Gastro-oesophageal reflux disease and eosinophilic oesophagitis: What is the relationship?

Prevalence of esophageal eosinophilia in patients referred for diagnostic upper gastrointestinal endoscopy

Background

Several conditions are associated with esophageal eosinophilia such as eosinophilic esophagitis (EoE) and gastro-esophageal reflux disease (GERD). The aim of this study was to detect the prevalence of esophageal eosinophilia in patients with upper gastrointestinal (GI) symptoms referred for diagnostic upper GI endoscopy. This study included 86 patients who underwent upper GI endoscopy and biopsies.

Results

Esophageal eosinophilia EE was found in 26 patients (30.2%): 3 patients (3.5%) had EoE and 23 patients (26.7%) had low-grade esophageal eosinophilia. The most common presenting symptoms were heart burn in 84 patients (97.7%) and upper abdominal pain in 78 patients (90.7%). Reflux esophagitis (ERD) was observed in 18.6% of patients. In histopathological examination, EoE was found in 3.5%, mild reflux esophagitis in 37.2%, and severe reflux esophagitis in 16.3%. There is statistically significant correlation between EE and male sex, hypertension, dysphagia, hiatus hernia, incompetent cardia, and fixed rings. Age, incompetent cardia, and dysphagia were statistically significant independent predictors of low-grade EE.

Conclusion

Esophageal eosinophilia EE was found in 30.2% of patients: 3.5% had eosinophilic esophagitis EoE and 26.7% had low-grade esophageal eosinophilia.

Retrospective Analysis of Eosinophilic Esophagitis in Patients with Refractory Gastroesophageal Reflux Disease

Introduction

Eosinophilic esophagitis (EoE) is not a common differential diagnosis in patients with longstanding refractory gastroesophageal reflux disease (GERD). The aim of this retrospective analysis was to assess the prevalence of EoE in patients with refractory GERD.

Methods

This retrospective analysis was performed in the Gastroenterology Department of a tertiary care institute in Karachi, Pakistan. Records of esophagogastroduodenoscopy (EGD) with esophageal biopsy from January 2016 till December 2018 were included.

Results

There were 16 (7.7%) patients of refractory GERD diagnosed with EoE. There were more females than males (5:3). The median age was 58 years (range: 41-63 years). Dysphagia was the chief complaint leading to EGD followed by food impaction and heartburn. The median duration of symptoms was 46.5 months (range: 22-65 months). Erosive esophagitis, white plaques, and friability are common endoscopic findings; however, strictures are also not uncommon.

Conclusion

Eosinophilic esophagitis is not uncommon in patients with refractory GERD. It may present with dysphagia, heartburn, and food impaction. Old patients with longstanding GERD, positive for atopy, not responding to gastric acid inhibitors must be considered for EoE screening via EGD and esophageal biopsy.