System: Gastrointestinal: Esophagus: Benign: Eosinophilic Esophagitis
Endoscopic image shows a feature classic for eosinophilic esophagitis -- concentric rings along the esophagus. This may be referred to as feline esophagus.
Longitudinal furrows are another feature sometimes seen in this disorder.
Food impaction may be encountered as a complication.
Discrete areas of exudate (whitish areas) are seen on the surface of the esophageal mucosa.
The esophagus shows reactive changes with a pronounced basal cell layer, spongiosis, and infiltration by numerous eosinophils.
The eosinophils are not only prominent, but also have a tendency to distribute towards the luminal aspect of the epithelium. In the pathogenesis of EE, the initiating event is theorized to be an allergen in the lumen of esophagus.
Another patient demonstrated these findings in the mid-esophagus, including marked elongation of papillae, basal zone hyperplasia, and spongiosis along with numerous esoinophils with a luminal preponderance.
The superficial layer of this squamous mucosa is heavily infiltrated by eosinophils.
Higher power shows clusters of eosinophils making up most of the surface.
Yet another example of this entity in classic form.
The incidence of eosinophilic esophagitis (EE) is increasing in both children and adults. In the past, EE was often diagnosed as GERD as reflux esophagitis also demonstrates intraepithelial eosinophils. However, a characteristic of EE is that the eosinophils persist despite anti-reflux medications and furthermore, and the number of eosinophils in EE is more prominent than in GERD. A proposed qualitative measure is >15-20 eosinophils in the most involved field using 400x (Brown-Whitehorn).
EE is isolated to the esophagus, whereas eosinophilic gastroenteritis affects numbers sites in the GI tract (including the esophagus).
Typically causes symptoms similar to GERD (regurgitation, epigastric pain and vomiting) in children, and in adolescents and adults, symptoms also include dysphagia and food impaction. EE is often seen in patients with asthma, allergies and a family history of atopy (allergies).
Endoscopy may reveal linear furrows, mucosal rings (trachealization), or strictures. Up to 1/3 of patients may have a normal endoscopy (Brown-Whitehorn, Wen).
A combination of dietary modification (to avoid food allergens) and steroids are currently used.
→Endoscopic findings include furrows and rings (feline eosphagus).
→Microscopic findings should include at least 15-20 eosinophils in the most involved HPF.
• Stomach : Eosinophilic Gastritis
Brown-Whitehorn T, Liacouras CA. Eosinophilic Esophagitis. Current Opinion in Pediatrics. 2007;19:575-580.
Wen J, Chu AS, Mascarenhas R. Eosphagitis. eMedicine. Accessed 8/10/09. Available at: http://emedicine.medscape.com/article/928891-overview