Curious elements of esophageal foreign body impaction and eosinophilic esophagitis.

摘要: Esophageal eosinophilia is increasingly being recognized as a histologic finding in number of diseases, including gastroesophageal reflux disease (GERD), eosinophilic esophagitis (EoE), celiac disease, and Crohn’s disease.1 Critical to the interpretation this pathology clinical context which it was obtained. Jordan associates describe an common scenario 2 otherwise healthy children presented with accidental coin ingestions.2 No apparent structural obstructions were present. Gross mucosal appearance suggested inflammation, biopsies demonstrated dense esophageal eosinophilia. The authors ruled out GERD underlying cause inflammation treated patients topical corticosteroid. This case report emphasizes several important timely points. First, despite fact that foreign body impaction, linear furrows, white exudates, eosinophilia, pediatric gastroenterologists did not make virtually reflexive diagnosis EoE. Linear furrows are nonspecific representation likely represent edema mucosa.3 Whitish material on mucosa can Candida, swallowed food, anesthetic spray, pus.4 physicians growing literature supporting all these features be seen any inflammatory EoE.5 Thus, exclusion more GERD, months high-dose proton pump inhibition appropriate indicated.6 Second, knew EoE possibility and, thus, obtained biopsies. disease. Young typically present chronic symptoms vomiting, feeding dysfunction, or abdominal pain,7 whereas adults, most often males, stereotypical pattern dysphagia food impaction.8 In some circumstances, may acutely, cases, impaction. Our work, others, has shown significant presenting particularly when recurrent, have histopathologic EoE.9-13 importance obtaining sample at time removal cannot overemphasized, even though procedure inconvenient, frequently performed middle night without nursing assistance. many institutions, our own, responsibility extraction rotates daily between surgeon gastroenterologist. other duty lies only hands surgeon. extracted pausing obtain determine cause. If occurs, missed go untreated for years, potentially leading complications such stricture, small-caliber esophagus, crepe-paper esophagus. institution, surgeons agreed entertain potential diagnosis. Third, prior presentation, both reportedly asymptomatic obvious eating problems. It wondered how degree whether could underweight unidentified dysfunction. experience, suggests adults adapted malfunction variety changes manner they eat. Identification adaptive behavior requires asking probing questions.14-17 For instance, simple question “Do you problems swallowing eating?” will met immediate answer “No.” More revealing would series additional, specific questions as: “How long does take finish meal?”; do chew your food?”; need glass water cut into small bites?”; “Are last person leave table?”; avoid foods bagels meats?”; feel isolated because takes eat?” Answers affirmative evidence lifestyle accommodations been made compensate dysfunction. Finally, pathophysiology presentation debated literature. dysmotility spasm18-20 remodeling21,22 resulting fixed anatomic lesions suggested. An alternative theory relies concept allergic disease.23,24 light, one wonders acute impaction related hypersensitivity reaction metal coin. interesting skin testing zinc copper showed reactivity. Taking idea step further, who suffer from should undergo impacted proteins. if patient develops piece beef steak, possible represents response proteins led edema. addition, break contributed initiation illness. Acid, trauma, agents contribute increasing permeability exposure local immunologic milieu luminal antigens.25,26 Alternatively, use inhibitors (PPIs) actually generation disease?27 Interestingly, widespread PPIs increased parallel prevalence EoE, causative relationship identified. Appropriate recognition critical health well-being patients. As field esophagology entered new phase procuring samples assess changes, hopes trend continue, adult gastroenterologists, but surgical colleagues well.28