A study on eosinophilic and lymphocytic esophagitis in patients with typical gastroesophageal reflux disease symptoms / Mahmoud Hassan Ali Morsy Eliouny ; Supervised Mahasen Abdalrahman Mabrouk , Shendy Mohammed Sherif , Mohammed Ahmed Mohey Eldin

Thesis (Ph.D.) - Cairo University - Faculty of Medicine- Department of Tropical Medicine

Eosinophilic esophagitis (EoE) is a clinico-pathological entity with esophageal symptoms and dense esophageal eosinophilic infiltration throughout the esophagus. Lymphocytic esophagitis is a histologic phenotype of esophagitis characterized by high numbers of intraepithelial lymphocytes gathered mainly in a peripapillary distribution and by none or occasional intraepithelial granulocytes Objective: We have conducted a prospective study of adult patients with typical GERD symptoms to evaluate the presence of eosinophilic and lymphocytic esophagitis. Patients and methods: The study was conducted on 200 patients with typical reflux symptoms, all patients under went upper endoscopy with esophageal (proximal and distal) and gastric biopsies after full history taking and through clinical examination. EREFS score used to document any special endoscopic character for EoE and Los Angeles classification was used to evaluate GERD. EoE was diagnosed when eosinophil count in esophageal biopsies was more than 15 Eo/HPF. A diagnosis of lymphocytic esophagitis was established if the biopsies had a high number of intraepithelial lymphocytes and the presence of a dense peripapillary lymphocytic infiltrate. Results: six cases out of 200 hundred were diagnosed with EoE with eosinophil count above 15/hpf. Mean age of diagnosis was (28.83 ± 6.65) with male predominance. All the cases reported history of allergy and the main presenting symptoms were dysphagia and vomiting. Five (83.3%) cases were classified as refractory GERD. Two cases had food impaction. Serum IgE was elevated in all cases. Peripheral serum eosinophilia was present in 50% of cases. Linear furrows were present in all positive cases followed by erythema, trachealization and friability. Other histopathological findings seen among positive EoE cases were Basal cell hyperplasia, Dilated intercellular spaces, Elongation of vascular papillae, Inter cellular edema and two cases had eosinophilic microabscesses. No cases of lymphocytic esophagitis were seen

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