Eosinophilic granuloma, a rare disease, has various clinical manifestations and no specific X-rays features and is thus easily misdiagnosed. This paper reports a case of multifocal eosinophilic granuloma of jaw with long-term follow-up. The patient initially presented with periodontal tissue destruction.The diagnosis, treatment and prognosis of multifocal eosinophilic granuloma of jaw were discussed in combination with the literature to alert this disease in clinical practice.
Diagnosis, Differential ; Eosinophilic Granuloma/diagnostic imaging* ; Humans ; Jaw ; Periodontium ; Radiography

eosinophilic esophagitis (EoE) varies from center to center. In this study, we evaluated the effectiveness of a dairy-free diet (DFD) and the 6-Food Elimination Diet (SFED) as initial therapies for the treatment of EoE in our practice.METHODS: This was a retrospective study of children who had been treated for EoE at Connecticut Children's Medical Center, Hartford, CT, USA. Pre- and post-treatment endoscopy findings and histology results of patients treated with DFD or SFED were examined.RESULTS: One hundred fifty-two patients (age 9.2±5.2 years, 76.3% male, 69.7% caucasian) met the inclusion criteria for initial treatment with DFD (n=102) or SFED (n=50). Response for DFD was 56.9% and for SFED was 52.0%. Response based on treatment duration ( < 10, 10–12, and >12 weeks) were 81.8%, 50.0%, and 55.1% for DFD, and 68.8%, 50.0%, and 40.0% for SFED. Response based on age ( < 6, 6–12, and >12 years) were 59.3%, 42.9%, and 67.5% for DFD, and 36.4%, 58.8%, and 72.7% for SFED. In patients treated with DFD, concomitant proton pump inhibitor (PPI) administration resulted in improved outcomes (p=0.0177). Bivariate regression analysis showed that PPI with diet is the only predictor of response (p=0.0491), however, there were no significant predictors on multiple regression analysis.CONCLUSION: DFD and SFED are effective first line therapies for EoE. DFD should be tried first before extensive elimination diets. Concomitant therapy with PPI's may be helpful.]]>
Child ; Connecticut ; Diet ; Endoscopy ; Eosinophilic Esophagitis ; Eosinophils ; Humans ; Male ; Proton Pump Inhibitors ; Proton Pumps ; Retrospective Studies

Eosinophilic esophagitis (EoE) is a recently recognized esophageal inflammatory disease with clinical manifestations arising from esophageal dysfunction. The etiology of EoE is currently being clarified and food allergy is evolving as the central cornerstone of EoE disease pathogenesis. Given the large number of eosinophils in the esophagus of people with EoE verified by data from murine models EoE is widely considered as the hallmark T-helper type 2 (Th2) disease of the esophagus. It is also known that some eosinophilic inflammation is controlled by other subsets of T cells such as Th9 or Th17 and control is also exerted by type 2 innate lymphoid cells acting together with basophils. In this paper we review results from molecular studies of mouse models in light of the results from the first clinical trials targeting key cytokines in humans and present in-depth molecular understanding of EoE.
Animals ; Basophils ; Cytokines ; Eosinophilic Esophagitis ; Eosinophils ; Esophagus ; Food Hypersensitivity ; Humans ; Inflammation ; Lymphocytes ; Mice ; T-Lymphocytes

With the advances in technology and medical knowledge, new diseases are being identified and investigated. Esophageal motility disorders have been re-defined using high-resolution manometry and their pathogenesis are being better understood. The use of opioid analgesics is increasing worldwide, particularly in the United States, but their chronic use can cause opioid-induced esophageal dysfunction, which mimics spastic motor disorders, including achalasia type 3 or 2 and esophagogastric junction outflow obstruction. Eosinophilic esophagitis is identified by eosinophilic infiltration confirmed on a pathological examination. The condition is often associated with esophageal motility abnormalities. On the other hand, recent studies have suggested that muscle-predominant eosinophilic infiltration, eosinophilic esophageal myositis, might manifest as spastic motor disorders, including achalasia or jackhammer esophagus. Lymphocytic esophagitis is an unusual esophageal condition, which is confirmed by the increased number of lymphocytes in the esophageal epithelium. Although several reports have supported the existence of lymphocytic esophagitis, it is still unclear whether lymphocytic esophagitis is a distinct disease entity or another spectrum of other esophageal diseases, such as gastroesophageal reflux disease or eosinophilic esophagitis. This review presents evidence and reports on the emerging issues in esophageal motility disorders, including opioid-induced esophageal dysfunction, eosinophilic esophagitis with eosinophilic esophageal myositis, and lymphocytic esophagitis.
Analgesics, Opioid ; Eosinophilic Esophagitis ; Eosinophils ; Epithelium ; Esophageal Achalasia ; Esophageal Diseases ; Esophageal Motility Disorders ; Esophagitis ; Esophagogastric Junction ; Esophagus ; Gastroesophageal Reflux ; Hand ; Lymphocytes ; Manometry ; Motor Disorders ; Muscle Spasticity ; Myositis ; United States

