco-regionally recurrent esophageal cancer after initial radiotherapy,IMRT is an alternative effective method,can improve the local

  3. Early Involvement of Death-Associated Protein Kinase Promoter Hypermethylation in the Carcinogenesis of Barrett's Esophageal Adenocarcinoma and Its Association with Clinical Progression

    Doerthe Kuester


    Full Text Available Esophageal Barrett's adenocarcinoma (BA develops through a multistage process, which is associated with the transcriptional silencing of tumor-suppressor genes by promoter CpG island hypermethylation. In this study, we explored the promoter hypermethylation and protein expression of proapoptotic deathassociated protein kinase (DAPK during the multistep Barrett's carcinogenesis cascade. Early BA and paired samples of premalignant lesions of 61 patients were analyzed by methylation-specific polymerase chain reaction and immunohistochemistry. For the association of clinicopathological markers and protein expression, an immunohistochemical tissue microarray analysis of 66 additional BAs of advanced tumor stages was performed. Hypermethylation of DAPK promoter was detected in 20% of normal mucosa, 50% of Barrett's metaplasia, 53% of dysplasia, and 60% of adenocarcinomas, and resulted in a marked decrease in DAPK protein expression (P < .01. The loss of DAPK protein was significantly associated with advanced depth of tumor invasion and advanced tumor stages (P < .001. Moreover, the severity of reflux esophagitis correlated significantly with the hypermethylation rate of the DAPK promoter (P < .003. Thus, we consider DAPK inactivation by promoter hypermethylation as an early event in Barrett's carcinogenesis and suggest that a decreased protein expression of DAPK likely plays a role in the development and progression of BA.

  4. Long-gap esophageal atresia.

    Shieh, Hester F; Jennings, Russell W


    The management of long-gap esophageal atresia remains challenging with limited consensus on the definition, evaluation, and surgical approach to treatment. Efforts to preserve the native esophagus have been successful with delayed primary anastomosis and tension-based esophageal growth induction processes. Esophageal replacement is necessary in a minority of cases, with the conduit of choice and patient outcomes largely dependent on institutional expertise. Given the complexity of this patient population with significant morbidity, treatment and long-term follow-up are best done in multidisciplinary esophageal and airway treatment centers. Copyright © 2017 Elsevier Inc. All rights reserved.

  5. Esophagitis Induced by Doxycycline Treatment

    Engin Şenel


    Full Text Available Esophagitis is the most common disease of the esophagus. Drug use is one of the reasons of chemical esophagitis. Herein, we report two male patients of 17 and 18 years of age who developed esophagitis in acne treatment with doxycycline. Both patients took doxycycline capsules for approximately one week. Ulcerations were detected at upper and mid-esophagus of the 17-year-old patient. Circular ulcerations were found at mid-esophagus of the 18-year-old case. Doxycycline induced esophagitis is a preventable disease with the physician giving appropriate medication ingestion advice to the patient.

  6. Chronic rhinitis: Effects of local corticosteroids on eosinophils

    Ursulović Dejan D.


    Full Text Available Clinical manifestation of chronic rhinitis is due to local release of mediators from inflammatory cells. Eosinophil leukocytes are important in pathogenesis of nasal hypersensitivity as well as nasal hyperreactivity [1,2]. The aim of the study was to follow-up the effect of local corticosteroid treatment on a number of eosinophils in nasal secretion of patients with chronic rhinitis. The study was prospective and controlled. A total number of 88 subjects was included in the study. Patients with chronic rhinitis who were treated with local corticosteroids (63 constituted the experimental group (37 with isolated allergic rhinitis, 10 with isolated nonallergic noninfective hyperreactive rhinitis, 10 with allergic rhinitis associated with nasal polyposis and 6 with nonallergic noninfective hyperreactive rhinitis associated with nasal polyposis. There were 25 patients with chronic rhinitis in the control group (18 with iso- lated allergic rhinitis, 2 with isolated nonallergic noninfective hyperreactive rhinitis, 3 with allergic rhinitis associated with nasal polyposis, and 2 with nonallergic noninfective, hyperreactive rhinitis associated with nasal polyposis. During the treatment with beclomethasone dipropionate aqueous nasal spray (daily dose was 400 micrograms during 6 weeks for isolated rhinitis and 6 months for associated forms of rhinitis, control examinations were regularly performed. The first control was after one week the second after six weeks, the third after three months and the fourth after six months. The same control was carried out in the control group of patients who were without therapy. Cytological examination of nasal secretions included brush method of collecting secretions, staining smears with Leishman's stain and light microscopic scrutinising of nasal smear magnified up to 1000 times. The results of the study demonstrated the highly significant decrease in the number of eosinophils after the therapy in patients with isolated

  7. Cystatin F Ensures Eosinophil Survival by Regulating Granule Biogenesis.

    Matthews, Stephen P; McMillan, Sarah J; Colbert, Jeff D; Lawrence, Rachel A; Watts, Colin


    Eosinophils are now recognized as multifunctional leukocytes that provide critical homeostatic signals to maintain other immune cells and aid tissue repair. Paradoxically, eosinophils also express an armory of granule-localized toxins and hydrolases believed to contribute to pathology in inflammatory disease. How eosinophils deliver their supporting functions while avoiding self-inflicted injury is poorly understood. We have demonstrated that cystatin F (CF) is a critical survival factor for eosinophils. Eosinophils from CF null mice had reduced lifespan, reduced granularity, and disturbed granule morphology. In vitro, cysteine protease inhibitors restored granularity, demonstrating that control of cysteine protease activity by CF is critical for normal eosinophil development. CF null mice showed reduced pulmonary pathology in a model of allergic lung inflammation but also reduced ability to combat infection by the nematode Brugia malayi. These data identify CF as a "cytoprotectant" that promotes eosinophil survival and function by ensuring granule integrity. VIDEO ABSTRACT.

  8. Endoscopic management of esophageal stenosis in children:New and traditional treatments


    Post-esophageal atresia anastomotic strictures and postcorrosiveesophagitis are the most frequent types ofcicatricial esophageal stricture. Congenital esophagealstenosis has been reported to be a rare but typicaldisease in children; other pediatric conditions are peptic,eosinophilic esophagitis and dystrophic recessiveepidermolysis bullosa strictures. The conservative treatmentof esophageal stenosis and strictures (ES) ratherthan surgery is a well-known strategy for children.Before planning esophageal dilation, the esophagealmorphology should be assessed in detail for its length,aspect, number and level, and different conservativestrategies should be chosen accordingly. Endoscopicdilators and techniques that involve different adjuvanttreatment strategies have been reported and dependon the stricture's etiology, the availability of differenttools and the operator's experience and preferences.Balloon and semirigid dilators are the most frequentlyused tools. No high-quality studies have reported on thedifferences in the efficacies and rates of complicationsassociated with these two types of dilators. There is noconsensus in the literature regarding the frequency ofdilations or the diameter that should be achieved. Theuse of adjuvant treatments has been reported in casesof recalcitrant stenosis or strictures with evidence ofdysphagic symptoms. Corticosteroids (either systemicallyor locally injected), the local application of mitomycin C,diathermy and laser ES sectioning have been reported.Some authors have suggested that stenting can reduceboth the number of dilations and the treatment length. Inmany cases, this strategy is effective when either metallicor plastic stents are utilized. Treatment complications,such esophageal perforations, can be conservativelymanaged, considering surgery only in cases with severepleural cavity involvement. In cases of stricture relapse,even if such relapses occur following the execution ofwell-conducted conservative

  9. Diagnosis of esophageal motility disorders: esophageal pressure topography versus conventional line tracing

    Carlson, DA; Ravi, K; Kahrilas, PJ; Gyawali, CP; Bredenoord, AJ; Castell, DO; Spechler, SJ; Halland, M; Kanuri, N; Katzka, DA; Leggett, CL; Roman, S; Saenz, JB; Sayuk, GS; Wong, AC; Yadlapati, R; Ciolino, JD; Fox, MR; Pandolfino, JE


    Background Enhanced characterization of esophageal peristaltic and sphincter function provided by esophageal pressure topography (EPT) offers a potential diagnostic advantage over conventional line tracings (CLT). However, high-resolution manometry (HRM) and EPT require increased equipment costs over conventional systems and evidence demonstrating a significant diagnostic advantage of EPT over CLT is limited. Our aim was to investigate whether the inter-rater agreement and/or accuracy of esophageal motility diagnosis differed between EPT and CLT. Methods Forty previously-completed patient HRM studies were selected for analysis using a customized software program developed to perform blinded independent interpretation in either EPT or CLT (six pressure sensors) format. Six experienced gastroenterologists with a clinical focus in esophageal disease (attendings) and six gastroenterology trainees with minimal manometry experience (fellows) from three academic centers interpreted each of the 40 studies using both EPT and CLT formats. Rater diagnoses were assessed for inter-rater agreement and diagnostic accuracy, both for exact diagnosis and for correct identification of a major esophageal motility disorder. Results The total group agreement was moderate (κ = 0.57; 95% CI 0.56–0.59) for EPT and fair (κ = 0.32; 0.30–0.33) for CLT. Inter-rater agreement between attendings was good (κ = 0.68; 0.65–0.71) for EPT and moderate (κ = 0.46; 0.43–0.50) for CLT. Inter-rater agreement between fellows was moderate (κ = 0.48; 0.45–0.50) for EPT and poor to fair (κ = 0.20; 0.17–0.24) for CLT. Among all raters, the odds of an incorrect exact esophageal motility diagnosis were 3.3 times higher with CLT assessment than with EPT (OR 3.3; 95% CI 2.4–4.5; p<0.0001) and the odds of incorrect identification of a major motility disorder were 3.4 times higher with CLT than EPT (OR 3.4; 2.4–5.0; p<0.0001). Conclusions Superior inter-rater agreement and diagnostic accuracy

  10. Effect of lodoxamide and disodium cromoglycate on tear eosinophil cationic protein in vernal keratoconjunctivitis

    Leonardi, A.; Borghesan, F.; Avarello, A.; Plebani, M.; Secchi, A.


