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Eosinophilic esophagitis: red on microscopy, white on endoscopy
Alex Straumann1, Hans-Peter Spichtin, Kathleen A Bucher
1Department of Gastroenterology, Kantonsspital Olten, Roemerstrasse 7, CH-4600 Olten, Switzerland. alex.straumann@hin.ch
Digestion
|September 24, 2004
Summary
Eosinophilic esophagitis (EE) causes varied endoscopic signs, but white exudates correlate with more frequent dysphagia. Diagnosis is challenging due to non-specific findings and infiltration heterogeneity.
Area of Science:
- Gastroenterology
- Immunology
- Pathology
Background:
- Eosinophilic esophagitis (EE) is a chronic T(H)2-inflammatory disease characterized by dysphagia and eosinophilic infiltration of the esophageal mucosa.
- Endoscopic findings in EE are often non-specific or misleading, complicating diagnosis.
- Understanding endoscopic manifestations is crucial for accurate diagnosis and management.
Purpose of the Study:
- To characterize the endoscopic manifestations of eosinophilic esophagitis (EE).
- To analyze the nature and clinical features of white alterations observed during endoscopy in EE patients.
- To investigate the correlation between endoscopic findings and dysphagia frequency.
Main Methods:
- Thirty adult patients with confirmed EE underwent structured interviews, physical examinations, laboratory tests, and upper endoscopy.
- Histomorphometric examination of esophageal mucosal biopsies was performed.
- Endoscopic findings were systematically recorded and analyzed.
Main Results:
- All patients exhibited esophageal mucosal abnormalities, including loss of vascular pattern (93.3%) and white exudates (53.3%).
- Biopsies showed significantly higher eosinophil counts in white exudates compared to surrounding mucosa (108.4 vs. 14.0 cells/hpf).
- A significant correlation existed between the presence of white exudates and increased dysphagia frequency.
Conclusions:
- Eosinophilic esophagitis presents with diverse endoscopic signs, lacking a pathognomonic pattern.
- White exudates represent foci of dense eosinophilic infiltration, indicating active inflammation.
- The heterogeneity of endoscopic findings and eosinophilic infiltration complicates EE diagnosis, despite the association of white exudates with more frequent dysphagia.