Clinical Features of Esophageal Eosinophilia According to Endoscopic Phenotypes

  • Kon Takashi
    Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
  • Abe Yasuhiko
    Division of Endoscopy, Yamagata University Hospital, Japan Internal Medicine, Shinoda General Hospital, Japan
  • Sasaki Yu
    Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
  • Kikuchi Ryosuke
    Department of Gastroenterology, JR Sendai Hospital, Japan
  • Uchiyama Shiho
    Department of Gastroenterology, JR Sendai Hospital, Japan
  • Kusaka Gen
    Department of Gastroenterology, JR Sendai Hospital, Japan
  • Yaoita Takao
    Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
  • Yagi Makoto
    Division of Endoscopy, Yamagata University Hospital, Japan
  • Shoji Masakuni
    Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
  • Onozato Yusuke
    Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
  • Mizumoto Naoko
    Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan
  • Ueno Yoshiyuki
    Department of Gastroenterology, Faculty of Medicine, Yamagata University, Japan

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Abstract

<p>Objective Esophageal eosinophilia (EE), a histological hallmark of eosinophilic esophagitis, is classified into two endoscopic phenotypes: localized and diffuse EE. Our aim was to determine the prevalence of EE localized in the lower esophagus and to describe its clinical features in comparison with diffuse EE. </p><p>Methods Data from 81 consecutive patients with EE were retrospectively investigated. EE was histologically defined as ≥15 eosinophils per high-power field. Based on the endoscopic appearance with a histological assessment, EE was classified as either diffuse or localized type. We compared the clinical features, including the medical treatment and natural course, between the two types. </p><p>Results Of the 81 patients, 52 (64.2%) had diffuse EE, and 29 (35.8%) had localized EE. Among men patients, localized EE was significantly more common than diffuse EE. In localized EE, dysphagia and food impaction were less prevalent, and the presence of rings was significantly less common than in diffuse EE. Acid-suppressive therapy was administered to only 3 of the 29 patients with localized EE. In asymptomatic patients, especially those with localized EE, endoscopic abnormalities did not worsen but rather improved in some findings, such as with regard to furrows or exudate, during the natural course of three years without medical treatment. </p><p>Conclusion Localized EE has a strong predilection for men patients and accounted for more than one third of all cases of EE. This condition appears to be less symptomatic and necessitates milder medical treatment than diffuse EE and might not worsen progressively. </p>

Journal

  • Internal Medicine

    Internal Medicine 59 (23), 2971-2979, 2020-12-01

    The Japanese Society of Internal Medicine

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