    AIM—To validate the use of tear eosinophil cationic protein (ECP) as a marker for eosinophil activation, and its pharmacological modulation, in addition to evaluating the efficacy of lodoxamide and sodium cromoglycate in the treatment of vernal keratoconjunctivitis (VKC).
METHODS—Tears were collected from 30 patients affected by active mild to moderate VKC before and after therapy with disodium cromoglycate 4% (DSCG) (n=15) or lodoxamide 0.1% (n=15) for 10 days. Tear cytology and ECP measurement were performed, and ocular signs and symptoms evaluated.
RESULTS—While statistically significant changes did not occur after DSCG therapy, mean tear ECP increased from 343 (SD 363) µg/l to 571 (777) µg/l due to marked elevation in six eyes. The clinical score in DSCG eyes did not improve. After lodoxamide therapy, both clinical signs and symptoms, and tear ECP levels (560 (756) µg/l to 241 (376) µg/l) decreased significantly (p<0.0001 and p<0.01, respectively). Compared with DSCG treatment, lodoxamide was more effective in reducing signs and symptoms (p<0.005). ECP levels were significantly correlated with signs, symptoms, corneal involvement, and number of eosinophils in tears (p<0.0001).
CONCLUSIONS—In patients with VKC, lodoxamide significantly reduced ECP tear levels, and thus, eosinophil activation, and was more effective than DSCG in reducing clinical signs and symptoms.


  11. [Giant esophageal fibrovascular polyp].

    Palacios, Fernando; Contardo, Carlos; Guevara, Jorge; Vera, Augusto; Aguilar, Luis; Huamán, Manuel; Palomino, Américo; Yabar, Alejandro


    Fibrovascular polyps are extremely rare benign neoplasias of the esophagus, which usually originate in the lower cricoid area. They do not produce any discomfort in the patient for a long time, however it may make itself evident by the patient's regurgitation of the polyp, producing asphyxia or, more frequently, dysphagia. The case of a 58 year old male patient is presented herein, with a 9 month record of dysphagia, weight loss and intermittent melena. The barium x-ray showed a distended esophagus, with a tumor running from the upper esophageal sphincter to the cardia. The endoscopy confirmed the presence of a pediculated tumor, implanted in the cervical esophagus. Surgeons suspected the potential malignancy of the tumor and performed a transhiatal esophagectomy. The final pathologic diagnosis was giant fibrovascular esophageal polyp.

  12. Esophageal Inlet Patch

    C. Behrens


    Full Text Available An inlet patch is a congenital anomaly consisting of ectopic gastric mucosa at or just distal to the upper esophageal sphincter. Most inlet patches are largely asymptomatic, but in problematic cases complications related to acid secretion such as esophagitis, ulcer, web and stricture may occur. The diagnosis of inlet patch is strongly suggested on barium swallow where the most common pattern consists of two small indentations on the wall of the esophagus. The diagnosis of inlet patch is confirmed via endoscopy with biopsy. At endoscopy, the lesion appears salmon-coloured and velvety and is easily distinguished from the normal grey-white squamous epithelium of the esophagus. The prominent margins correlate with the radiological findings of indentations and rim-like shadows on barium swallow. Histopathology provides the definitive diagnosis by demonstrating gastric mucosa adjacent to normal esophageal mucosa. No treatment is required for asymptomatic inlet patches. Symptomatic cases are treated with proton pump inhibitors to relieve symptoms related to acid secretion. Strictures and webs are treated with serial dilatation and should be biopsied to rule out malignancy.

  13. Hypnotherapy for Esophageal Disorders

    Riehl, Megan E.; Keefer, Laurie


    Hypnotherapy is an evidence based intervention for the treatment of functional bowel disorders, particularly irritable bowel syndrome. While similar in pathophysiology, less is known about the utility of hypnotherapy in the upper gastrointestinal tract. Esophageal disorders, most of which are functional in nature, cause painful and uncomfortable symptoms that impact patient quality of life and are difficult to treat from a medical perspective. After a thorough medical workup and a failed trial of proton pump inhibitor therapy, options for treatment are significantly limited. While the pathophysiology is likely multifactorial, two critical factors are believed to drive esophageal symptoms—visceral hypersensitivity and symptom hypervigilance. The goal of esophageal directed hypnotherapy is to promote a deep state of relaxation with focused attention allowing the patient to learn to modulate physiological sensations and symptoms that are not easily addressed with conventional medical intervention. Currently, the use of hypnosis is suitable for dysphagia, globus, functional chest pain/non-cardiac chest pain, dyspepsia, and functional heartburn. In this article the authors will provide a rationale for the use of hypnosis in these disorders, presenting the science whenever available, describing their approach with these patients, and sharing a case study representing a successful outcome. PMID:26046715

  14. Genetic polymorphism of antioxidant enzymes in eosinophilic and non-eosinophilic nasal polyposis.

    Akyigit, Abdulvahap; Keles, Erol; Etem, Ebru Onalan; Ozercan, Ibrahim; Akyol, Hatice; Sakallioglu, Oner; Karlidag, Turgut; Polat, Cahit; Kaygusuz, Irfan; Yalcin, Sinasi


    Chronic rhinosinusitis with nasal polyps (CRSwNP) is a chronic inflammatory disease of the paranasal sinuses, and its pathophysiology is not yet precisely known. It is suggested that oxygen free radicals play an important role in the pathogenesis of nasal polyposis. This study aimed to identify genetic polymorphisms of superoxide dismutase (SOD 2), catalase (CAT), and inducible nitric oxide synthase (iNOS) enzymes in eosinophilic CRSwNP and non-eosinophilic CRSwNP patients; the study also aimed to evaluate the effect of genetic polymorphism of antioxidant enzymes on CRSwNP etiopathogenesis. One hundred thirty patients, who received endoscopic sinus surgery due to CRSwNP, and 188 control individuals were included in this study. Nasal polyp tissues were divided into two groups histopathologically as eosinophilic CRSwNP and non-eosinophilic CRSwNP. Venous blood samples were taken from the patient and control groups. Polymorphisms in the Ala16Va1 gene, which is the most common variation of SOD-2 gene, and 21 A/T polymorphisms in catalase gene were evaluated with the restriction fragment length polymorphism method and -277 C/T polymorphism in the iNOS gene was evaluated with the DNA sequencing method. The GG genotype distribution for the (-277) A/G polymorphism in the iNOS gene was a statistically significant difference between eosinophilic CRSwNP and control groups (p  0.05). The TT genotype distribution for the A/T polymorphism in catalase gene at position -21 was statistically significant differences in eosinophilic CRSwNP and control groups (p levels, which are considered effective factors in the pathogenesis of CRSwNP, can occur due to genetic polymorphism of enzymes in the antioxidant system and genetic polymorphism of antioxidant enzymes in eosinophilic CRSwNP patients might contribute to the pathophysiology.

  15. The association between reflux esophagitis and airway hyper-reactivity in patients with gastro-esophageal reflux

    Ashraf Karbasi


    Full Text Available Background: The association of gastro-esophageal reflux (GER with a wide variety of pulmonary disorders was recognized. We aimed to evaluate the effect of GER-induced esophagitis on airway hyper-reactivity (AHR in patients and the response to treatment. Materials and Methods: In this cohort study, 30 patients attending the gastrointestinal clinic of a university hospital with acid reflux symptoms were included. All patients were evaluated endoscopically and divided into case group with esophagitis and control group without any evidence of esophagitis. Spirometry and methacholine test were done in all patients before and after treatment of GER with pantoprazole 40 mg daily for six months. Results: There was a significant difference in the rate of positive methacholine test between the cases (40% and the controls (6.7% prior to anti-acid therapy (P < 0.0001. After six months of treatment, the frequency of positive methacholine test diminished from 40 to 13.3% in the case group (P < 0.05 but did not change in the controls (P = 0.15. Conclusion: The presence of esophagitis due to GER would increase the AHR and treatment with pantoperazole would decrease AHR in patients with proved esophagitis and no previous history of asthma after six months.

