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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 -
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 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 -
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 -
Journal of Investigational Allergology... Dec 2022Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by... (Review)
Review
Eosinophilic esophagitis is a chronic antigen-mediated esophageal disease characterized clinically by symptoms related to esophageal dysfunction and histologically by TH2 inflammation (at least 15 eosinophils/high power field) when other secondary systemic and local causes of esophageal eosinophilia are excluded. Although this disease was initially ascribed to a delayed reaction to food allergens, emerging evidence suggests that aeroallergens may also play a role in pathogenesis and disease course. Some studies support seasonal variations in the diagnosis of eosinophilic esophagitis and disease exacerbations owing to the increase in aeroallergens to which patients are sensitized. It is also known that this disease can be caused by extensive, identifiable exposure to aeroallergens and after treatment with specific immunotherapy based on food or aeroallergens. It was recently postulated that treatment of allergic rhinoconjunctivitis can improve the symptoms of eosinophilic esophagitis, although data are limited to case reports and small series. Currently, biomarkers and biologic therapies are not helpful for diagnosis or inducing clinical and histological remission of the disease. Nevertheless, there are high hopes for dupilumab. This review aims to give visibility to the involvement of aeroallergens in the triggering and exacerbation of eosinophilic esophagitis, since many of them, in addition to being airborne and inhalant, can also be ingested as food. Clearly, we must try to identify the cause of the disease to ensure remission.
Topics: Humans; Eosinophilic Esophagitis; Allergens; Food Hypersensitivity; Eosinophils; Disease Progression
PubMed: 36000828
DOI: 10.18176/jiaci.0853 -
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 -
Archives of Pathology & Laboratory... Jun 2015Inflammatory lesions of the esophagus are a diverse group, often with nonspecific histologic findings. These benign changes can produce diagnostic difficulties for... (Review)
Review
CONTEXT
Inflammatory lesions of the esophagus are a diverse group, often with nonspecific histologic findings. These benign changes can produce diagnostic difficulties for pathologists.
OBJECTIVE
To discuss the typical histologic findings of a variety of the most common causes of esophagitis (reflux, eosinophilic esophagitis, infections, medications) along with less common issues such as sloughing esophagitis and skin disorders involving the squamous mucosa.
DATA SOURCES
The literature has been reviewed to discuss histologic definitions of current and developing issues in the area of esophagitis.
CONCLUSIONS
Histologic features are not entirely sensitive and specific for inflammatory esophageal disorders. Awareness of these problems is essential; clinical and endoscopic information can be very useful in distinguishing among the various lesions.
Topics: Biopsy; Candidiasis; Crohn Disease; Esophagitis; Esophagus; Humans; Pharmaceutical Preparations; Risk Factors; Skin Diseases
PubMed: 26030241
DOI: 10.5858/arpa.2014-0132-RA -
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 -
Ugeskrift For Laeger Nov 2018
Topics: Candida; Candidiasis; Esophagitis; Humans; Risk Factors
PubMed: 30404710
DOI: No ID Found -
The American Journal of Case Reports Sep 2021BACKGROUND Gastroesophageal reflux disease, infectious esophagitis, and eosinophilic esophagitis are the most frequent causes of esophagitis, the latter 2 etiologies...
BACKGROUND Gastroesophageal reflux disease, infectious esophagitis, and eosinophilic esophagitis are the most frequent causes of esophagitis, the latter 2 etiologies being generally considered independently. However, the association between both entities has been suggested through case reports in immunocompetent patients. CASE REPORT We present the case of an immunocompetent 26-year-old man presenting with fever, adynamia, retrosternal pain, and dysphagia. Endoscopy was performed, showing whitish lesions in circular plates with erosions, and in some depressed areas in the middle and distal esophagus. Biopsies showed the presence of ulcerated foci covered by fibrinoleukocyte exudate in granulation tissue and nuclear inclusions with a viral appearance. The immunohistochemical study for herpes simplex virus (HSV) was positive. The patient was treated symptomatically and progressed favorably. The endoscopic control carried out at 3 months showed longitudinal grooves and trachealization, findings compatible with the diagnosis of eosinophilic esophagitis and with biopsies that confirmed the etiology by showing an increase in eosinophil count >20 per field, without isolating HSV. CONCLUSIONS This clinical case confirms the possible relationship between esophagitis caused by HSV and eosinophilic esophagitis. Alterations at the immune level and damage to the esophageal mucosa barrier may explain this relationship. In this scenario, an endoscopic follow-up should be considered.
Topics: Adult; Eosinophilic Esophagitis; Esophagitis; Gastroesophageal Reflux; Herpes Simplex; Humans; Male; Simplexvirus
PubMed: 34565790
DOI: 10.12659/AJCR.933565