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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
Proposed criteria to differentiate heterogeneous eosinophilic gastrointestinal disorders of the esophagus, including eosinophilic esophageal myositis
Hiroki Sato, Nao Nakajima, Kazuya Takahashi, Go Hasegawa, Ken-ichi Mizuno, Satoru Hashimoto, Satoshi Ikarashi, Kazunao Hayashi, Yutaka Honda, Junji Yokoyama, Yuichi Sato, Shuji Terai
Hiroki Sato, Nao Nakajima, Kazuya Takahashi, Ken-ichi Mizuno, Satoru Hashimoto, Satoshi Ikarashi, Kazunao Hayashi, Yutaka Honda, Junji Yokoyama, Yuichi Sato, Shuji Terai, Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
Hiroki Sato, Division of Gastroenterology and Hepatology, Saiseikai Niigata Daini Hospital, Niigata 950-1104, Japan
Go Hasegawa, Division of Cellular and Molecular Pathology, Department of Cellular Function, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8520, Japan
Author contributions: Sato H designed the research study and wrote the paper; Nakajima N analyzed the RT-PCR data; Takahashi K analyzed the manometry data; Hasegawa G analyzed the histological data and critically revised the manuscript; Mizuno K, Hashimoto S, Ikarashi S, Hayashi K, Honda Y and Yokoyama J collected the clinical data; Sato Y and Terai S critically revised the manuscript; all authors contributed to this manuscript.
Supported by JSPS Grants-in-Aid for Scientific Research, No. 16K19332; and Takeda medical research grants.
Conflict-of-interest statement: The authors declare no competing interests.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hiroki Sato, MD, PhD, Division of Gastroenterology and Hepatology, Niigata University Medical and Dental Hospital, 757-1, Asahimachidori, Chuo-ku, Niigata City, Niigata 951-8510, Japan. pyloki@yahoo.co.jp
Telephone: +81-25-2232207 Fax: +81-25-2230776
Received: November 17, 2016
Peer-review started: November 18, 2016
First decision: February 9, 2017
Revised: February 27, 2017
Accepted: March 15, 2017
Article in press: March 15, 2017
Published online: April 7, 2017
AIM
To define clinical criteria to differentiate eosinophilic gastrointestinal disorder (EoGD) in the esophagus.
METHODS
Our criteria were defined based on the analyses of the clinical presentation of eosinophilic esophagitis (EoE), subepithelial eosinophilic esophagitis (sEoE) and eosinophilic esophageal myositis (EoEM), identified by endoscopy, manometry and serum immunoglobulin E levels (s-IgE), in combination with histological and polymerase chain reaction analyses on esophageal tissue samples.
RESULTS
In five patients with EoE, endoscopy revealed longitudinal furrows and white plaques in all, and fixed rings in two. In one patient with sEoE and four with EoEM, endoscopy showed luminal compression only. Using manometry, failed peristalsis was observed in patients with EoE and sEoE with some variation, while EoEM was associated with hypercontractile or hypertensive peristalsis, with elevated s-IgE. Histology revealed the following eosinophils per high-power field values. EoE = 41.4 ± 7.9 in the epithelium and 2.3 ± 1.5 in the subepithelium; sEoE = 3 in the epithelium and 35 in the subepithelium (conventional biopsy); EoEM = none in the epithelium, 10.7 ± 11.7 in the subepithelium (conventional biopsy or endoscopic mucosal resection) and 46.8 ± 16.5 in the muscularis propria (peroral esophageal muscle biopsy). Presence of dilated epithelial intercellular space and downward papillae elongation were specific to EoE. Eotaxin-3, IL-5 and IL-13 were overexpressed in EoE.
CONCLUSION
Based on clinical and histological data, we identified criteria, which differentiated between EoE, sEoE and EoEM, and reflected a different pathogenesis between these esophageal EoGDs.
Core tip: Eosinophilic esophagitis has long been considered as the only eosinophilic gastrointestinal disorder (EoGD) in the esophagus. However, eosinophilic esophageal myositis, characterized by esophageal symptoms and eosinophilic infiltration in the esophageal muscle layer, has been identified using peroral esophageal muscle biopsy. Combining clinical and histological data, we have defined clinical criteria to differentiate EoGDs in the esophagus.