  16. Esophageal button battery ingestion in children.

    Şencan, Arzu; Genişol, İncinur; Hoşgör, Münevver


    Button battery lodged in the esophagus carries a high risk of morbidity and mortality. The purpose of this study was to present cases of patients with esophageal button battery ingestion treated at our clinic and to emphasize the importance of early diagnosis and treatment. Records of patients admitted to our hospital for foreign body ingestion between January 2010 and May 2015 were retrospectively reviewed. Cases with button battery lodged in the esophagus were included in the study. Patient data regarding age, sex, length of time after ingestion until admission, presenting clinical symptoms, type and localization of the battery, management, and prognosis were analyzed. Among 1891 foreign body ingestions, 71 were localized in the esophagus, and 8 of those (11.2%) were cases of button battery ingestion. Mean age was 1.7 years. Admission was within 6 hours of ingestion in 5 cases, after 24 hours had elapsed in 2, and 1 month after ingestion in 1 case. All patients but 1 knew the history of ingestion. Prompt endoscopic removal was performed for all patients. Three patients developed esophageal stricture, which responded to dilatation. Early recognition and timely endoscopic removal is mandatory in esophageal button battery ingestion. It should be suspected in the differential diagnosis of patients with persistent respiratory and gastrointestinal symptoms.

  17. Eotaxin and IL-4 levels are increased in induced sputum and correlate with sputum eosinophils in patients with nonasthmatic eosinophilic bronchitis.

    Zhang, Rui; Luo, Wei; Liang, Zhenyu; Tan, Yaxia; Chen, Ruchong; Lu, Wenju; Zhong, Nanshan


    Nonasthmatic eosinophilic bronchitis (NAEB) is characterized by chronic cough and airway eosinophilic inflammation. Airway and systemic inflammation cytokine profile have not been comprehensively described in patients with NAEB.The aim of the study was to identify the cytokine profile in sputum and serum of NAEB patients. Furthermore, the relationship between cytokines and clinical features would be evaluated.Induced sputum and serum were collected from untreated NAEB patients and healthy subjects. The cytokine profile in sputum and serum was analyzed by a bead-based multiplex cytokine assay including 21 cytokines.The levels of EGF, eotaxin, GM-CSF, GRO, IFN-γ, IL-1β, IL-4, IL-6, IL-17A, IP-10, MIP-1α, and TNF-α in sputum were significantly higher in NAEB patients than that in healthy subjects (all P < 0.05). Values of area under the receiver operating characteristic curve (AUROC) of these cytokines were all above 0.750. The concentrations of eotaxin and IL-4 were positively correlated with sputum eosinophil percentage (r = 0.726, P = 0.002; r = 0.511, P = 0.043; respectively). No significant correlations between other cytokines (EGF, GM-CSF, GRO, IFN-γ, IL-1β, IL-6, IL-17A, IP-10, MIP-1α, and TNF-α) in sputum and sputum eosinophil percentage were found. The level of IL-4 in serum was slightly higher in NAEB patients than in healthy subjects. However, there was no correlation between serum IL-4 levels and sputum eosinophil percentage.We identified the cytokine profile in sputum and serum from NAEB patients. Sputum eotaxin and IL-4 could have the potential to become the biomarkers for NAEB and might be useful to assist in the diagnosis of NAEB.

  18. Adult-onset eosinophilic asthma

    de Groot, J.C.


    In the last decades, it has been recognized that asthma is not a single disease, but comprises several clinical syndromes, which all share respiratory symptoms and lung function abnormalities, associated with different types of airway inflammation. These syndromes are now known as different asthma p

  19. The clinical observation on Mucosolvin atomization preventing lung complication after esophageal carcinoma surgery%沐舒坦雾化吸入预防食管癌术后肺部并发症的临床观察

    张淑音; 黄少娅; 詹若燕


    Objective Study the clinical efficacy with Mucosolvin atomization preventing lung complication after esophageal carcinoma surgery.Methods 122 esophageal cancer patients were randomly divided into two groups by the date of admission.The observation group was 62 cases and the control group was 60 cases.The observation group was treated by Mucosolvin ultrasonic atomizing inhalation,the control group was treated by traditional ultrasonic atomizing inhalation,contrast analyzed the incidence rate of pulmonary atelectasis and pneumonic in both group,then did the statistical treatment.Results There is significant difference in the incidence rate of pulmonary atelectasis and pneumonic between two groups,P<0.001.It demonstrated that Mucosolvin ultrasonic atomizing inhalation can effectually reduced pulmonary infection rate in the post-surgery esophageal cancer patient.Conclusion The Mucosolvin ultrasonic atomizing can make the drug directly effect on the airway,decrease the stagnation of airway,promote to eject the sputum,improve the respiratory function.The Mucosolvin ultrasonic atomizing is obviously better than the traditional ultrasonic atomizing.%目的 探讨食管癌术后患者应用沐舒坦雾化吸入预防肺部并发症的临床效果.方法 将122例食管癌手术患者按入院日期单双号随机分组法分为两组,观察组62例和对照组60例,观察组应用沐舒坦超声雾化吸入,对照组采用传统超声雾化吸入,对比分析两组患者的肺不张及肺炎的发生率,并经统计学处理.结果 两组患者的肺不张、肺炎发生率分别经统计学处理,有显著性差异,P<0.001.说明食管癌术后患者采用沐舒坦超声雾化有效地降低患者肺部感染率.结论 沐舒坦超声雾化能将药液直接作用于气道,可减少气道黏膜滞留、促进排痰、改善呼吸功能的作用.沐舒坦超声雾化明显优于传统超声雾化法.

  20. Eosinophil Activation Status in Separate Compartments and Association with Asthma

    Mats W. Johansson


    Full Text Available Asthma is frequently characterized by eosinophil-rich airway inflammation. Airway eosinophilia is associated with asthma exacerbations and likely plays a part in airway remodeling. Eosinophil recruitment from the bloodstream depends on circulating eosinophils becoming activated, which leads to eosinophil arrest on activated endothelium, extravasation, and continued movement through the bronchial tissue by interaction with the extracellular matrix (ECM. Circulating eosinophils can exist at different activation levels, which include non-activated or pre-activated (sensitized or “primed”. Further, the bloodstream may lack pre-activated cells, due to such eosinophils having arrested on endothelium or extravasated into tissue. Increased expression, and in some instances, decreased expression of cell-surface proteins, including CD44, CD45, CD45R0, CD48, CD137, neuropeptide S receptor, cytokine receptors, Fc receptors, and integrins (receptors mediating cell adhesion and migration by interacting with ligands on other cells or in the ECM, and activated states of integrins or Fc receptors on blood eosinophils have been reported to correlate with aspects of asthma. A subset of these proteins has been reported to respond to intervention, e.g., with anti-interleukin (IL-5. How these surface proteins and the activation state of the eosinophil respond to other interventions, e.g., with anti-IL-4 receptor alpha or anti-IL-13, is unknown. Eosinophil surface proteins suggested to be biomarkers of activation, particularly integrins, and reports on correlations between eosinophil activation and aspects of asthma are described in this review. Intermediate activation of beta1 and beta2 integrins on circulating eosinophils correlates with decreased pulmonary function, airway inflammation, or airway lumen eosinophils in non-severe asthma. The correlation does not appear in severe asthma, likely due to a higher degree of extravasation of pre-activated eosinophils

  1. Multidisciplinary management for esophageal and gastric cancer

    Boniface MM


    Full Text Available Megan M Boniface,1 Sachin B Wani,2 Tracey E Schefter,3 Phillip J Koo,4 Cheryl Meguid,1 Stephen Leong,5 Jeffrey B Kaplan,6 Lisa J Wingrove,7 Martin D McCarter1 1Section of Surgical Oncology, Division of GI, Tumor and Endocrine Surgery, Department of Surgery, 2Division of Gastroenterology and Hepatology, Department of Therapeutic and Interventional Endoscopy, 3Department of Radiation Oncology, 4Division of Radiology-Nuclear Medicine, Department of Radiology, 5Division of Medical Oncology, 6Department of Pathology, University of Colorado Denver, 7Department of Food and Nutrition Services, University of Colorado Hospital Cancer Center, Aurora, CO, USA Abstract: The management of esophageal and gastric cancer is complex and involves multiple specialists in an effort to optimize patient outcomes. Utilizing a multidisciplinary team approach starting from the initial staging evaluation ensures that all members are in agreement with the plan of care. Treatment selection for esophageal and gastric cancer often involves a combination of chemotherapy, radiation, surgery, and palliative interventions (endoscopic and surgical, and direct communication between specialists in these fields is needed to ensure appropriate clinical decision making. At the University of Colorado, the Esophageal and Gastric Multidisciplinary Clinic was created to bring together all experts involved in treating these diseases at a weekly conference in order to provide patients with coordinated, individualized, and patient-centered care. This review details the essential elements and benefits of building a multidisciplinary program focused on treating esophageal and gastric cancer patients. Keywords: tumor board, upper gastrointestinal malignancies, patient centered

  2. Eosinophilic myocarditis during treatment with olanzapine

    Vang, Torkel; Rosenzweig, Mary; Bruhn, Christina Hedegaard;


    BACKGROUND: Drug-induced eosinophilic myocarditis is a life-threatening and frequently overlooked condition. The prevalence of myocarditis in clozapine-treated patients may be as high as 3 %. An association between olanzapine and myocarditis has not previously been described, but given the chemical...... fatal cases of eosinophilic myocarditis associated with the use of olanzapine. CASE PRESENTATION: Case 1 was a 39-year-old Caucasian man with known substance abuse and schizophrenia. He was found dead in his home. Olanzapine was prescribed at day -54, and dose at time of death was 40 mg/day. Post......-mortem toxicological examination demonstrated presence of olanzapine, morphine, venlafaxine and oxazepam. Syringes indicating substance abuse were found in his home. Case 2 was a 36-year-old Caucasian man diagnosed with schizophrenia was found dead unexpectedly. There was no history of substance abuse. Current...

