Eosinophilic In Adults: Ø Dysphagia Ø Repeated food

Eosinophilic
Esophagitis An Overview:

Abbreviations:

Ø  GERD= Gastrophageal reflux disease

Ø  GI=Gastrointestinal

Ø  EE/EoE=Eosinophilic Esophagitis

Ø  MDI=meter dose inhaler

Ø  IL=Interleukin

Ø  E=Eosinophil

What
is the Anatomy of esophagus?

The esophagus is a muscular duct about 23 to 25 cm. long, expand
from the pharynx to the stomach. It begins in the neck at the lower edge of the
cricoids cartilage, opposite the sixth cervical vertebra, descends along the
front of the vertebral column, through the superior and posterior mediastina, by
pass through the diaphragm, and, entering the abdomen, ends at the cardiac
orifice of the stomach.

Introduction:

EE is a severe immune system
disease. It has been recognized only in the past two decades, but considered a
major reason of digestive system (gastrointestinal) illness. In the existence
of eosinophilia (an abnormally increase in a number of white blood cells) the
esophagus has been noted in patients who have (GERD). It is an inciting
condition of the esophagus. White blood cells assemble up in the lining of the
tube that joins your mouth to your esophagus. This happen, owed by a response
to foods, allergens or acid reflux; causes irritation or injures the esophageal
tissue. Injured esophageal tissue can lead to trouble in gulp.

 

 

 

What
are the Clinical Sign & Symptoms?

In Adults:

Ø 
Dysphagia

Ø 
Repeated
food Impaction

Ø 
Centrally
located chest pain (not respond to antacid)

Ø 
Not
responded to GERD medication

Ø 
Heart
burn

Ø 
Stomach-ache

Ø 
Undigested
food backflow

Ø 
Diarrhea(Rarely)

Ø 
Nausea

In Children:

Ø 
Feeding
problem in infants

Ø 
Eating
problem in children

Ø 
Emesis

Ø 
Abdominal
pain

Ø 
Poor
growth

Ø 
Malnutrition

Ø 
Weight
loss

Ø 
Heart
burn

Ø 
Food
impaction

 

Age
Grouped:

The patient age group
ranged from 2 months to 89 years. It was stated that males are more influence
in both children (66%) and adults (76%).

 

 Etiology of Eosinophilic Esophagitis:

Allergic effect have been strongly
suggested a reason of EE. This proof with results of patients with EE has
conditions such as atopic dermatitis, allergic rhinitis, asthma, and eczema. The
patients with it also illustrate allergic antigen sensitization from skin
testing or antigen-specific immunoglobulin E (IgE) appearance from plasma
testing. Interleukin (IL)-4, IL-5, IL-13, and mast cells are originated in the
esophagus of patients with EE. Seasonal dissimilarity in symptoms has been shows
in seasonal changes in eosinophilic ranges in the proximal esophagus. The raised
rate of eczema and other atopic allergies need that the patient be evaluated by
an allergist. Inhaled allergens may also exit a role in EE, and the patient
should thus be evaluated for this as a causative issue. 

Which Diagnostic
tests requires?

Diagnostic test for EE consists
of:

Upper endoscopy. Insert a long narrow tube
containing a light and minute camera and put in it through mouth down the
esophagus. Inspect the lining of esophagus for irritation and amplification,
horizontal rings, vertical furrows, narrowing (strictures), and white
patches.

 

Biopsy: Biopsy
of esophagus by taking a small piece of tissue & takes many samples
from esophagus and then check the tissue under a microscope for
eosinophils.Blood tests: If suspect EE, some additional
tests to confirm the diagnosis and to begin to seem for the sources of
allergens. Blood tests to rule out  elevated than normal eosinophil counts or
total immunoglobulin E levels, suggesting allergy.

What is
the Treatment of Eosinophilic Esophagitis?

Treatment strategies for EE are consist
of:

Dietary
control:

If persons have food
allergies, take allergen-free diets. If patients do not respond to food taking
away of specific antigens, amino acid-based formula management is the recent
gold standard for evaluating. This treatment has been very important in
children, with a successful rate .Resolution of symptoms occurred within 7 to
10 days, and with histological improvement seen within 4 to 5 weeks. Amino
acid-based formulas generally have an unlikable taste, and often the feedings
are given via nasogastral tubes. A slow introduction of certain foods can be
started when symptoms resolve and histology recover. The six most common
allergic foods are:

Dairy,
Eggs, Wheat, Soy, Peanuts and Fish or shellfish

Treatment:

Esophageal dilation may be required
in patients with food impactions cause by fixed strictures as a effect of
esophageal narrowing. Esophageal dilation may be done to treat the stricture in
cases of dysphagia or esophageal impaction. It is suggested that, if feasible,
an endoscopy with biopsy be done earlier to an esophageal dilation, helpful for
medical or dietary treatment. Complications from dilation can effect in
esophageal tears or lacerations. Presently, there are no records to assess
which patients will be at high risk for complications. However, patients who
have already developed esophageal rings, strictures, or narrowing are
considered to be at high risk for difficulty. 

