Clinical characteristics and diagnostic value of endoscopic ultrasonography for adult eosinophilic esophagitis
10.3760/cma.j.cn321463-20240204-00365
- VernacularTitle:成人嗜酸细胞性食管炎的临床特征及超声内镜诊断价值
- Author:
Wei CHEN
1
;
Chengzhi LI
;
Lu HAO
;
Bo LI
;
Fenming ZHANG
;
Wei HUANG
;
Hongtan CHEN
Author Information
1. 浙江大学医学院附属第一医院消化内科，杭州 310003
- Keywords:
Eosinophilic esophagitis;
Endoscopic ultrasonography;
Topical corticosteroid therapy;
Gastroesophageal reflux disease
- From:
Chinese Journal of Digestive Endoscopy
2024;41(10):792-797
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics of adult eosinophilic esophagitis (EoE) and the diagnostic value of endoscopic ultrasonography (EUS).Methods:Data from 12 adult patients with EoE diagnosed at the First Affiliated Hospital of Zhejiang University School of Medicine from 2011 to 2022 were retrospectively analyzed for the clinical manifestations, imaging and endoscopic findings, EUS characteristics, treatment and prognosis.Results:Among the 12 EoE patients, 9 were male and 3 were female, with a mean age at diagnosis of 48.5 years (17-73 years). Two patients had a history of asthma, 1 had urticaria, and 5 had a history of food and/or drug allergy. The time from symptom onset to diagnosis ranged from 2 weeks to 30 years. The most common clinical symptoms were acid regurgitation (8 cases), abdominal pain (8 cases), and obstruction dysphagia (5 cases). Four (4/11) patients had increased peripheral blood eosinophils and 4 (4/10) patients had increased peripheral blood immunoglobulin E. Contrast-enhanced CT of the esophagus showed esophageal wall thickening and enhancement in 7 patients (7/8). One (1/8) patient showed multiple mediastinal lymph nodes enlargement. Under endoscopy, edema (12 cases), linear furrows (5 cases), rings (4 cases), exudates (1 case), and luminal narrowing (1 case) were observed in the mucosa. Eight patients underwent EUS, and all of them showed esophageal wall thickening, and the muscularis propria thickening being the most common (5.0-12.5 mm), with various hierarchical structures and unclear boundaries. Topical corticosteroid therapy led to significant symptom improvement and mucosal healing in 6 patients. Biopsy showed that the infiltration of eosinophils in the esophageal mucosa was significantly reduced or completely relieved. The clinical symptoms recurred in 5 patients after receiving acid suppression therapy, and 2 of them still had eosinophil infiltration in esophageal mucosal.Conclusion:The clinical presentation of EoE in adults can mimic gastroesophageal reflux disease, highlighting the importance of accurate diagnosis. The typical endoscopic findings of EoE are edema, linear furrows, rings, exudates and luminal narrowing. EUS can be used for the diagnosis, differential diagnosis, and objective evaluation of esophageal wall remodeling in patients with EoE. Adult patients with EoE have poor response to antacid therapy alone, while topical corticosteroid therapy can achieve good clinical efficacy and pathological remission.