  3. Dietary habits and esophageal cancer.

    Palladino-Davis, A G; Mendez, B M; Fisichella, P M; Davis, C S


    Cancer of the esophagus is an underestimated, poorly understood, and changing disease. Its overall 5-year survival is less than 20%, even in the United States, which is largely a function of a delay in diagnosis until its more advanced stages. Additionally, the epidemiologic complexities of esophageal cancer are vast, rendering screening and prevention limited at best. First, the prevalence of esophageal cancer is unevenly distributed throughout the world. Second, the two histological forms (squamous cell and adenocarcinoma) vary in terms of their geographic prevalence and associated risk factors. Third, some populations appear at particular risk for esophageal cancer. And fourth, the incidence of esophageal cancer is in continuous flux among groups. Despite the varied prevalence and risks among populations, some factors have emerged as consistent associations while others are only now becoming more fully recognized. The most prominent, scientifically supported, and long-regarded risk factors for esophageal cancer are tobacco, alcohol, and reflux esophagitis. Inasmuch as the above are regarded as important risk factors for esophageal cancer, they are not the sole contributors. Dietary habits, nutrition, local customs, and the environment may be contributory. Along these lines, vitamins, minerals, fruits, vegetables, meats, fats, salted foods, nitrogen compounds, carcinogens, mycotoxins, and even the temperature of what we consume are increasingly regarded as potential etiologies for this deadly although potentially preventable disease. The goal of this review is to shed light on the less known role of nutrition and dietary habits in esophageal cancer.

  4. CT-guided corticosteroid injection for solitary eosinophilic granuloma of the spine

    Rimondi, Eugenio; Rossi, Giuseppe [Istituto Ortopedico Rizzoli, University of Bologna, Department of Radiology and Interventional Angiographic Radiology, Bologna (Italy); Mavrogenis, Andreas F. [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Orthopaedic Oncology Service, Bologna (Italy); Ussia, Giuseppe; Angelini, Andrea [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Ruggieri, Pietro [Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopedics, Bologna (Italy); Istituto Ortopedico Rizzoli, University of Bologna, Department of Orthopaedics, Bologna (Italy)


    To evaluate the clinical and imaging outcome of patients with symptomatic eosinophilic granuloma of the spine treated with CT-guided intralesional methylprednisolone injection after biopsy. Patients (n =19) with symptomatic solitary eosinophilic granuloma of the spine treated by CT-guided intralesional methylprednisolone injection were retrospectively studied. There were 12 males and seven females with a mean age of 17 years (range, 3-43 years). The mean follow-up was 6 years (median, 4 years; range, 0.5-19 years). Spinal location included the cervical (two patients), thoracic (seven patients), lumbar spine (eight patients), and the sacrum (two patients). Vertebra plana was observed in two patients. All patients had biopsies before treatment. Complete resolution of pain and healing of the lesion was observed in 17 patients (89.5%); none of these patients had recurrence at the latest examination. Reconstitution of the T1 and L1 vertebra plana was observed in both patients. Two patients initially diagnosed and treated for a solitary eosinophilic granuloma had constant pain after the procedure; in these patients, 6 and 12 months after the procedure, respectively, imaging showed multifocal disease and systemic therapy was administered. Complications related to the procedure were not observed. General anesthesia was administered in two patients because of intolerable pain during the procedure. In view of the benign clinical course of eosinophilic granuloma, in patients with symptomatic lesions, CT-guided intralesional corticosteroid injection is a safe and effective outpatient treatment with a low complication rate. (orig.)

  5. Clinicopathologic and immunophenotypic features of eosinophilic fasciitis and morphea profunda: A comparative study of 27 cases.

    Onajin, Oluwakemi; Wieland, Carilyn N; Peters, Margot S; Lohse, Christine M; Lehman, Julia S


    Eosinophilic fasciitis (EF) and morphea profunda (MP) are inflammatory and sclerosing disorders of the subcutis that can exhibit clinical and pathologic presentations that overlap. To identify clinicopathologic features that can be used to distinguish EF from MP. We performed a retrospective review of 16 patients with EF and 11 patients with MP. Hematoxylin-eosin, CD123, CD34, and Verhoeff-Van Gieson stains were evaluated on skin biopsies that included the fascia. EF patients were more likely than MP patients to be men (P = .047), have forearm involvement (P = .003), and have peripheral eosinophilia (P < .01). Compared with MP patients, patients with EF were more likely to have fascia that contained eosinophils (P = .003), although eosinophils were absent in 3 (19%) patients with EF. Focal absence of CD34 staining was more prominent in the fascia of EF patients (P = .04). The extent of Verhoeff-Van Gieson staining did not differ between the 2 groups. Dermal sclerosis was not detected in many cases of EF and MP (56% and 36%, respectively). This was a retrospective study at a single institution. Although EF and MP share clinical and pathologic features, our results indicate that the presence of eosinophils in the blood and fascia and focal loss of CD34 staining might be more suggestive of EF than MP. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  6. Strongyloides stercoralis hyperinfection causing eosinophilic ascites.

    Shukla, Shailaja; Chauhan, Richa; Wadhwa, Shveta; Sehgal, Shivali; Singh, Smita


    Strongyloidiasis is associated with Strongyloides stercoralis, an intestinal nematode with greater prevalence in tropical and subtropical regions. Hyperinfection syndrome with dissemination may occur in immunosuppressed individuals. However, invasion of peritoneal cavity with peritoneal effusion is rarely reported in the literature. We report a case of S. stercoralis hyperinfection in a young alcoholic patient with Diabetes mellitus, liver disease and ascites. Diagnostic paracentesis showed numerous filariform larvae of S. stercoralis against a background of eosinophils.

  7. Assessment of effectiveness of different dosage regimens of pantoprazole in controlling symptoms and healing esophageal lesions of patients with mild erosive esophagitis

    MORETZSOHN Luciana Dias


    Full Text Available Background - Gastroesophageal reflux disease is a very common affection, and esophageal involvement is particularly frequent. The means to effectively control symptoms and improve esophageal inflammation in these patients is to reduce esophageal acid exposure. For this purpose, we use gastric proton pump inhibitor, that can suppress gastric acid secretion. Aim - To compare the effectiveness of two different pantoprazole dosage regimens (20 and 40 mg/day, in controlling symptoms and healing esophageal lesions of patients with mild erosive esophagitis. Material and Methods - Fifty-seven patients with endoscopically confirmed mild erosive esophagitis characterized as non-confluent erosions in the distal esophagus, were randomly to be treated either with pantoprazole 20 mg/day (group I, 28 patients or 40 mg/day (group II, 29 patients over a period of 4 weeks. After treatment completion, the patients were assessed for clinical and endoscopic outcome, i.e., absence of erosions in distal esophagus and improvement of gastroesophageal reflux symptoms. Results - At the end of the treatment, 73.1% of the patients in group I and 85.7% of the patients in group II had endoscopic improvement. We also observed, that 88.5% of the patients in group I and 92.9% of the patients in group II had complete elimination of heartburn and regurgitation. Conclusion - Pantoprazole dosage regimens of 20 mg/day and 40 mg/day provide equivalent effectiveness in controlling symptoms and healing esophageal lesions of mild esophagitis.

  8. Pulmonary Cavity due to Chronic Eosinophilic Pneumonia Associated with Arsenicosis

    A Sengupta


    Full Text Available In developing country like India arsenic poisoning is a major public health problem. Association of chronic eosinophilic pneumonia and chronic diarrhea with arsenicosis is rare. Also pulmonary cavity formation in chronic eosinophilic pneumonia is very uncommon. A 44-year-old male patient, resident of an arsenic affected area was admitted for evaluation of chronic diarrhoea, persistent peripheral eosinophilia along with radiologically visible cavity in right upper zone. There were dermatological manifestations of arsenicosis along with presence of noncirrhotic portal fibrosis and peripheral eosinophilia. On bronchoalveolar lavage study, eosinophil comprised 40% of total cellularity making the diagnosis of chronic eosinophilic pneumonia. After ruling out all possible causes of diarrhoea and chronic eosinophilic pneumonia, we came to conclusion that arsenic could be implicated as causative agent. Keywords: Arsenicosis, chronic diarrhoea, chronic eosinophilic pneumonia, noncirrhotic portal fibrosis.

  9. [Minimally Invasive Treatment of Esophageal Benign Diseases].

    Inoue, Haruhiro


    As a minimally invasive treatment of esophageal achalasia per-oral endoscopic myotomy( POEM) was developed in 2008. More than 1,100 cases of achalasia-related diseases received POEM. Success rate of the procedure was more than 95%(Eckerdt score improvement 3 points and more). No serious( Clavian-Dindo classification III b and more) complication was experienced. These results suggest that POEM becomes a standard minimally invasive treatment for achalasia-related diseases. As an off-shoot of POEM submucosal tumor removal through submucosal tunnel (per-oral endoscopic tumor resection:POET) was developed and safely performed. Best indication of POET is less than 5 cm esophageal leiomyoma. A novel endoscopic treatment of gastroesophageal reflux disease (GERD) was developed. Anti-reflux mucosectomy( ARMS) is nearly circumferential mucosal reduction of gastric cardia mucosa. ARMS is performed in 56 consecutive cases of refractory GERD. No major complications were encountered and excellent clinical results. Best indication of ARMS is a refractory GERD without long sliding hernia. Longest follow-up case is more than 10 years. Minimally invasive treatments for esophageal benign diseases are currently performed by therapeutic endoscopy.

