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Canadian Journal of Gastroenterology &... 2019Esophageal candidiasis (EC) is the most common type of infectious esophagitis. In the gastrointestinal tract, the esophagus is the second most susceptible to candida... (Review)
Review
Esophageal candidiasis (EC) is the most common type of infectious esophagitis. In the gastrointestinal tract, the esophagus is the second most susceptible to candida infection, only after the oropharynx. Immunocompromised patients are most at risk, including patients with HIV/AIDS, leukemia, diabetics, and those who are receiving corticosteroids, radiation, and chemotherapy. Another group includes those who used antibiotics frequently and those who have esophageal motility disorder (cardiac achalasia and scleroderma). Patients complained of pain on swallowing, difficulty swallowing, and pain behind the sternum. On physical examination, there is a plaque that often occurs together with oral thrush. Endoscopic examination is the best approach to diagnose this disease by directly observing the white mucosal plaque-like lesions and exudates adherent to the mucosa. These adherent lesions cannot be washed off with water from irrigation. This disease is confirmed histologically by taking the biopsy or brushings of yeast and pseudohyphae invading mucosal cells. The treatment is by systemic antifungal drugs given orally in a defined course. It is important to differentiate esophageal candidiasis from other forms of infectious esophagitis such as cytomegalovirus, herpes simplex virus, gastroesophageal reflux disease, medication-induced esophagitis, radiation-induced esophageal injury, and inflammatory conditions such as eosinophilic esophagitis. Except for a few complications such as necrotizing esophageal candidiasis, fistula, and sepsis, the prognosis of esophageal candidiasis has been good.
Topics: Antifungal Agents; Candidiasis; Esophagitis; Humans
PubMed: 31772927
DOI: 10.1155/2019/3585136 -
Gut Jan 2024The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or... (Review)
Review
The Lyon Consensus provides conclusive criteria for and against the diagnosis of gastro-oesophageal reflux disease (GERD), and adjunctive metrics that consolidate or refute GERD diagnosis when primary criteria are borderline or inconclusive. An international core and working group was assembled to evaluate research since publication of the original Lyon Consensus, and to vote on statements collaboratively developed to update criteria. The Lyon Consensus 2.0 provides a modern definition of actionable GERD, where evidence from oesophageal testing supports revising, escalating or personalising GERD management for the symptomatic patient. Symptoms that have a high versus low likelihood of relationship to reflux episodes are described. Unproven versus proven GERD define diagnostic strategies and testing options. Patients with no prior GERD evidence (unproven GERD) are studied using prolonged wireless pH monitoring or catheter-based pH or pH-monitoring off antisecretory medication, while patients with conclusive GERD evidence (proven GERD) and persisting symptoms are evaluated using pH-impedance monitoring while on optimised antisecretory therapy. The major changes from the original Lyon Consensus criteria include establishment of Los Angeles grade B oesophagitis as conclusive GERD evidence, description of metrics and thresholds to be used with prolonged wireless pH monitoring, and inclusion of parameters useful in diagnosis of refractory GERD when testing is performed on antisecretory therapy in proven GERD. Criteria that have not performed well in the diagnosis of actionable GERD have been retired. Personalisation of investigation and management to each patient's unique presentation will optimise GERD diagnosis and management.
Topics: Humans; Esophageal pH Monitoring; Consensus; Gastroesophageal Reflux; Esophagitis; Proton Pump Inhibitors
PubMed: 37734911
DOI: 10.1136/gutjnl-2023-330616 -
Gut Aug 2022Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with...
British Society of Gastroenterology (BSG) and British Society of Paediatric Gastroenterology, Hepatology and Nutrition (BSPGHAN) joint consensus guidelines on the diagnosis and management of eosinophilic oesophagitis in children and adults.
BACKGROUND
Eosinophilic oesophagitis (EoE) is an increasingly common cause of dysphagia in both children and adults, as well as one of the most prevalent oesophageal diseases with a significant impact on physical health and quality of life. We have provided a single comprehensive guideline for both paediatric and adult gastroenterologists on current best practice for the evaluation and management of EoE.
METHODS
The Oesophageal Section of the British Society of Gastroenterology was commissioned by the Clinical Standards Service Committee to develop these guidelines. The Guideline Development Group included adult and paediatric gastroenterologists, surgeons, dietitians, allergists, pathologists and patient representatives. The Population, Intervention, Comparator and Outcomes process was used to generate questions for a systematic review of the evidence. Published evidence was reviewed and updated to June 2021. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system was used to assess the evidence and make recommendations. Two rounds of voting were held to assess the level of agreement and the strength of recommendations, with 80% consensus required for acceptance.
RESULTS
Fifty-seven statements on EoE presentation, diagnosis, investigation, management and complications were produced with further statements created on areas for future research.