Antibiotics:

New study information that
antibiotic use in the first year of infancy was related with six times the odds
of developing EE. The usage of antibiotics has been linked to allergy
development in mice. Amusingly the occurrence of H.pylori in gastric biopsies is also
inversely associated with EE. There is, however, no indication to recommend
that patients undergoing antibiotic induced H.
pylori eradication are at higher risk for EE.

EE is a polygenic disorder
in which a dysregulated environment in the oesophageal mucosa shows to lead to
inflammatory cell infiltration and disease development in response to food
allergens and aeroallergen). Both genetic and/or environmental cause appear to manipulate
the production of mediators such as TSLP and eotaxin-3 by epithelial and other
stromal cells. Eosinophils, Th2 lymphocytes, and mast cells are conscript to
the mucosa. B lymphocytes may go through local IgE class switching. Increasing
evidence show that environmental factors, in particular medications such as
antibiotics, particularly early in life, could put in to disease development
and may even account for the amplified occurrence of disease observed.

 

 

 

 Lifestyle modification/ home remedies:

If heartburn, these way of
life modification may help decrease the occurrence or severity of indication:

Maintain a well weight: Excess pounds put pressure on
your abdomen, pushing up your stomach and causing acid to back up into
your esophagus. If weight is at a healthy level, work to maintain it. If
obese, work to slowly drop weight — no more than 0.5 to 1 kg /week.

 

Evade foods and drinks that cause
heartburn:
General triggers, such as fatty or fried foods, tomato sauce, alcohol,
chocolate, mint, garlic, onion, and caffeine, may create heartburn worse. Evade
foods you know will cause your heartburn.

 

 

Raise the top of your bed: Regularly experience heartburn
at night or while trying to sleep, put gravity to work. Need to elevate
your bed.

 

Alternative
medications:

No other medicinal therapy
has been proved to treat eosinophilic esophagitis. Still, some complementary
and substitute treatment may provide some release from heartburn or reflux signs.
Other treatments options may include:

Herbal therapy: Herbal therapy sometimes used
for heartburn or reflux symptoms include licorice, slippery elm,
chamomile, marshmallow and others. Herbal treatment can have serious side
effects, and they may hinder with medications. Relaxation treatment: This Method to calm stress and
anxiety may decrease signs of heartburn or reflux. Such as progressive
muscle relaxation.Acupuncture: Acupuncture involves introduce
thin needles into definite points on your body. Limitedly it may effective,
but most of the time not beneficial.

Conclusion

EE is a chronic condition. It
may have been misdiagnosed as GERD. Though GERD can co-exist with EE and both
have similarity in signs, EE not respond at high dose (2 mg/kg/day) PPI
therapy. Allergic responses have been strongly recommended as a reason of EE,
and many patients respond to an allergen-free diet.

Other non-FDA recommended
treatments consist of short-term use of systemic and topical corticosteroids.
Montelukast has been used to treat a minimal number of EE patients along
inhaled allergens. Reslizumab, anti-IL-5, mepolizumab, and viscous budesonide
are currently in clinical trial for the management of EE. Esophageal dilation
may be important in patients who increase a food impaction as  effect of esophageal narrowing.

Main messages:

·        
The
occurrence of eosinophilic oesophagitis is rising.

·        
EE
is illustrate by signs of dysphagia, food impaction and proton pump inhibitor
defiant dyspepsia, and histological
by major eosinophilic infiltration of the oesophageal mucosa.

·        
A
minimum of 2–4 oesophageal biopsies should be taken from the proximal and
distal oesophagus to identify EE.

·        
EE
is linked with atopy and T helper type 2 reactions. A thorough allergy history necessary
to be taken before testing for food and aeroallergens in EE patients.

·        
Genome-wide
analysis studies have form EE to be associated with a region on chromosome 5q22
in a pediatric cohort. The gene for thymic stromal lymphopoietin is localised
to this region.