  10. Aspirin and esophageal squamous cell carcinoma: bedside to bench

    Li Peng; Cheng Rui; Zhang Shutian


    Objective To review the advances of studies on clinical results of aspirin's chemopreventive effect against esophageal squamous cell carcinoma (ESCC) and evidences for mechanisms of the antitumoural effects of aspirin in experimental research.Data sources A comprehensive search of the PubMed literatures without restriction on the publication date was carried out using keywords such as aspirin and esophageal cancer.Study selection Articles associated with aspirin and esophageal cancer are analyzed.Results This review focuses on the current evidence for use of aspirin as a chemopreventive agent in ESCC.Aspirin is the most widely used among all nonsteroidal anti-inflammatory drugs (NSAIDs),which is cheap and acceptable to patients.Several observational results provide the further investigation of prevention and therapy of aspirin or similar drugs in esophageal cancer.Data from case control studies,cohort studies and randomized controlled trials (RCTs) also give some support of a beneficial role of aspirin on ESCC.Experimental data suggest that aspirin may prevent carcinogenesis of ESCC by favorably affecting proliferation,apoptosis,or other as yet unidentified growth-regulating processes.But the mechanism by which aspirin influence on esophageal squamous cell carcinoma needs further investigation.Conclusion A wealth of evidences ranging from clinical data to experimental results are building to suggest that aspirin has significant effects in reducing both the incidence and mortality of ESCC.

  11. 多环黏膜切除术治疗早期食管癌及癌前病变的临床价值%Clinical value of multiband mucosectomy for the treatment of early esophageal cancer and precancerous lesions

    柴同海; 靳西凤; 张晶; 孙庆燕; 李曙晖


    目的 探讨多环黏膜切除术(MBM)治疗早期食管癌及癌前病变的临床价值.方法 回顾性分析2010年1月至2011年1月山东济宁医学院附属滕州市中心人民医院收治的43例食管癌以及癌前病变患者的临床资料.43例患者(13例早期癌、30例癌前病变)共51个病灶经术前内镜检查及黏膜活组织检查证实后行MBM治疗.术后1、3、6、12个月门诊行内镜检查并于原病灶处进行活组织检查,以后每6个月定期复查内镜.结果 43例患者共行52次MBM,共切除标本180份;切除病灶大小为10 mm×8mm~25 mm×23 mm;手术时间为(37±5)min.病灶完全切除率为92.2% (47/51).4例未完全切除病灶的患者中,1例早期食管癌患者术后病理检查示鳞状细胞癌侵犯黏膜下层,切缘见癌细胞浸润而追加手术治疗;1例鳞状上皮癌患者术后2周追加放射治疗;其余2例患者追加氩离子凝固术(APC)治疗.52次MBM术中出现4次创面出血,治疗过程中均未出现食管穿孔.1例患者术后10 d发生延迟性出血,行APC止血;1例发生食管轻度狭窄,无需扩张治疗,6个月后逐渐恢复.手术前后病理检查结果准确率为51.0%(26/51).43例患者随访1年,3例复发,复发患者行MBM或APC治疗,无一例患者死亡.结论 MBM治疗早期食管癌及癌前病变简便、安全、有效,有较好的应用前景.%Objective To investigate the clinical value of multiband mucosectomy (MBM) for the treatment of early esophageal cancer and precancerous lesions.Methods The clinical data of 43 patients with early esophageal cancer or precancerous lesions (including 13 cases of early esophageal cancer and 30 cases of precancerous lesion) who were admitted to the Tengzhou Central People's Hospital from January 2010 to January 2011 were retrospectively analyzed.A total of 51 lesions were confirmed by preoperative endoscopy and mucosal biopsy,and then were treated by MBM.Results A total of 52 MBM procedures were

  12. Laparoscopic anterior esophageal myotomy and toupet fundoplication for achalasia.

    Heniford, B T; Matthews, B D; Kercher, K W; Yavorski, R; Greer, S F; Goldstein, S L; Deal, S E; Paccico, T; Drake, S; Colvin, A; Cyzner, R; Sing, R F


    Achalasia is an esophageal motility disorder characterized by the failure of lower esophageal sphincter relaxation and the absence of esophageal peristalsis. The purpose of this study was to evaluate the clinical outcomes of patients undergoing laparoscopic esophageal myotomy and Toupet fundoplication for achalasia. A 9-cm myotomy was performed in most cases extending 7 cm above and 2 cm below the gastroesophageal junction. Severity of dysphagia, heartburn, chest pain, and regurgitation was graded preoperatively and postoperatively using a five-point symptomatic scale (0-4). Patients also graded their outcomes as excellent, good, fair, or poor. Between December 1995 and November 2000 a total of 49 patients (23 male, 26 female) with a mean age of 44.3 years (range 23-71 years) were diagnosed with achalasia. Mean duration of symptoms was 40.2 months (range 4-240 months). Thirty-seven patients (76%) had had a previous nonsurgical intervention or combinations of nonsurgical interventions [pneumatic dilation (23), bougie dilation (five), and botulinum toxin (19)], and two patients had failed esophageal myotomies. Forty-five patients underwent laparoscopic esophageal myotomy and Toupet fundoplication. Two patients received laparoscopic esophageal myotomies without an antireflux procedure, and two were converted to open surgery. One patient presented 10 hours after a pneumatically induced perforation and underwent a successful laparoscopic esophageal myotomy and partial fundoplication. Mean operative time was 180.5 minutes (range 145-264 minutes). Mean length of stay was 1.98 days (range 1-18 days). There were five (10%) perioperative complications but no esophageal leaks. There was a significant difference (P < 0.05) between the preoperative and postoperative dysphagia, chest pain, and regurgitation symptom scores. All patients stated that they were improved postoperatively. Eighty-six per cent rated their outcome as excellent, 10 per cent as good, and 4 per cent as fair

  13. Feline familial pedal eosinophilic dermatosis in two littermates

    Charline Pressanti; Marie-Christine Cadiergues


    In cats, the most common eosinophilic dermatoses are feline miliary dermatitis and eosinophilic granuloma complex. The most commonly identified underlying cause is a hypersensitivity reaction. Few cases of familial forms of eosinophilic dermatoses are reported in the literature. Two young adult cats from the same litter presented 2 years apart with a severe and chronic fluid or tissue infiltration of the distal part of several limbs. Lesions started on the forelegs and developed on the other ...

  14. [Prevalence of erosive esophagitis and peptic esophageal strictures].

    Vasilevskiĭ, D I; Skurikhin, S S; Luft, A V; Mednikov, S N; Silant'ev, D S; Kulagin, V I; Dvoretskiĭ, S Iu; Bagnenko, S F


    Gastroesophageal reflux disease is a widespread among population in economically developed countries including Russia. It was analyzed the results of 34 903 endoscopic examinations of upper gastrointestinal tract in ethnically and socially homogeneous population of Leningrad region with symptoms of gastric dispepsia. Procedures were performed for the period 2007-2013. Prevalence of erosive esophagitis was 4.9%. Peptic esophageal strictures due to chronic reflux-associated inflammation were revealed in 0.2% of examined patients (3.7% of patients with erosive esophagitis). Obtained data allow to considergastroesophageal reflux disease as a socially significant problem in Russia requiring close attention and further study.

  15. Eosinophilic cholangitis is a potentially underdiagnosed etiology in indeterminate biliary stricture

    Walter, Dirk; Hartmann, Sylvia; Herrmann, Eva; Peveling-Oberhag, Jan; Bechstein, Wolf O; Zeuzem, Stefan; Hansmann, Martin-Leo; Friedrich-Rust, Mireen; Albert, Jörg G


    AIM To investigate presence and extent of eosinophilic cholangitis (EC) as well as IgG4-related disease in patients with indeterminate biliary stricture (IBS). METHODS All patients with diagnosis of sclerosing cholangitis (SC) and histopathological samples such as biopsies or surgical specimens at University Hospital Frankfurt from 2005-2015 were included. Histopathological diagnoses as well as further clinical course were reviewed. Tissue samples of patients without definite diagnosis after complete diagnostic work-up were reviewed regarding presence of eosinophilic infiltration and IgG4 positive plasma cells. Eosinophilic infiltration was as well assessed in a control group of liver transplant donors and patients with primary sclerosing cholangitis. RESULTS one hundred and thirty-five patients with SC were included. In 10/135 (13.5%) patients, no potential cause of IBS could be identified after complete diagnostic work-up and further clinical course. After histopathological review, a post-hoc diagnosis of EC was established in three patients resulting in a prevalence of 2.2% (3/135) of all patients with SC as well as 30% (3/10) of patients, where no cause of IBS was identified. 2/3 patients with post-hoc diagnosis of EC underwent surgical resection with suspicion for malignancy. Diagnosis of IgG4-related cholangitis was observed in 7/135 patients (5.1%), whereas 3 cases were discovered in post-hoc analysis. 6/7 cases with IgG4-related cholangitis (85.7%) presented with eosinophilic infiltration in addition to IgG4 positive plasma cells. There was no patient with eosinophilic infiltration in the control group of liver transplant donors (n = 27) and patients with primary sclerosing cholangitis (n = 14). CONCLUSION EC is an underdiagnosed benign etiology of SC and IBS, which has to be considered in differential diagnosis of IBS. PMID:28246478

  16. Wogonin Induces Eosinophil Apoptosis and Attenuates Allergic Airway Inflammation

    Dorward, David A.; Sharma, Sidharth; Rennie, Jillian; Felton, Jennifer M.; Alessandri, Ana L.; Duffin, Rodger; Schwarze, Jurgen; Haslett, Christopher; Rossi, Adriano G.


