A recent interaction posted in Digestive and Liver Disease outlined several medical complications that require immediate treatment in patients with eosinophilic esophagitis (EoE), in addition to upper digestive comorbidities (UDC).
According to the authors, the most classic sign that gives rise to EoE diagnosis in adults and the most likely reason of dysphagia in young adults and children is esophageal alimentary impactions (EAI). According to the researchers, this diagnosis, along with mucosal tears and esophageal perforation (EP), may necessitate a quick response in patients.
Digestive comorbidities associated with EoE have received less attention than more common atopic comorbidities.
In a research letter, the researchers conducted an analysis of the available studies on this issue and presented the observations of a twelve-year review of individuals diagnosed at an allergy-specific health centre of Spain.
Researchers discovered that 15percent of total patients were identified before the age of 18 and a 76percent of them were male, which is consistent with the data from the review. The large bulk of the patients was suffering from atopy, EAI, or dysphagia.
Vomiting and retching have both been identified as the risk factors for complications such as spontaneous EPs and tears, both of which can result in ER visits.
According to one study, a number of patients who presented with the symptom had EoE. Despite a lack of consensus in the literature, the authors concluded that “esophageal biopsies should be performed in all paediatric patients during endoscopic monitoring of EAI.”
Mucosa tears were observed in impacted patients following urgent esophagogastroduodenoscopy (EGD), a procedure used to extract impacted food caused by EAI. Despite having three EP patients over a twelve-year period, the majority of them had positive outcomes. After intravenous antibiotic therapy combined with a proton pump inhibitor drug, all three recovered successfully.
They stated that when possible, conservative treatment of PE is favoured over surgical treatment in this patient population.
One patient in the health centre also had lung abscess and active EoE that needed a month of hospitalisation.
“The existence of transmural eosinophil extension causes intense fibrosis, inflammation, and remodelling, impacting esophageal dispensability and integrity and possibly predisposing rupture,” the researchers write. “In a young patient admitted with spontaneous EP, EoE must be ruled out because subsequent treatment could avoid recurrent perforation.”
Further research suggests that Helicobacter Pylori (HP) infection may protect against EoE, though the results are debatable, with few experts concluding that the infection must be considered a biomarker for atopic diseases. In Spain, the seroprevalence of HP infection is around 87 per cent, with comorbidity seen in 25% of patients at the clinic under study.
Despite their rarity, cases of gastroesophageal reflux disease (GERD) have been reported in EoE. Fibrostenosis can also cause esophageal and functional changes, with this symptom typically indicating untreated active EoE.
According to the researchers, the study results of the single-center study may not be generally applicable. They do warn doctors to be wary of previously undiagnosed or untreated EoE in any young, male, atopic patients who present with EAI.
“Late descovery and/or treatment, as well as the presence of upper digestive comorbidities,” the authors concluded, “could contribute to the release of fibrostenosis with symptoms or serious complications such as esophageal tears linked with PE, requiring urgent hospitalisation, increasing mortality and morbidity and reducing patients’ life quality.”