Diagnosis and Management of Eosinophilic Esophagitis

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Presentation transcript:

Diagnosis and Management of Eosinophilic Esophagitis Evan S. Dellon  Clinical Gastroenterology and Hepatology  Volume 10, Issue 10, Pages 1066-1078 (October 2012) DOI: 10.1016/j.cgh.2012.06.003 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 Endoscopic findings of EoE include fixed esophageal rings (A), narrow-caliber esophagus (B; also note pale/congested mucosa with decreased vascularity), longitudinal furrows running parallel to the axis of the esophagus (C), white plaques or exudates (D), and crêpe-paper mucosa that tears at the passage of the endoscope alone (E). Often, a combination of these findings can be seen at the same time (F). Clinical Gastroenterology and Hepatology 2012 10, 1066-1078DOI: (10.1016/j.cgh.2012.06.003) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 Histologic findings of EoE include brisk infiltrate of eosinophils in the esophageal epithelium, eosinophilic microabscesses (clusters of 4 or more eosinophils), spongiosis, and basal zone hyperplasia (A). In addition to eosinophilic infiltrate, spongiosis, and basal zone hyperplasia, this sample shows eosinophil degranulation, with extracellular eosinophil granules dispersed throughout the epithelium (B). If an esophageal biopsy contains tissue deeper than epithelium, fibrosis of the lamina propria can often be seen (C). Clinical Gastroenterology and Hepatology 2012 10, 1066-1078DOI: (10.1016/j.cgh.2012.06.003) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 Endoscopic dilation for treatment of EoE. A TTS balloon dilator has been inflated to diameter of 12 mm in a patient with EoE and narrow-caliber esophagus (A). When the balloon is deflated, a longitudinal rent is noted, indicating good dilation effect (B). Clinical Gastroenterology and Hepatology 2012 10, 1066-1078DOI: (10.1016/j.cgh.2012.06.003) Copyright © 2012 AGA Institute Terms and Conditions

Figure 4 An approach to diagnosis and management of EoE. Clinical Gastroenterology and Hepatology 2012 10, 1066-1078DOI: (10.1016/j.cgh.2012.06.003) Copyright © 2012 AGA Institute Terms and Conditions