    Rationale: Eosinophils are key effector cells in allergic diseases, including allergic rhinitis, eczema, and asthma. Their tissue presence is regulated by both recruitment and increased longevity at inflamed sites. Objectives: To investigate the ability of the flavone wogonin to induce eosinophil apoptosis in vitro and attenuate eosinophil-dominant allergic inflammation in vivo in mice. Methods: Human and mouse eosinophil apoptosis in response to wogonin was investigated by cellular morphology, flow cytometry, mitochondrial membrane permeability, and pharmacological caspase inhibition. Allergic lung inflammation was modeled in mice sensitized and challenged with ovalbumin. Bronchoalveolar lavage (BAL) and lung tissue were examined for inflammation, mucus production, and inflammatory mediator production. Airway hyperresponsiveness to aerosolized methacholine was measured. Measurements and Main Results: Wogonin induced time- and concentration-dependent human and mouse eosinophil apoptosis in vitro. Wogonin-induced eosinophil apoptosis occurred with activation of caspase-3 and was inhibited by pharmacological caspase inhibition. Wogonin administration attenuated allergic airway inflammation in vivo with reductions in BAL and interstitial eosinophil numbers, increased eosinophil apoptosis, reduced airway mucus production, and attenuated airway hyperresponsiveness. This wogonin-induced reduction in allergic airway inflammation was prevented by concurrent caspase inhibition in vivo. Conclusions: Wogonin induces eosinophil apoptosis and attenuates allergic airway inflammation, suggesting that it has therapeutic potential for the treatment of allergic inflammation in humans. PMID:25629436

  17. The lymphokine eosinophil stimulation promoter and human schistosomiasis mansoni.

    Kazura, J W; Mahmoud, A A; Karb, K S; Warren, K S


    An in vitro assay for the new lymphokine eosinophil stimulation promoter has been adapted for use with human material. Peripheral eosinophils from patients with schistosomiasis mansoni were specifically induced to migrate on incubation with egg antigen. Furthermore, the peripheral lymphocytes of these patients on incubation with the egg antigen secreted the lymphokine eosinophil stimulation promoter, which enhanced the migration of purified eosinophils from patients with or without schistosomiasis. The test can be easily performed with human target cells and may be helpful for diagnostic or investigative purposes.

  18. Resected case of eosinophilic cholangiopathy presenting with secondary sclerosing cholangitis

    Fumihiko Miura; Takehide Asano; Hodaka Amano; Masahiro Yoshida; Naoyuki Toyota; Keita Wada; Kenichiro Kato; Tadahiro Takada; Junichi Fukushima; Fukuo Kondo; Hajime Takikawa


    Eosinophilic cholangiopathy is a rare condition characterized by eosinophilic infiltration of the biliary tract and causes sclerosing cholangitis. We report a patient with secondary sclerosing cholangitis with eosinophilic cholecystitis. A 46-year-old Japanese man was admitted to our hospital with jaundice.Computed tomography revealed dilatation of both the intrahepatic and extrahepatic bile ducts, diffuse thickening of the wall of the extrahepatic bile duct, and thickening of the gallbladder wall. Under the diagnosis of lower bile duct carcinoma, he underwent pyloruspreserving pancreatoduodenectomy and liver biopsy.On histopathological examination, conspicuous fibrosis was seen in the lower bile duct wall. In the gallbladder wall, marked eosinophilic infiltration was seen. Liver biopsy revealed mild portal fibrosis. He was diagnosed as definite eosinophilic cholecystitis with sclerosing cholangitis with unknown etiology. The possible etiology of sclerosing cholangitis was consequent fibrosis from previous eosinophilic infiltration in the bile duct. The clinicopathological findings of our case and a literature review indicated that eosinophilic cholangiopathy could cause a condition mimicking primary sclerosing cholangitis (PSC). Bile duct wall thickening in patients (PSC). Bile duct wall thickening in patients with eosinophilic cholangitis might be due to fibrosis of the bile duct wall. Eosinophilic cholangiopathy might be confused as PSC with eosinophilia.

  19. Clinical nursing of cervical anastomotic fistula in patients with esophageal carcinoma%食管癌颈部吻合口瘘的临床护理

    阴爱华; 郁殿琴; 杨晓娟


    Objective To promote the healing of cervical anastomotic fistula,alleviate the suffering of patients and shorten the duration of hospitalization. Methods Among 75 patients who received esophageal carcinoma surgery,8 had cervical anastomotic fistula. They received early interventions such as strengthening of psychological nursing,the fistula nursing and nutritional support. Results All of the 8 patients with cervical anastomotic fistula healed well. Conclusion Cervical anastomosis fistula is the common complication of esophageal carcinoma surgery. Early detection of anastomotic fistula by nursing staff is essential to the healing of cervical anastomotic fistula. The psychological nursing,nutritional support and care are important to the recovery of cervical anastomotic fistula,which can also relieve suffering,improve life quality,and shorten the duration of hospitalization.%目的 为使食管癌颈部吻合口瘘早期愈合,减轻患者的痛苦,缩短患者住院时间.方法 对行食管癌根治术的75例中发生颈部吻合口瘘的8例患者,进行及早干预、加强心理护理、瘘口护理、营养支持等.结果 本组8例患者颈部吻合口瘘均愈合良好.结论 食管癌术后颈部吻合瘘,是常见的并发症.护理人员及早发现吻合口瘘的发生,是促进吻合口瘘早期愈合的前提.加强患者心理护理、营养支持、颈部瘘口护理等是吻合口瘘愈合的重要保证,并可以减轻痛苦,提高生活质量,缩短患者住院时间.

  20. Feline eosinophilic keratoconjunctivitis: a retrospective study of 45 cases (56 eyes).

    Dean, Eric; Meunier, Valerie


    The medical records of 45 cases (56 eyes) of feline eosinophilic keratoconjunctivitis (EKC) diagnosed between 2005 and 2011 were reviewed. Cats were included if a clinical diagnosis of EKC was recorded and eosinophils were found on corneal cytology. Median age at presentation was 5 years (interquartiles 5-9 years) for both males and females. Domestic shorthair was the predominant breed, accounting for 77.8% of the cats. The condition was unilateral in 75.6% of cases, with the superotemporal quadrant of the cornea the most frequently affected position (76.8% of eyes). A history of corneal ulceration was recorded in 37.8% of cases, and corneal ulcers were present at or before diagnosis in 66.7% of the cats. Eosinophils were found in 92.0% of conjunctival scrapings. We performed polymerase chain reaction (PCR) for feline herpesvirus type 1 (FHV-1) for 33/45 cats. Viral DNA was detected in 54.5% of these cats. FHV-1 DNA was detected by PCR in 66.7% of cats with a history and/or presence of a corneal ulcer at first presentation, which is significantly more than those with no corneal ulcer at any time (22.2% FHV-1 DNA detected). Our findings suggest that a corneal ulcer can be present prior to the development of eosinophilic keratitis. Further studies are mandatory to explore the role that FHV-1 could play in EKC-associated corneal ulceration.

  1. The Monitoring Features Under Eosinophilic Phenotype of Bronchial Asthma Among the Children

    Tatiana Bilous


    Full Text Available Abstract Purpose: to study features of monitoring in the dynamics of the basic treatment of eosinophilic phenotype of asthma in school-age children. Materials and methods. Surveyed 88 school-age children with bronchial asthma. The first group included 45 patients who met eosinophilic phenotype (EFBA and group II formed the 43 patients with evidence of neutrophilic phenotype (NFBA. Results and discussion. It should be noted that if the early inflammatory therapy destination exchange only 10.5% of the patients disease was defined as EFBA controlled and the finishing treatment increased the proportion of cases of controlled to 25.6% (Pφ>0,05 and in the second clinical group – at 22.3% of 50.0% patients, Pφ<0,05. Also marked anti-inflammatory effect in both groups in exhaled breath condensate and increase in the lability of the bronchi occurred in 39.1% of children with EFBA, and 60.0% of the representatives of the comparison group. Conclusions. Thus, in patients with signs of eosinophilic phenotype compared with children with neutrophilic airway inflammation markers hyperresponsiveness and inflammation of the bronchi more expressive as the lability of the respiratory tract. Under the influence of the basic anti-inflammatory treatment in patients with eosinophilic asthma phenotype is a reduction of inflammation of the bronchi, but not lability and hyperresponsiveness.

