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Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis

Author Spotlight: Investigating the Pathophysiology of Eosinophilic Esophagitis

Published on: May 10, 2024

Non eosinophilic chronic stricturing esophagitis: Lessons from thirty eight cases

Flavius-Stefan Marin¹, Antoine Assaf², Sarra Oumrani²

¹Gastroenterology and Digestive Oncology Department, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, France.

Clinics and Research in Hepatology and Gastroenterology

|September 1, 2023

Summary

Non-eosinophilic chronic stricturing esophagitis is difficult to manage, often requiring systemic treatment informed by dermatological evaluation. Endoscopic surveillance is crucial due to cancer risk.

Area of Science:

Gastroenterology
Dermatology
Pathology

Background:

Atypical esophagitis can present with esophageal strictures and chronic inflammation, mimicking eosinophilic esophagitis.
Esophageal biopsies may show chronic inflammation without eosinophils, posing diagnostic challenges.
Associated dermatological conditions are frequently observed in these patients.

Purpose of the Study:

To report the management strategies for non-eosinophilic chronic stricturing esophagitis.
To assess the prevalence of associated dermatological conditions in patients with this condition.
To evaluate the impact of dermatological evaluation on treatment decisions.

Main Methods:

Retrospective analysis of medical records for patients with non-eosinophilic stricturing esophagitis.
Review of clinical, endoscopic, and pathology data.
Dermatological evaluation, including blood immunoassay and skin biopsy when indicated.

Main Results:

Thirty-eight patients (26 female) with a median age of 56.5 years were included.
Dysphagia and weight loss were common presenting symptoms; endoscopic findings included esophageal stenosis.
Dermatological examination revealed lesions in 21 patients, guiding systemic treatment in 55% and limiting endoscopic dilatation.
Five patients developed esophageal squamous cell carcinoma.

Conclusions:

Management of non-eosinophilic chronic stricturing esophagitis is challenging due to biopsy limitations and refractory strictures.
Dermatological evaluation is valuable for guiding systemic treatment and reducing reliance on endoscopic dilatation.
Endoscopic follow-up is essential due to the increased risk of esophageal squamous cell carcinoma.

Keywords:

Atypical esophagitis Esophageal stricture Lichen planus Lymphocytic esophagitis

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