Corrugated (multiple) ringed esophagus, GERD versus allergy?

摘要: TO THE EDITOR: Having observed 12 patients (1, 2), some for a dozen years, with multiple rings (corrugated ringed esophagus [CRE] seems nicely descriptive!), I question Morrow et al.'s (3) gastroesophageal reflux disease (GERD) primacy postulate. Their pathologist, as many formerly did, equates esophageal eosinophilia to GERD! That ignores CRE's similarities adolescent idiopathic eosinophilic "allergic" esophagitis (IEE)—both manifesting major maleness, allergic histories, and intramucosal eosinophilia. Originally IEE was also attributed GERD. But normal ambulatory pH studies total failure respond intensive acid suppression (even fundoplications), accompanied by striking full-length on biopsy (4, 5, 6), led its recognition. IEEs are dramatically normalized symptomwise attacking causes—oral prednisone (5, topical corticosteroids (7), or elimination diets (6, 8). Esophageal has been carefully studied in both GERD 6, 9). In the criteria greater than 20/high powered field (hpf). counts lower, contrast CRE, upper two thirds of is nearly devoid eosinophils. Walsh's group (9) found mean five/hpf distally, none over 11, only one/hpf proximally! Moreover, Ahmed al. (10) no 52% documented monitor-positive GERDs.