pulmicort and Esophageal-Perforation

Eosinophilic oesophagitis is a disease that has been recognized in the past 30 years. It causes dysphagia and other symptoms of oesophageal dysfunction. Eosinophilic oesophagitis presents either with a chronic feeling of difficulty swallowing, with food moving slowly through the oesophagus, or as an acute food bolus obstruction requiring emergency attention. Patients may also experience chest pain at this time. It is an inflammatory disorder, thought to be driven by food or environmental antigens, where the most distinctive cell type is eosinophils. Eosinophilic oesophagitis is mediated through a local IgG4 mechanism and does not manifest as a systemic disease. It is diagnosed only on endoscopy and biopsy - there are characteristic endoscopic appearances with oedema, rings, furrows and strictures but the golden rule in its diagnosis is to perform multiple biopsies from multiple sites in the oesophagus in all patients with dysphagia or other oesophageal dysfunction. Finding a peak concentration of >15 eosinophils per high power field in this situation is diagnostic of eosinophilic oesophagitis. Eosinophilic oesophagitis is not usually related to gastro-oesophageal reflux disease, but the two conditions may co-exist. Current therapies include topical steroids (oro-dispersible formulation of budesonide), proton pump inhibitors and dietary exclusions. Therapeutic oesophageal dilatation is reserved for refractory symptoms or tight strictures.

Topics: Administration, Topical; Biopsy; Budesonide; Deglutition Disorders; Diet Therapy; Eosinophilic Esophagitis; Eosinophils; Esophageal Perforation; Esophageal Stenosis; Esophagoscopy; Esophagus; Glucocorticoids; Humans; Immunoglobulin G; Proton Pump Inhibitors; Quality of Life

Idiopathic eosinophilic esophagitis is an underdiagnosed disease with typical endoscopic findings, which have not been well described.. Charts and pathology reports at two tertiary care centers from June 1993 to April 2002 were reviewed to describe the endoscopic findings of this disease and to correlate them with clinical characteristics. Eight patients were identified as having eosinophilic esophagitis based on clinical symptoms and pathology reports.. Soft and subtle ring(s) in the esophagus were found in 7 of 8 patients. In 3 of 8 patients, the esophagus appeared rigid. Mucosal rents occurred with simple passage of the endoscope in 5 of 8 patients. One patient developed a perforation after simple passage of the endoscope. Endoscopic findings can be normal or very subtle in these patients, and the findings can easily be missed during endoscopy. Tearing of the esophagus can occur with simple passage of the endoscope or biopsy even in the absence of overt rings. A minimum of 8 weeks of medical therapy (proton pump inhibitor, histamine antagonists, immunosuppressants) should be undertaken before considering dilation because of the high risk involved with the procedure and the good response to medical therapy.. We recommend considering dilation only in patients with eosinophilic esophagitis who do not respond to medical therapy and have rings that appear to be obstructing the lumen.

Topics: Adult; Anti-Inflammatory Agents; Azathioprine; Biomarkers; Biopsy; Budesonide; Catheterization; Deglutition Disorders; Diagnosis, Differential; Dilatation, Pathologic; Endoscopy, Digestive System; Eosinophilia; Eosinophils; Esophageal Perforation; Esophagitis; Esophagus; Female; Follow-Up Studies; Gastric Mucosa; Gastroesophageal Reflux; Gastrointestinal Motility; Histamine H1 Antagonists; Histamine H2 Antagonists; Humans; Immunosuppressive Agents; Male; Prednisone; Proton Pump Inhibitors; Proton Pumps; Recurrence; Risk Factors; Tomography, X-Ray Computed; Treatment Outcome