CONCLUSIONS
These comprehensive adult and paediatric guidelines of the British Society of Gastroenterology and British Society of Paediatric Gastroenterology, Hepatology and Nutrition are based on evidence and expert consensus from a multidisciplinary group of healthcare professionals, including patient advocates and patient support groups, to help clinicians with the management patients with EoE and its complications.
Topics: Adult; Child; Consensus; Eosinophilic Esophagitis; Gastroenterology; Humans; Quality of Life; Societies, Medical
PubMed: 35606089
DOI: 10.1136/gutjnl-2022-327326 -
Minerva Gastroenterologica E Dietologica Jun 2010Eosinophilic esophagitis (EoE) is a chronic, eosinophil-predominant inflammatory condition that can affect esophageal mucosa at any age. Distinguished from... (Review)
Review
Eosinophilic esophagitis (EoE) is a chronic, eosinophil-predominant inflammatory condition that can affect esophageal mucosa at any age. Distinguished from gastroesophageal reflux disease in the mid 1990's, it has seemed to be increasingly prevalent, and is usually a manifestation of food allergy. The endoscopic and histologic features are well described. The clinical manifestations vary considerably by age, with adolescents and adults complaining primarily of dysphagia. Younger children may present with pain, vomiting, other evidence for food allergy, or feeding difficulties. Treatment options include swallowed (non-systemic) steroids and dietary antigen elimination, and must be maintained indefinitely due to the extremely high rate of recurrence off therapy. The complications of untreated disease include fibrosis of the esophageal lamina propria and stricture formation that result in chronic dysphagia, risking food impaction and perforation.
Topics: Adolescent; Adult; Deglutition Disorders; Diagnosis, Differential; Eosinophils; Esophagitis; Fibrosis; Food Hypersensitivity; Gastroscopy; Glucocorticoids; Humans; Risk Factors; Treatment Outcome
PubMed: 20485252
DOI: No ID Found -
Journal of Gastrointestinal and Liver... Mar 2020Eosinophilic esophagitis (EoE) is an eosinophil-rich, Th2 antigen-mediated disease of increasing worldwide prevalence. Originally considered common in children and young... (Review)
Review
Eosinophilic esophagitis (EoE) is an eosinophil-rich, Th2 antigen-mediated disease of increasing worldwide prevalence. Originally considered common in children and young adults, it can be seen at any age, with the highest prevalence between 30 and 40 years. Symptoms reflect esophageal dysfunction, and typical endoscopic pictures consist of rings, furrows, exudates and edema. Progressive disease leads to pathologic tissue remodeling, with ensuing esophageal rigidity and loss of luminal diameter caused by strictures. The definitive diagnosis is histological (at least 15 eosinophils/HPF, high power field), upper gastrointestinal endoscopy with multiple esophageal biopsies being mandatory. Current therapeutic options include dietary and pharmacologic treatments. Despite being successful in a high proportion of patients, elemental diet has multiple disadvantages. Therefore, a step-up approach (using a two-, four- and six food elimination diets) is preferred, being globally effective in up to 79% of cases and avoiding unnecessary restrictions. Drug therapy relies on proton pump inhibitors and topical corticosteroids. Esophageal dilation may be required to increase luminal patency, leading to immediate symptomatic improvement in 95% of EoE patients, who have strictures or narrow caliber esophagus. The chronic nature of the disease necessitates long-term therapy. In this review, current diagnostic and treatment options are discussed and a treatment algorithm is proposed.
Topics: Disease Management; Eosinophilic Esophagitis; Humans
PubMed: 32176746
DOI: 10.15403/jgld-768 -
Ugeskrift For Laeger Nov 2018
Topics: Candida; Candidiasis; Esophagitis; Humans; Risk Factors
PubMed: 30404710
DOI: No ID Found -
Acta Medica Portuguesa Dec 2011Eosinophilic esophagitis (EE) is an inflammatory disease of the esophagus characterized by significant and isolated infiltration of the esophageal mucosa by eosinophils,... (Review)
Review
Eosinophilic esophagitis (EE) is an inflammatory disease of the esophagus characterized by significant and isolated infiltration of the esophageal mucosa by eosinophils, associated with clinical symptoms of esophageal dysfunction, affecting children and adults. It is an increasingly frequent cause of symptoms similar to gastroesophageal reflux disease but refractory to anti-acid therapeutic. It is commonly associated with food allergies or other atopic diseases. Since there are no symptoms, signs, serological biomarkers or endoscopic findings pathognomonic of EE, the diagnosis requires a high degree of suspicion; moreover, due to its chronic relapsing nature the potential to cause major esophageal structural changes, its early recognition and close cooperation between gastroenterologists and immunoallergologists is essential for the timely institution of appropriate therapy. The treatment is based on two main strategies: diet and / or pharmacotherapy, depending on the co-existence of sensitization to food allergens. It is our aim to review this issue, considering recent guidelines, as well as propose a diagnostic and therapeutic algorithm.
