Upper GI endoscopy in eosinophilic diseases

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The role of endoscopy, when examining eosinophilic diseases, is similar to the general procedure of an endoscopic check in which a definitive diagnosis is found through a macroscopic view and a general histological examination of biopsies. The endoscopic procedure does not give specific pictures when reviewing eosinophilic gastroenteritis (EGE) and eosinophilic esophagitis (EoE); however, the findings from the procedure are often very important to suspecting the disease, to guiding biopsies, and to ruling out other diagnoses. Eosinophilic gastroenteritis (EGE) is a rare disease that affects both adults and children and is most commonly found in Caucasians, according to several clinical findings. Presentation may vary depending on location as well as the depth and extent of gastrointestinal tract involvement (i.e. crampy abdominal pain, nausea, vomiting, diarrhea, gastrointestinal bleeding and weight loss). It is associated with peripheral eosinophilia, which causes eosinophilic to infiltrate the stomach and intestine. The infiltration usually occurs in patients with prior history of atopy. EGE is classified into three types of diseases based on the anatomic location of eosinophilic infiltration in different layers of the intestinal wall (mucosal, muscularis, and subserosal layers). EGE is characterized by dense eosinophilic inflammation of one or several digestive tract sections. An infiltration of >20-30 eosinophils per high power field (HPF) in at least five HPF, exhibiting signs of eosinophilic degranulation and extending to the muscolaris mucosa or submucosa, are all histological indications of EGE located in the crypt. Corticosteroids are the central components of therapy used for EGE, but dietary therapy could also be considered. Eosinophilic esophagitis (EoE) is a chronic immune/antigen mediated esophageal inflammatory disease associated with esophageal dysfunction, resulting from severe eosinophilic predominant inflammation. The updated definition of the disease includes the histological presence of >=15 eosinophils per HPF in at least one endoscopic esophageal mucosal biopsy (peak value) taken at upper gastrointestinal endoscopy, and/or eosinophilic microabscesses, superficial layering, or extracellular eosinophil granules. Endoscopy plays different roles when examining EoE.: At diagnosis, the first examination is useful when analyzing the esophageal eosinophilia; subsequently, a second EGD should be performed by proton pump inhibitors (PPIs) therapy, which helps to discriminate EoE from different causes of esophageal eosinophilia. During the follow up, endoscopy is essential when verifying the degree of eosinophilic infiltration in order to modify therapy for any nonresponses. Further research is required to elucidate the roles of allergens in the pathogenesis of EoE, so proper tools are used for diagnostic and specific treatment.

Original languageEnglish
Title of host publicationGastrointestinal Endoscopy in Children
PublisherNova Science Publishers, Inc.
Pages187-199
Number of pages13
ISBN (Print)9781634630795, 9781634630740
Publication statusPublished - Oct 1 2014

Keywords

  • Eosinophilic esophagitis
  • eosinophilic gastro intestinal disorders
  • eosinophilic gastroenteritis
  • upper endoscopy

ASJC Scopus subject areas

  • Medicine(all)

Fingerprint Dive into the research topics of 'Upper GI endoscopy in eosinophilic diseases'. Together they form a unique fingerprint.

  • Cite this

    Rea, F., Romeo, E., Faraci, S., Caldaro, T., Torroni, F., di Abriola, G. F., Dall'Oglio, L., & De Angelis, P. (2014). Upper GI endoscopy in eosinophilic diseases. In Gastrointestinal Endoscopy in Children (pp. 187-199). Nova Science Publishers, Inc..