Eosinophilic Esophagitis: A 10-Year Experience in 381 Children

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Presentation transcript:

Eosinophilic Esophagitis: A 10-Year Experience in 381 Children Chris A. Liacouras, Jonathan M. Spergel, Eduardo Ruchelli, Ritu Verma, Maria Mascarenhas, Edisio Semeao, Jonathan Flick, Janice Kelly, Terry Brown–Whitehorn, Petar Mamula, Jonathan E. Markowitz Clinical Gastroenterology and Hepatology Volume 3, Issue 12, Pages 1198-1206 (December 2005) DOI: 10.1016/S1542-3565(05)00885-2 Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 1 Endoscopic image from a patient with EoE with visually normal-appearing esophageal mucosa. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 2 Endoscopic image from a patient with EoE with multiple esophageal rings considered to be “trachealization” or a “feline” esophagus. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 3 Endoscopic image from a patient with EoE with linear esophageal “furrows” giving a “railroad track” appearance to the esophagus. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 4 Endoscopic image from a patient with EoE with multiple, small, pinpoint, white esophageal lesions representing eosinophilic abscess formation. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 5 Graph representing the number of new EoE patients diagnosed from January 1 to December 31 each year for the years 1994 to 2003. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 6 Age of presentation of new patients when first diagnosed with EoE. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 7 Graph representing the effect of oral corticosteroids, swallowed topical corticosteroids, and a mast cell stabilizer on the maximal number of esophageal eosinophils (per most involved 400× HPF) in individual patients before initiating therapy, 4–5 weeks after beginning therapy, and 6 months after discontinuing therapy. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 8 Graph representing the effect of using a specific food elimination diet based on skin prick and patch testing on the number of esophageal eosinophils, GERD symptoms, and dysphagia. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 9 Graph representing the effect of using a strict amino acid–based formula on the number of esophageal eosinophils, GER symptoms, and dysphagia. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 10 Esophageal histology of a patient with severe EoE before the initiation of dietary therapy with an amino acid–based formula. Note the large number of eosinophils and the hypertrophied basal cell layer. H&E stain, original magnification 400×. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions

Figure 11 Esophageal histology of the same patient 1 month after treatment with an amino acid–based formula, water, white grapes, and a natural white grape juice. Note complete resolution of esophageal eosinophils and a normal basal cell layer. H&E stain, original magnification 200×. Clinical Gastroenterology and Hepatology 2005 3, 1198-1206DOI: (10.1016/S1542-3565(05)00885-2) Copyright © 2005 American Gastroenterological Association Terms and Conditions