Topics: Algorithms; Eosinophilic Esophagitis; Humans
PubMed: 22863504
DOI: No ID Found -
Clinical Medicine (London, England) Nov 2023Lymphocytic oesophagitis is a rare inflammatory condition that was first described in 2006. Although it is being increasingly diagnosed, it remains poorly described and... (Review)
Review
Lymphocytic oesophagitis is a rare inflammatory condition that was first described in 2006. Although it is being increasingly diagnosed, it remains poorly described and characterised. There is limited research on the natural history, diagnosis and management of this condition. The most common presenting symptoms are dysphagia, chest pain and heartburn. Endoscopic features can mimic eosinophilic oesophagitis. International consensus is needed to secure a histological definition, to agree on an endoscopic severity scoring system and to determine an appropriate management algorithm. This review summarises the main evidence for the diagnosis and management of lymphocytic oesophagitis, thus setting the scene for the future directions needed to improve the management of this condition.
Topics: Humans; Eosinophilic Esophagitis; Gastritis
PubMed: 38065611
DOI: 10.7861/clinmed.2023-0440 -
World Journal of Gastroenterology Feb 2017Lymphocytic esophagitis (LE) is a clinicopathologic entity first described by Rubio et al in 2006. It is defined as peripapillary intraepithelial lymphocytosis with... (Review)
Review
Lymphocytic esophagitis (LE) is a clinicopathologic entity first described by Rubio et al in 2006. It is defined as peripapillary intraepithelial lymphocytosis with spongiosis and few or no granulocytes on esophageal biopsy. This definition is not widely accepted and the number of lymphocytes needed to make the diagnosis varied in different studies. Multiple studies have described potential clinical associations and risk factors for LE, such as old age, female gender and smoking history. This entity was reported in inflammatory bowel disease in the pediatric population but not in adults. Other associations include gastroesophageal reflux disease and primary esophageal motility disorders. The most common symptom is dysphagia, with a normal appearing esophagus on endoscopy, though esophageal rings, webs, nodularities, furrows and strictures have been described. Multiple treatment modalities have been used such as proton pump inhibitors and topical steroids. Esophageal dilation seems to be therapeutic when dysphagia is present along with esophageal narrowing secondary to webs, rings or strictures. The natural history of the disease remains unclear and needs to be better delineated. Overall, lymphocytic esophagitis seems to have a chronic and benign course, except for two cases of esophageal perforation in the literature, thought to be secondary to this entity.
Topics: Biopsy; Botulinum Toxins, Type A; Endoscopy; Esophageal Motility Disorders; Esophagitis; Gastroesophageal Reflux; Glucocorticoids; Humans; Lymphocytosis; Proton Pump Inhibitors
PubMed: 28246468
DOI: 10.3748/wjg.v23.i6.949 -
American Journal of Physiology.... Nov 2018Classically, eosinophilic esophagitis is an antigen-mediated chronic disease distinct from gastroesophageal reflux disease. Eosinophilic esophagitis is an emerging... (Review)
Review
Classically, eosinophilic esophagitis is an antigen-mediated chronic disease distinct from gastroesophageal reflux disease. Eosinophilic esophagitis is an emerging clinical problem that is growing in recognition. It is characterized clinically by feeding dysfunction, dysphagia, and reflux-like symptoms. Histologically, eosinophilic esophagitis is identifiable by a dense epithelial eosinophilic infiltrate. Experimental modeling and clinical studies over the last decade have greatly improved mechanistic insights and led to improvements in clinical understanding and the assessment of therapeutic options for patients and their clinicians who manage this disease. Here, we review the clinicopathologic diagnostic criteria and our understanding of eosinophilic esophagitis as an allergic disease with genetic and immunological components. We present studies defining the importance of the epithelial barrier and the concept of barrier dysfunction as an initiating or perpetuating factor for this disease. We discuss the relationship between the symptoms of dysphagia and feeding dysfunction, our current knowledge of the underlying pathophysiologic mechanisms, and advances in clinical assessment of esophageal distensibility and narrowing in eosinophilic esophagitis patients. Finally, therapeutic implications relating to the advances that have led to our current understanding of the pathophysiology of eosinophilic esophagitis are explored.
Topics: Animals; Eosinophilic Esophagitis; Eosinophils; Epithelial Cells; Humans; Immunoglobulin G
PubMed: 30212252
DOI: 10.1152/ajpgi.00174.2018