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Case 23 - Discussion

Surgical Pathology Case

 

Eosinophilic Esophagitis

Clinical Futures
 
  • Young children: failure to thrive and food refusal;
  • Older children: vomiting, regurgitation, and epigastric and chest pain.
  • Adults: intermittent dysphagia, food impaction, heartburn;
  • Allergic symptoms (eczema, allergic rhinitis, and bronchospasm): 50% cases
Microscopic Findings
 
  • 25 eosinophils /HPF;
  • Eosinophilic microabscess (>4 eosinophils );
  • Profound eosinophilic degranulation;
  • Epithelial proliferation, with thickened basal epithelial layer and elongated papillae);
  • Involve proximal and distal esophagus with normal gastric and duodenal mucosa;
  • All these patterns are resistant to PPI.
Differential Diagnosis
 
  • GERD
Treatment and Prognosis
 
  • Resistant to proton pump inhibition;
  • Dietary elimination;
  • Topical steroids
  • Endoscopic treatment
Reference
 
  • GI Motility online (May 2006)
  • New England Journal of Medicine Volume 351:940-941
  • Modern Pathology (2006) 19, 9096.