  2. Idiopathic Chronic Eosinophilic Pneumonia: Retrospective Analysis of 17 Cases from a Single Center in Turkey

    Sibel Arınç


    Full Text Available Objective: Idiopathic chronic eosinophilic pneumonia (ICEP is a rare eosinophilic lung disorder with an unknown etiology and is characterized by subacute or chronic respiratory and general symptoms, alveolar and/or peripheral eosinophilia, and the accumulation of eosinophils in the lungs. We aimed to present diagnostic test results and follow-up outcomes of 17 patients who were diagnosed with ICEP in our hospital in light of literature. Methods: Between 2008 and 2013, we examined 17 cases of ICEP. We evaluated clinical and laboratory findings together with the long-term follow-up data. Results: The patients had a mean age of 40.8 years at presentation, and the female/male ratio was 0.8. The most common symptoms were cough (94%, shortness of breath (76%, and high fever (35%. Bronchoalveolar lavage eosinophil percentages of the patients ranged from 3% to 80%. Nine (53% patients experienced recurrence. Six patients were maintained on low dose steroid due to repeating relapses. Among these patients, 7 (77.7% had a total IgE level of above 500/IU/mL. Conclusion: Relapses are common in ICEP after the withdrawal of corticosteroid treatment or during dose reduction. We point out the importance of the close monitoring of patients for identifying relapse. A higher total IgE level during diagnosis may serve as a predictor of recurrence.

  3. Endoscopic appearance of esophageal hematomas

    Rodica Ouatu-Lascar; Gayatri Bharadhwaj; George Triadafilopoulos


    @@INTRODUCTION Esophageal hematomas develop from the dissection of the mucosa from the muscular layers of the esophageal wall and represent an uncommon condition affecting all ages[t-3]. Although the most common cause of esophageal hematomas is iatrogenic mechanical injury-induced by prolonged nasogastric intubation, difficult or forceful endoscopic intubation, or the result of variceal injection sclerotherapy- some may be spontaneous,particularly in patients receiving anticoagulants[3-6]. Presenting symptoms most commonly include dysphagia, hematemesis, and sub-sternal or epigastric pain[5,9].

  4. Esofagite eosinofílica na criança = Eosinophilic esophagitis in the child

    Epifanio, Matias


    Conclusões: Esofagite eosinofilica é uma inflamação com infiltrado de eosinófilos, que ocorre de forma isolada no esôfago, onde os sintomas, usualmente, são confundidos com os da doença por refluxo gastresofágico. A incidência desta doença vem aumentando nos últimos anos, sendo diagnosticada através da endoscopia digestiva alta e biópsias. O tratamento consiste em uma dieta de eliminação dos alérgenos envolvidos, assim como corticosteróides tópicos ou sistêmicos

  5. The Eosinophil Count Tends to Be Negatively Associated with Levels of Serum Glucose in Patients with Adrenal Cushing Syndrome.

    Lee, Younghak; Yi, Hyon Seung; Kim, Hae Ri; Joung, Kyong Hye; Kang, Yea Eun; Lee, Ju Hee; Kim, Koon Soon; Kim, Hyun Jin; Ku, Bon Jeong; Shong, Minho


    Cushing syndrome is characterized by glucose intolerance, cardiovascular disease, and an enhanced systemic inflammatory response caused by chronic exposure to excess cortisol. Eosinopenia is frequently observed in patients with adrenal Cushing syndrome, but the relationship between the eosinophil count in peripheral blood and indicators of glucose level in patients with adrenal Cushing syndrome has not been determined. A retrospective study was undertaken of the clinical and laboratory findings of 40 patients diagnosed with adrenal Cushing syndrome at Chungnam National University Hospital from January 2006 to December 2016. Clinical characteristics, complete blood cell counts with white blood cell differential, measures of their endocrine function, description of imaging studies, and pathologic findings were obtained from their medical records. Eosinophil composition and count were restored by surgical treatment of all of the patients with adrenal Cushing disease. The eosinophil count was inversely correlated with serum and urine cortisol, glycated hemoglobin, and inflammatory markers in the patients with adrenal Cushing syndrome. Smaller eosinophil populations in patients with adrenal Cushing syndrome tend to be correlated with higher levels of blood sugar and glycated hemoglobin. This study suggests that peripheral blood eosinophil composition or count may be associated with serum glucose levels in patients with adrenal Cushing syndrome.

  6. Radiologic Findings of Immunoglobulin G4 Related Sclerosing Esophagitis: A Case Report

    Kim, Mi Sun; Kim, Su Young; Lee, Byung Hoon; Hwang, Yoon Joon; Han, Yoon Hee [Dept. of Radiology, Ilsan Paik Hospital, Inje University College of Medicine, Koyang (Korea, Republic of)


    We describe a case of immunoglobulin G4 (IgG4)-related sclerosing esophagitis occurring in a 63-year-old man with progressive dysphagia and 10-kg weight loss over 9 months. An esophagoscopy revealed significant stricture with diffuse mucosal friability and ulceration at mid esophagus level. Barium esophagogram showed diffuse stenosis at the mid and lower esophagus levels with ulcerations and irregularity of the mucosa. Multidetector computed tomography revealed diffuse edematous and circumferential thickening of the submucosa and muscle layer of this esophageal segment. Fluorine 18 fluorodeoxyglucose positron emission tomography (FDG PET) revealed diffuse mild FDG uptake in mid to lower esophagus. Although benign inflammatory lesion was suspected based on the imaging findings, the patient underwent surgery for worsening esophageal stricture and the esophageal lesion was pathologically confirmed as IgG4-related sclerosing esophagitis. Radiologic benignancy and high clinical suspicion for IgG4-related sclerosing disease may help making a proper decision and avoiding unnecessary operation.

  7. Differential expression analsis of matrix metallo-proteinase 20 (MMP20) in human esophageal cancer


    The aim of this study was to investigate the different expressions of MMP20 in the process of esophageal cancer. RT-PCR, immunohistochemistry and Western blot were employed to detect the mRNA expression and protein expression of MMP20. Compared with the corresponding normal esophagus tissues, results showed the common trend of the dramatical overexpression of MMP20 in the esopha-geal cancer tissues. The analysis of MMP20 expression in different clinical early stages of esophageal cancer by RT-PCR indicated that MMP20 was much more overexpressed in the esophageal cancer with invasion than in the early stages. This suggested that MMP20 might play an important role in the progression of esophageal cancer. It probably plays a critical role in tumor invasion.

  8. Treatment of medium and late stage esophageal carcinoma with combined endoscopic metal stenting and radiotherapy

    钟捷; 吴云林; 许帧; 刘晓天; 许斌; 翟祖康


    Objective To evaluate clinical feasibility and efficacy of endoscopic metal stenting combined with radiotherapy for treatment of medium and late stages of esophageal carcinoma. Methods Thirty-four patients of late stage esophageal carcinoma were treated with endoscopic stent implantation in combination with radiotherapy. Evaluations of CES stainless steel metal stent on the effect of radiation, clinical symptom alleviation and complication and survival rates in both groups were made. Conclusion Endoscopic metal stenting in combination with radiotherapy was a feasible and practical management in treating medium and late stages esophageal carcinoma and was superior to simple metal stent implantation.

  9. CT findings of chronic eosinophilic pneumonia

    Kigami, Yusuke; Nishizawa, Sadahiko; Kuroda, Yasumasa (Tenri Hospital, Nara (Japan)) (and others)


    CT scans in 11 cases of chronic eosinophilic pneumonia (CEP) were reviewed. Peripheral dense opacities suggesting air-space consolidation were the most peculiar findings seen in 9 patients on CT, but 7 on chest radiographs. Five patients showed broad plate-like opacities parallel to the pleura, which were the results of resolution from the periphery of the consolidation. Diffuse interstitial opacities suggesting alveolitis were the predominant finding in 3 patients, one of which also had peripheral air-space consolidation. Follow-up CT showed no residual abnormality except one who had DIP concomitant with CEP. CT scans are useful tool for both diagnosis and follow-up of CEP. (author).

  10. Eosinophilic granuloma of bone: diagnosis and management

    Nauert, C.; Zornoza, J.; Harle, T.S.; Ayala, A.


    Fifty patients with eosinophilic granuloma of bone were reviewed. Thirty-one lesions were in the head and neck, 24 in the extremities, seven in the pelvis, and five in the ribs. The lesions were lytic with ill-defined margins, endosteal erosion, and solid periosteal reaction. The diagnoses were obtained by surgical biopsy in 36 patients and by percutaneous biopsy in 14. Twenty-six lesions were treated with radiotherapy, 14 by surgery, and nine by surgery and radiotherapy. The last 14 cases have been treated by percutaneous injection of methylprednisolone sodium succinate into the lesion. Healing was obtained in every lesion. There were no complications.

  11. Eosinophilic myocarditis during treatment with olanzapine

    Vang, Torkel; Rosenzweig, Mary; Bruhn, Christina Hedegaard


    -mortem toxicological examination demonstrated presence of olanzapine, morphine, venlafaxine and oxazepam. Syringes indicating substance abuse were found in his home. Case 2 was a 36-year-old Caucasian man diagnosed with schizophrenia was found dead unexpectedly. There was no history of substance abuse. Current...... fatal cases of eosinophilic myocarditis associated with the use of olanzapine. CASE PRESENTATION: Case 1 was a 39-year-old Caucasian man with known substance abuse and schizophrenia. He was found dead in his home. Olanzapine was prescribed at day -54, and dose at time of death was 40 mg/day. Post...

