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Kim: Esophageal Lesions: A High Index of Suspicion is Important for Diagnosis

Quiz

A 55-year-old woman visited the hospital after experiencing heartburn and dysphagia for several months. She underwent endoscopy screening 2 years prior, at which time there were no remarkable findings. This time, endoscopy revealed longitudinal furrows and multiple papilloma-like nodules in the esophagus (Fig. 1). There was no mucosal break at the esophagogastric junction. A biopsy of the esophageal lesions was performed (Fig. 2).
What is the most likely diagnosis?
 

NOTES

Conflicts of Interest: The author has no financial conflicts of interest.

Fig. 1.
Endoscopic findings revealed longitudinal furrows and multiple papilloma-like nodules in the esophagus (A, B). There was no mucosal break at the esophagogastric junction (C).
ce-2020-278f1.jpg
Fig. 2.
Microscopic findings showed significant intraepithelial eosinophilic infiltration more than 15 cells/HPF. (A) Hematoxylin and eosin, ×100. (B) Hematoxylin and eosin, ×400.
ce-2020-278f2.jpg
Table 1.
Endoscopic Score EREFS for Grading Eosinophilic Esophagitis
Endoscopic findings Scoring
Exudates 0- Absent
1- Mild (<10% of the esophageal surface area)
2- Severe (≥10% of the esophageal surface areas)
Rings 0- Absent
1- Mild (subtle circumferential ridges)
2- Moderate (distinct rings)
3- Severe (rings that impair passage of a standard adult diagnostic endoscope)
Edema 0- Absent
1- Present (loss of vascular markings)
Furrows 0- Absent
1- Mild (present but without visible depth)
2- Severe (visible depth or mucosal indentation)
Strictures 0- Absent
1- Present

Adapted from Hirano et al. [3]

REFERENCES

1. Dellon ES, Liacouras CA, Molina-Infante J, et al. Updated international consensus diagnostic criteria for eosinophilic esophagitis: proceedings of the AGREE conference. Gastroenterology 2018;155:1022-1033 e10.
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2. Surdea-Blaga T, Popovici E, Fadgyas Stănculete M, Dumitrascu DL, Scarpignato C. Eosinophilic esophagitis: diagnosis and current management. J Gastrointestin Liver Dis 2020;29:85-97.
crossref pmid
3. Hirano I, Moy N, Heckman MG, Thomas CS, Gonsalves N, Achem SR. Endoscopic assessment of the oesophageal features of eosinophilic oesophagitis: validation of a novel classification and grading system. Gut 2013;62:489-495.
crossref pmid
4. Lucendo AJ, Molina-Infante J, Arias Á, et al. Guidelines on eosinophilic esophagitis: evidence-based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J 2017;5:335-358.
crossref pmid pmc
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