BACKGROUND/AIMS: The epidemiology and pathogenesis of eosinophilic esophagitis (EoE) remain unclear in Asian countries. We investigated clinicopathological characteristics and diagnostic trends of EoE, and evaluated 3 tissue biomarkers for correlation with disease activity and treatment response in Korean patients with EoE. METHODS: We retrospectively reviewed 25 271 esophageal biopsies performed during upper endoscopies between 2006 and 2017. We diagnosed EoE based on ≥ 15 eosinophils/high-power field (HPF) and, symptoms of esophageal dysfunction. We performed immunohistochemical analysis for tryptase, eosinophilic derived neurotoxin (EDN), and eotaxin-3. RESULTS: We diagnosed EoE in 72 patients (53 men and 19 women; mean age, 46.2 years) with presenting symptoms of, dysphagia (15.3%), epigastric pain (31.9%), and heartburn (30.6%). The diagnostic rate of EoE considerably increased between 2006 and 2017, from 0.29 diagnoses to 7.99 diagnoses per 1000 esophageal biopsies (P < 0.001). The mean peak eosinophil count (PEC) was 56.0 (± 77.8)/HPF. Whereas the EDN (rho = 0.667, P < 0.001) and eotaxin-3 levels (rho = 0.465, P < 0.001) correlated with PEC, tryptase and PEC were weakly correlated (rho = 0.291, P = 0.013). EDN (rho = 0.279, P = 0.017), and tryptase (rho = 0.279, P = 0.033) correlated with the inflammatory score of Eosinophilic Esophagitis Endoscopic Reference Score. Immunohistochemical analysis and changes in tryptase, EDN, and eotaxin-3 levels were associated with histologic and endoscopic improvements. CONCLUSIONS: EoE incidence considerably increased during the 12-year period, regardless of endoscopic esophageal biopsy rate. Tryptase, EDN, and eotaxin-3 levels in esophageal biopsy specimens could be promising biomarkers for disease activity, symptom, and endoscopic response in Korea.
Asian Continental Ancestry Group ; Biomarkers ; Biopsy ; Deglutition Disorders ; Diagnosis ; Endoscopy ; Eosinophilic Esophagitis ; Eosinophils ; Epidemiology ; Esophagus ; Female ; Heartburn ; Humans ; Incidence ; Korea ; Male ; Retrospective Studies ; Tryptases

Eosinophilic esophagitis is a rare disease in Asian countries, but its incidence is growing rapidly in Western countries. The main pathophysiology of eosinophilic esophagitis is esophageal epithelial barrier dysfunction; disruption of the esophageal epithelial barrier easily induces antigen sensitization to foods and aeroallergens, which leads to subsequent esophageal inflammation as a result of eosinophil recruitment. Here we report a case of an 11-year-old Korean boy who suffered from fever, odynophagia, dysphagia, and chest pain. His upper endoscopic findings showed longitudinal ulcers with a volcano-like appearance at the distal esophagus. Polymerase chain reaction test results and biopsy specimens were positive for herpes simplex virus type 1. He was treated with acyclovir and a proton pump inhibitor, but his follow-up endoscopy showed typical patterns of eosinophilic esophagitis, and the biopsy specimens were compatible with the diagnostic criteria for eosinophilic esophagitis. Therefore, we report a very rare case of eosinophilic esophagitis after herpes esophagitis in a Korean child with normal immunity.
Acyclovir ; Asian Continental Ancestry Group ; Biopsy ; Chest Pain ; Child ; Deglutition Disorders ; Endoscopy ; Eosinophilic Esophagitis ; Eosinophils ; Esophagitis ; Esophagus ; Fever ; Follow-Up Studies ; Herpesvirus 1, Human ; Humans ; Incidence ; Inflammation ; Male ; Polymerase Chain Reaction ; Proton Pumps ; Rare Diseases ; Simplexvirus ; Ulcer

With the advances in technology and medical knowledge, new diseases are being identified and investigated. Esophageal motility disorders have been re-defined using high-resolution manometry and their pathogenesis are being better understood. The use of opioid analgesics is increasing worldwide, particularly in the United States, but their chronic use can cause opioid-induced esophageal dysfunction, which mimics spastic motor disorders, including achalasia type 3 or 2 and esophagogastric junction outflow obstruction. Eosinophilic esophagitis is identified by eosinophilic infiltration confirmed on a pathological examination. The condition is often associated with esophageal motility abnormalities. On the other hand, recent studies have suggested that muscle-predominant eosinophilic infiltration, eosinophilic esophageal myositis, might manifest as spastic motor disorders, including achalasia or jackhammer esophagus. Lymphocytic esophagitis is an unusual esophageal condition, which is confirmed by the increased number of lymphocytes in the esophageal epithelium. Although several reports have supported the existence of lymphocytic esophagitis, it is still unclear whether lymphocytic esophagitis is a distinct disease entity or another spectrum of other esophageal diseases, such as gastroesophageal reflux disease or eosinophilic esophagitis. This review presents evidence and reports on the emerging issues in esophageal motility disorders, including opioid-induced esophageal dysfunction, eosinophilic esophagitis with eosinophilic esophageal myositis, and lymphocytic esophagitis.
Analgesics, Opioid ; Eosinophilic Esophagitis ; Eosinophils ; Epithelium ; Esophageal Achalasia ; Esophageal Diseases ; Esophageal Motility Disorders ; Esophagitis ; Esophagogastric Junction ; Esophagus ; Gastroesophageal Reflux ; Hand ; Lymphocytes ; Manometry ; Motor Disorders ; Muscle Spasticity ; Myositis ; United States