  12. Practice guidelines on the use of esophageal manometry - A GISMAD-SIGE-AIGO medical position statement.

    Savarino, Edoardo; de Bortoli, Nicola; Bellini, Massimo; Galeazzi, Francesca; Ribolsi, Mentore; Salvador, Renato; Savarino, Vincenzo; Penagini, Roberto


    Patients with esophageal symptoms potentially associated to esophageal motor disorders such as dysphagia, chest pain, heartburn and regurgitation, represent one of the most frequent reasons for referral to gastroenterological evaluation. The utility of esophageal manometry in clinical practice is: (1) to accurately define esophageal motor function, (2) to identify abnormal motor function, and (3) to establish a treatment plan based on motor abnormalities. With this in mind, in the last decade, investigations and technical advances, with the introduction of high-resolution esophageal manometry, have enhanced our understanding and management of esophageal motility disorders. The following recommendations were developed to assist physicians in the appropriate use of esophageal manometry in modern patient care. They were discussed and approved after a comprehensive review of the medical literature pertaining to manometric techniques and their recent application. This position statement created under the auspices of the Gruppo Italiano di Studio per la Motilità dell'Apparato Digerente (GISMAD), Società Italiana di Gastroenterologia ed Endoscopia Digestiva (SIGE) and Associazione Italiana Gastroenterologi ed Endoscopisti Digestivi Ospedalieri (AIGO) is intended to help clinicians in applying manometric studies in the most fruitful manner within the context of their patients with esophageal symptoms.

  13. Serum type IV collagen level is predictive for esophageal varices in patients with severe alcoholic disease

    Satoshi Mamori; Yasuyuki Searashi; Masato Matsushima; Kenichi Hashimoto; Shinichiro Uetake; Hiroshi Matsudaira; Shuji Ito; Hisato Nakajima; Hisao Tajiri


    AIM: To determine factors predictive for esophageal varices in severe alcoholic disease (SAD).METHODS: Abdominal ultrasonography (US) was performed on 444 patients suffering from alcoholism. Forty-four patients found to have splenomegaly and/ or withering of the right liver lobe were defined as those with SAD. SAD patients were examined by upper gastrointestinal (UGI) endoscopy for the presence of esophageal varices. The existence of esophageal varices was then related to clinical variables.RESULTS: Twenty-five patients (56.8%) had esophageal varices. A univariate analysis revealed a significant difference in age and type IV collagen levels between patients with and without esophageal varices. A logistic regression analysis identified type IV collagen as the only independent variable predictive for esophageal varices (P = 0.017). The area under the curve (AUC) for type IV collagen as determined by the receiver operating characteristic (ROC) for predicting esophageal varices was 0.78.CONCLUSION: This study suggests that the level of type IV collagen has a high diagnostic accuracy for the detection of esophageal varices in SAD.

  14. Exhaled nitric oxide thresholds associated with a sputum eosinophil count ≥3% in a cohort of unselected patients with asthma.

    Schleich, Florence N; Seidel, Laurence; Sele, Jocelyne; Manise, Maite; Quaedvlieg, Valerie; Michils, Alain; Louis, Renaud


    It has been claimed that exhaled nitric oxide (FeNO) could be regarded as a surrogate marker for sputum eosinophil count in patients with asthma. However, the FeNO threshold value that identifies a sputum eosinophil count ≥3% in an unselected population of patients with asthma has been poorly studied. This retrospective study was conducted in 295 patients with asthma aged 15–84 years recruited from the asthma clinic of University Hospital of Liege. Receiver-operating characteristic (ROC) curve and logistic regression analysis were used to assess the relationship between sputum eosinophil count and FeNO, taking into account covariates such as inhaled corticosteroids (ICS), smoking, atopy, age and sex. Derived from the ROC curve, FeNO ≥41 ppb gave 65% sensitivity and 79% specificity (AUC=0.777, p=0.0001) for identifying a sputum eosinophil count ≥3%. Using logistic regression analysis, a threshold of 42 ppb was found to discriminate between eosinophilic and non-eosinophilic asthma (pppb) than the rest of the group (48 ppb, pppb for atopic vs 30 ppb for non-atopic patients, pppb) compared with non-smokers (46 ppb, p=0.066). Age and sex did not affect the relationship between FeNO and sputum eosinophilia. When combining all variables into the logistic model, FeNO (p<0.0001), high-dose ICS (p<0.05) and smoking (p<0.05) were independent predictors of sputum eosinophilia, while there was a trend for atopy (p=0.086). FeNO is able to identify a sputum eosinophil count ≥3% with reasonable accuracy and thresholds which vary according to dose of ICS, smoking and atopy.

  15. Multimodality Imaging Evaluation of an Uncommon Entity: Esophageal Heterotopic Pancreas

    Takman Mack


    Full Text Available A 25-year-old male was referred to the Radiology Department with new onset of right upper quadrant and epigastric abdominal pain. He had no past medical or surgical history. Physical exam was unremarkable. The patient underwent computed tomography (CT, fluoroscopic upper gastrointestinal (GI evaluation, endoscopic ultrasound (EUS, and positron emission tomography (PET evaluation, revealing the presence of a heterogeneous esophageal mass. In light of imaging findings and clinical workup, the patient was ultimately referred for thorascopic surgery. Surgical findings and histology confirmed the diagnosis of esophageal heterotopic pancreas.

  16. Esophageal cancer; Cancer de l'oesophage

    Dupuis, O.; Ganem, G.; Denis, F. [Centre Jean-Bernard, clinique Victor-Hugo, 72 - Le Mans (France); Bera, G.; Pointreau, Y. [Clinique d' oncologie radiotherapie, Centre Henry S. Kaplan, CHU Bretonneau, 37 - Tours (France); Pradier, O. [Departement de radiotherapie, CHU de Morvan, 29 - Brest (France); Martin, P. [Centre Bourgogne, 59 - Lille (France); Mirabel, X. [Departement universitaire de radiotherapie, centre Oscar-Lambret, 59 - Lille (France)


    Esophageal cancers are highly malignant tumours with often a poor prognosis, except for minimal lesions treated with surgery. Radiation therapy, or combined radiation and chemotherapy is the most used therapeutic modality, alone or before oesophagectomy. The delineation of target volumes is now more accurate owing the possibility to use routinely the new imaging techniques (mainly PET). The aim of this work is to precise the radio-anatomical particularities, the pattern of spread of esophageal cancer and the principles of 3D conformal radiotherapy illustrated with a clinical case. (authors)

  17. Prevention of Esophageal Variceal Rebleeding

    Gin-Ho Lo


    Full Text Available The rate of rebleeding of esophageal varices remains high after cessation of acute esophageal variceal hemorrhage. Many measures have been developed to prevent the occurrence of rebleeding. When considering their effectiveness in reduction of rebleeding, the associated complications cannot be neglected. Due to unavoidable high incidence of complications, shunt surgery and endoscopic injection sclerotherapy are now rarely used. Transjugular intrahepatic portosystemic stent shunt was developed to replace shunt operation but is now reserved for rescue therapy. Nonselective beta-blockers alone or in combination with isosorbide mononitrate and endoscopic variceal ligation are currently the first choices in the prevention of variceal rebleeding. The combination of nonselective beta-blockers and endoscopic variceal ligation appear to enhance the efficacy. With the advent of newly developed measures, esophageal variceal rebleeding could be greatly reduced and the survival of cirrhotics with bleeding esophageal varices could thereby be prolonged.

  18. Drugs Approved for Esophageal Cancer

    This page lists cancer drugs approved by the Food and Drug Administration (FDA) for esophageal cancer. The list includes generic names and brand names. The drug names link to NCI's Cancer Drug Information summaries.

  19. Esophageal Perforation due to Transesophageal Echocardiogram: New Endoscopic Clip Treatment

    John Robotis


    Full Text Available Esophageal perforation due to transesophageal echocardiogram (TEE during cardiac surgery is rare. A 72-year-old female underwent TEE during an operation for aortic valve replacement. Further, the patient presented hematemesis. Gastroscopy revealed an esophageal bleeding ulcer. Endoscopic therapy was successful. Although a CT scan excluded perforation, the patient became febrile, and a second gastroscopy revealed a big perforation at the site of ulcer. The patient's clinical condition required endoscopic intervention with a new OTSC® clip (Ovesco Endoscopy, Tübingen, Germany. The perforation was successfully sealed. The patient remained on intravenous antibiotics, proton pump inhibitors and parenteral nutrition for few days, followed by enteral feeding. She was discharged fully recovered 3 months later. We clearly demonstrate an effective, less invasive treatment of an esophageal perforation with a new endoscopic clip.

  20. A Critical Appraisal of Circumferential Resection Margins in Esophageal Carcinoma

    Pultrum, Bareld B.; Honing, Judith; Smit, Justin K.; van Dullemen, Hendrik M.; van Dam, Gooitzen M.; Groen, Henk; Hollema, Harry; Plukker, John Th. M.


    In esophageal cancer, circumferential resection margins (CRMs) are considered to be of relevant prognostic value, but a reliable definition of tumor-free CRM is still unclear. The aim of this study was to appraise the clinical prognostic value of microscopic CRM involvement and to determine the opti