CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(04): E433-E439
DOI: 10.1055/a-0859-7276
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Association between endoscopic findings of eosinophilic esophagitis and responsiveness to proton pump inhibitors

Akinari Sawada
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Atsushi Hashimoto
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Risa Uemura
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Koji Otani
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Fumio Tanaka
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Yasuaki Nagami
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Hirokazu Yamagami
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Tetsuya Tanigawa
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Toshio Watanabe
Department of Gastroenterology, Osaka City University Graduate School of Medicine
,
Yasuhiro Fujiwara
Department of Gastroenterology, Osaka City University Graduate School of Medicine
› Author Affiliations
Further Information

Publication History

submitted 15 October 2018

accepted after revision 29 January 2019

Publication Date:
21 March 2019 (online)

Abstract

Background and study aims Endoscopic findings of esophageal eosinophilia sometimes localize to small areas of the esophagus. A previous study suggested that pathogenesis of localized-type eosinophilic esophagitis (LEoE) was associated with acid reflux. However, LEoE treatment outcomes have not been studied. We aimed to analyze the clinical and histologic significance of LEoE in comparison with diffuse-type eosinophilic esophagitis (DEoE).

Patients and methods This study included 106 patients with esophageal eosinophilia. Esophageal eosinophilia was defined as a condition where the maximum number of intraepithelial eosinophils was ≥ 15 per high-power field. LEoE was defined as an endoscopic lesion confined to one-third of the esophagus: upper, middle, or lower. Esophageal eosinophilia encompassing more than two-thirds of the esophagus was defined as DEoE. We retrospectively compared LEoE and DEoE in terms of clinical characteristics, histologic findings, and proportion of proton pump inhibitor (PPI) responders.

Results Of 106 patients, 12 were classified as having LEoE and 94 were classified as having DEoE. The proportion of asymptomatic patients was significantly higher in the LEoE group than the DEoE group (42 % vs 7 %, P < 0.01). In the LEoE group, 10 patients (84 %) had endoscopic lesions in the lower esophagus. The maximum number of eosinophils did not differ between the groups (54 [24 – 71] for LEoE, 40 [20 – 75] for DEoE, P = 0.65). The prevalence of PPI responders was significantly higher in the LEoE group than the DEoE group (100 % vs 63 %, P = 0.01).

Conclusion LEoE can be a sign of good responsiveness to PPI therapy.