BACKGROUND/AIMS: The prevalence of eosinophilic esophagitis (EoE) is reportedly increasing in Western countries. However, its prevalence in Korea remains unknown. We investigated the diagnostic trends and clinical characteristics of EoE in Korea. METHODS: Using an endoscopic database maintained at a tertiary care center, we retrospectively reviewed the biopsy reports regarding 18 399 biopsy specimens collected from all patients who underwent esophagogastroduodenoscopy and esophageal biopsy at this facility between 2006 and 2014. The presence of more than 15 eosinophils per high-power field with symptoms related to esophageal dysfunction was considered to indicate EoE. RESULTS: A total of 37 patients (male:female ratio, 29:8; mean age, 44.0 ± 13.0 years) were diagnosed with EoE. These patients presented with dysphagia (21.6%), epigastric pain (21.6%), heartburn (24.3%), and other symptoms (32.4%). Typical endoscopic appearance of EoE was noted in 33 cases (89.1%) and included linear furrows in 24 cases (64.8%), ringed esophagus in 10 cases (27.0%), and white exudates in 11 cases (29.7%). The median eosinophilic count was 25 per high-power field (interquartile range, 20–70). Notable histopathological findings included eosinophilic microabscesses in 21 cases (56.7%). The diagnosis rate of EoE was found to have increased from 2006 and to 2014 (P-value < 0.001 by the Cochran-Armitage trend test). CONCLUSIONS: The number of patients with EoE appears to have increased significantly over the 9-year period investigated, while the number of endoscopic investigations increased only marginally. Greater awareness of EoE and the role of esophageal biopsies should be considered.
Biopsy ; Deglutition Disorders ; Diagnosis ; Endoscopy ; Endoscopy, Digestive System ; Eosinophilic Esophagitis ; Eosinophils ; Esophagus ; Exudates and Transudates ; Heartburn ; Humans ; Korea ; Prevalence ; Retrospective Studies ; Tertiary Care Centers

Eosinophilic esophagitis is a chronic inflammatory condition characterized by symptoms of esophageal dysfunction and eosinophil infiltration in the esophageal epithelium. The definition of eosinophilic esophagitis continues to evolve, most recently with the characterization of proton pump inhibitor-responsive esophageal eosinophilia. Diagnosis of eosinophilic esophagitis is based on consensus guidelines, but can be challenging because none of the symptoms, endoscopic findings, or histologic features are specific for eosinophilic esophagitis on their own. For treatment, either oral topical corticosteroids or dietary elimination therapy are reasonable first-line options. The choice will depend on both patient preference and clinician expertise. In cases with severe esophageal strictures, dilation is also performed. Proton pump inhibitors play an important role in current management.
Adrenal Cortex Hormones ; Consensus ; Constriction, Pathologic ; Diagnosis ; Eosinophilia ; Eosinophilic Esophagitis* ; Eosinophils* ; Epithelium ; Patient Preference ; Proton Pump Inhibitors ; Proton Pumps

Toxocara canis is an important roundworm of canids and a fearsome animal parasite of humans. Human infections can lead to syndromes called visceral larva migrans (VLM), ocular larva migrans, neurotoxocariasis, and covert toxocariasis. VLM is most commonly diagnosed in children younger than 8 years of age, but adult cases are relatively frequent among those infected by ingesting the raw tissue of paratenic hosts in East Asia. This research reports the case of a 59-year-old man with sigmoid colon cancer, who visited our institution for surgery. An intraperitoneal mass was found on preoperative computed tomography, and it was thought to be a metastatic mass from sigmoid colon cancer. A postoperative histologic examination and serum test showed eosinophilic granuloma due to toxocariasis. Diagnosis of VLM is often difficult and highly suspicious in adults. Researchers suggest, although rarely, that VLM be included in the differential diagnosis as a cause of intraperitoneal tumors.
Adult ; Animals ; Child ; Colon, Sigmoid* ; Colonic Neoplasms ; Diagnosis ; Diagnosis, Differential ; Eosinophilic Granuloma ; Far East ; Humans ; Larva Migrans ; Larva Migrans, Visceral ; Middle Aged ; Neoplasm Metastasis ; Parasites ; Research Report ; Sigmoid Neoplasms* ; Toxocara canis* ; Toxocara* ; Toxocariasis