2015-06-03 17:49:27 UTC

Microscopic Esophagitis

Clinical Snapshots

About

This AGA Clinical Snapshot is an executive summary of Drs. Chang and Moawad's presentation during the 2015 AGA Spring Postgraduate Course at DDW® 2015 in Washington, DC.

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Takeaways

1. Understand the similarities and differences between GERD, PPI-responsive eosinophilic esophagitis (REE) and eosinophilic esophagitis (EoE).

2. Understand the mechanism of PPI response in PPI-REE patients.

3. Recognize that PPI is first-line treatment in patients with esophageal eosinophilia.

About the Instructors

Edaire Cheng, MD, UT Southwestern Pediatric Gastroenterology

Fouad Moawad, MD, FACP, FACG Walter Reed National Military Medical Center

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Eosinophils in the Esophagus

In the early 1980s, esophageal eosinophilia was once regarded as a histologic feature of GERD and correlated with abnormal acid clearance determined by esophageal pH monitoring. Eosinophils were found in all levels of the esophagus, and involvement of the proximal esophagus was associated with greater abnormalities in the pH studies. In the 1990s, case series involving dense esophageal eosinophilia in atopic individuals with dysphagia and normal pH monitoring introduced the idea of eosinophilic esophagitis as an emerging entity distinct from GERD. By 2001, several case reports underscored the diagnostic confusion between GERD and EoE and demonstrated the need for clear diagnostic criteria …

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