CC BY-NC-ND 4.0 · Endosc Int Open 2018; 06(02): E165-E172
DOI: 10.1055/s-0043-122882
Original article
Eigentümer und Copyright ©Georg Thieme Verlag KG 2018

Ankylosaurus back sign: novel endoscopic finding in esophageal eosinophilia patients indicating proton pump inhibitor response

Norihisa Ishimura
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Shohei Sumi
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Mayumi Okada
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Daisuke Izumi
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Hironobu Mikami
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Eiko Okimoto
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Nahoko Ishikawa
Department of Pathology, Shimane University School of Medicine, Izumo, Japan
,
Yuji Tamagawa
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Tsuyoshi Mishiro
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Naoki Oshima
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Kotaro Shibagaki
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Shunji Ishihara
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
,
Riruke Maruyama
Department of Pathology, Shimane University School of Medicine, Izumo, Japan
,
Yoshikazu Kinoshita
Department of Gastroenterology and Hepatology, Shimane University School of Medicine, Izumo, Japan
› Author Affiliations
Further Information

Publication History

submitted 18 May 2017

accepted after revision 22 September 2017

Publication Date:
01 February 2018 (online)

Abstract

Background and study aims Characteristic endoscopic findings, such as linear furrows, rings, and whitish exudates, indicate the presence of esophageal eosinophilia (EE), though no specific findings are known to distinguish eosinophilic esophagitis (EoE) from proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE). Here, we present a novel endoscopic finding in some EE patients possessing a linear longitudinal arrangement of whitish nodules with the appearance of the back of an Ankylosaurus dinosaur, termed Ankylosaurus back sign (ABS), and evaluations of its significance in affected patients.

Patients and methods Fifty-five patients diagnosed with EE (≥ 15 eosinophils/high power field) who were treated at our hospital and shown to evaluate a PPI response were enrolled. Endoscopic findings at baseline and clinical parameters were retrospectively reviewed. Furthermore, the clinicopathological features of patients with ABS, as well as the relationship between its presence and PPI response were evaluated.

Results Fifty-five patients (47 males, 8 females) with EE (17 with EoE, 38 with PPI-REE) were evaluated, of whom 50 (90.9 %) had linear furrows, the most frequently found feature, while ABS was found in 9 (16.4 %). Inter-observer agreement was substantial for ABS (κ 0.77). Interestingly, all patients with ABS had PPI-REE. Our findings revealed that the presence of ABS was closely associated with reflux esophagitis (RE) in patients with PPI-REE.

Conclusions Although ABS was less frequent than typical endoscopic findings such as linear furrows in EE, this novel finding was closely associated with PPI-REE accompanied with RE. The clinical implications of ABS in patients with EE should be investigated further.