Volume 154, Issue 5, Pages e3 (April 2018)

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Volume 154, Issue 5, Pages 1217-1221.e3 (April 2018) New Eosinophilic Esophagitis Concepts Call for Change in Proton Pump Inhibitor Management Before Diagnostic Endoscopy Eunice Odiase Gastroenterology Volume 154, Issue 5, Pages 1217-1221.e3 (April 2018) DOI: 10.1053/j.gastro.2018.03.003 Copyright © 2018 AGA Institute Terms and Conditions

Figure 1 Endoscopic photograph of the distal esophagus and photomicrograph of an esophageal biopsy from patient 1’s initial endoscopy (on proton pump inhibitors) showing no mucosal abnormality endoscopically or histologically. Gastroenterology 2018 154, 1217-1221.e3DOI: (10.1053/j.gastro.2018.03.003) Copyright © 2018 AGA Institute Terms and Conditions

Figure 2 Endoscopic photograph of the distal esophagus and photomicrograph of an esophageal biopsy from patient 1’s repeat endoscopy (at 4 weeks off proton pump inhibitors) showing prominent linear furrows, rings, and dense eosinophilia. Gastroenterology 2018 154, 1217-1221.e3DOI: (10.1053/j.gastro.2018.03.003) Copyright © 2018 AGA Institute Terms and Conditions

Supplemental Figure 1 Patient 1. High-resolution esophageal manometry showing failed peristalsis. The integrated relaxation pressure was 12.4 mm Hg. Gastroenterology 2018 154, 1217-1221.e3DOI: (10.1053/j.gastro.2018.03.003) Copyright © 2018 AGA Institute Terms and Conditions

Supplemental Figure 2 Patient 1. Barium swallow showing mild narrowing of the distal esophagus. Gastroenterology 2018 154, 1217-1221.e3DOI: (10.1053/j.gastro.2018.03.003) Copyright © 2018 AGA Institute Terms and Conditions

Supplemental Figure 3 Endoscopic photograph showing an esophageal tear that resulted from passage of the endoscope through the narrowed distal esophagus. This endoscopy was performed 4 weeks after patient 1 stopped proton pump inhibitor therapy. Gastroenterology 2018 154, 1217-1221.e3DOI: (10.1053/j.gastro.2018.03.003) Copyright © 2018 AGA Institute Terms and Conditions

Supplemental Figure 4 Endoscopic photographs of the distal esophagus of Patient 2. A, Mild furrowing was noted on the initial endoscopy while the patient was taking proton pump inhibitors (PPIs), but esophageal biopsy specimens showed only scattered eosinophils, up to a maximum of 9 per high-power field in focal areas. B, Prominent furrowing was seen on repeat endoscopy after PPIs were stopped for 3 weeks, and esophageal biopsies showed prominent eosinophilia with up to 30 eosinophils per high-power field. Gastroenterology 2018 154, 1217-1221.e3DOI: (10.1053/j.gastro.2018.03.003) Copyright © 2018 AGA Institute Terms and Conditions