 
  • References

  • 1 Lucendo AJ, Molina-Infante J, Arias Á. et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017; 5: 335-358
  • 2 Dellon ES, Hirano I. Epidemiology and natural history of eosinophilic esophagitis. Gastroenterology 2018; 154: 319-332.e313
  • 3 Arias Á, Pérez-Martínez I, Tenías JM. et al. Systematic review with meta-analysis: the incidence and prevalence of eosinophilic oesophagitis in children and adults in population-based studies. Aliment Pharmacol Ther 2016; 43: 3-15
  • 4 Lucendo AJ, Arias Á, Molina-Infante J. Efficacy of proton pump inhibitor drugs for inducing clinical and histologic remission in patients with symptomatic esophageal eosinophilia: a systematic review and meta-analysis. Clin Gastroenterol Hepatol 2016; 14: 13-22.e11
  • 5 Molina-Infante J, Bredenoord AJ, Cheng E. et al. Proton pump inhibitor-responsive oesophageal eosinophilia: an entity challenging current diagnostic criteria for eosinophilic oesophagitis. Gut 2016; 65: 524-531
  • 6 Hirano I, Moy N, Heckman MG. et al. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013; 62: 489-495
  • 7 Abe Y, Iijima K, Ohara S. et al. Localized esophageal eosinophilia: Is it an early manifestation of eosinophilic esophagitis or a subtype of gastroesophageal reflux disease?. Dig Endosc 2014; 26: 337-343
  • 8 Lundell LR, Dent J, Bennett JR. et al. Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut 1999; 45: 172-180
  • 9 Kimura K, Takemoto T. An endoscopic recognition of the atrophic border and its significance in chronic gastritis. Endoscopy 1969; 1: 87-97
  • 10 Hill LD, Kozarek RA, Kraemer SJ. et al. The gastroesophageal flap valve: in vitro and in vivo observations. Gastrointest Endosc 1996; 44: 541-547
  • 11 Saffari H, Peterson KA, Fang JC. et al. Patchy eosinophil distributions in an esophagectomy specimen from a patient with eosinophilic esophagitis: Implications for endoscopic biopsy. J Allergy Clin Immunol 2012; 130: 798-800
  • 12 Liacouras CA, Furuta GT, Hirano I. et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol 2011; 128: 3-20.e26 ; quiz 21-22
  • 13 Dellon ES, Gonsalves N, Hirano I. et al. ACG clinical guideline: Evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol 2013; 108: 679-692 ; quiz 693
  • 14 Molina-Infante J, Ferrando-Lamana L, Ripoll C. et al. Esophageal eosinophilic infiltration responds to proton pump inhibition in most adults. Clin Gastroenterol Hepatol 2011; 9: 110-117
  • 15 Dellon ES, Speck O, Woodward K. et al. Clinical and endoscopic characteristics do not reliably differentiate PPI-responsive esophageal eosinophilia and eosinophilic esophagitis in patients undergoing upper endoscopy: a prospective cohort study. Am J Gastroenterol 2013; 108: 1854-1860
  • 16 Moawad FJ, Schoepfer AM, Safroneeva E. et al. Eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia have similar clinical, endoscopic and histological findings. Aliment Pharmacol Ther 2014; 39: 603-608
  • 17 Warners MJ, van Rhijn BD, Curvers WL. et al. PPI-responsive esophageal eosinophilia cannot be distinguished from eosinophilic esophagitis by endoscopic signs. Eur J Gastroenterol Hepatol 2015; 27: 506-511
  • 18 Iwakura N, Fujiwara Y, Tanaka F. et al. Basophil infiltration in eosinophilic oesophagitis and proton pump inhibitor-responsive oesophageal eosinophilia. Aliment Pharmacol Ther 2015; 41: 776-784
  • 19 Spechler SJ, Genta RM, Souza RF. Thoughts on the complex relationship between gastroesophageal reflux disease and eosinophilic esophagitis. Am J Gastroenterol 2007; 102: 1301-1306
  • 20 Dellon ES, Liacouras CA, Molina-Infante J. et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: Proceedings of the AGREE conference. Gastroenterology 2018; 155: 1022-1033
  • 21 Furuta GT, Liacouras CA, Collins MH. et al. Eosinophilic esophagitis in children and adults: a systematic review and consensus recommendations for diagnosis and treatment. Gastroenterology 2007; 133: 1342-1363
  • 22 Rodríguez-Sánchez J, Barrio-Andrés J, Nantes Castillejo O. et al. The Endoscopic Reference Score shows modest accuracy to predict either clinical or histological activity in adult patients with eosinophilic oesophagitis. Aliment Pharmacol Ther 2017; 45: 300-309
  • 23 van Rhijn BD, Verheij J, Smout AJ. et al. The Endoscopic Reference Score shows modest accuracy to predict histologic remission in adult patients with eosinophilic esophagitis. Neurogastroenterol Motil 2016; 28: 1714-1722
  • 24 Dellon ES, Cotton CC, Gebhart JH. et al. Accuracy of the eosinophilic esophagitis endoscopic reference score in diagnosis and determining response to treatment. Clin Gastroenterol Hepatol 2016; 14: 31-39
  • 25 Kim HP, Vance RB, Shaheen NJ. et al. The prevalence and diagnostic utility of endoscopic features of eosinophilic esophagitis: a meta-analysis. Clin Gastroenterol Hepatol 2012; 10: 988-996.e985
  • 26 Ronkainen J, Talley NJ, Aro P. et al. Prevalence of oesophageal eosinophils and eosinophilic oesophagitis in adults: the population-based Kalixanda study. Gut 2007; 56: 615-620
  • 27 Ma X, Xu Q, Zheng Y. et al. Prevalence of esophageal eosinophilia and eosinophilic esophagitis in adults: a population-based endoscopic study in Shanghai, China. Dig Dis Sci 2015; 60: 1716-1723
  • 28 Schoepfer AM, Safroneeva E, Bussmann C. et al. Delay in diagnosis of eosinophilic esophagitis increases risk for stricture formation in a time-dependent manner. Gastroenterology 2013; 145: 1230-1236.e1231-1232
  • 29 Fujiwara Y, Sugawa T, Tanaka F. et al. A multicenter study on the prevalence of eosinophilic esophagitis and PPI-responsive esophageal eosinophilic infiltration. Intern Med 2012; 51: 3235-3239
  • 30 Kedika RR, Souza RF, Spechler SJ. Potential anti-inflammatory effects of proton pump inhibitors: a review and discussion of the clinical implications. Dig Dis Sci 2009; 54: 2312-2317
  • 31 Odiase E, Schwartz A, Souza RF. et al. New eosinophilic esophagitis concepts call for change in proton pump inhibitor management before diagnostic endoscopy. Gastroenterology 2018; 154: 1217-1221.e1213
  • 32 Cheng E, Zhang X, Huo X. et al. Omeprazole blocks eotaxin-3 expression by oesophageal squamous cells from patients with eosinophilic oesophagitis and GORD. Gut 2013; 62: 824-832
  • 33 Huo X, Zhang X, Yu C. et al. In oesophageal squamous cells exposed to acidic bile salt medium, omeprazole inhibits IL-8 expression through effects on nuclear factor-κB and activator protein-1. Gut 2014; 63: 1042-1052
  • 34 Davis BP, Rothenberg ME. Eosinophils and cancer. Cancer Immunol Res 2014; 2: 1-8
  • 35 Ishibashi S, Ohashi Y, Suzuki T. et al. Tumor-associated tissue eosinophilia in human esophageal squamous cell carcinoma. Anticancer Res 2006; 26: 1419-1424