title: Overlap of reflux and eosinophilic esophagitis in two patients requiring different therapies: a review of the literature.
abstract: Eosinophilic esophagitis (EE) and gastroesophageal reflux disease (GERD) have overlapping clinical, manometric, endoscopic and histopathologic features. The diagnosis of EE is nowadays based upon the presence of 15 or more eosinophils per high power field (eo/HPF) in esophageal biopsies. We report the cases of two young males suffering from dysphagia and recurrent food impaction with reflux esophagitis and more than 20 eo/HPF in upper-mid esophagus biopsies, both of which became asymptomatic on proton pump inhibitor (PPI) therapy. The first patient also achieved a histologic response, while EE remained in the other patient after effective PPI treatment, as shown by 24-h esophageal pH monitoring. Topical steroid therapy combined with PPI led to complete remission in this latter patient. GERD and EE may be undistinguishable, even by histology, so diagnosis of EE should only be established after a careful correlation of clinical, endoscopic and pathologic data obtained under vigorous acid suppression. These diagnostic difficulties are maximal when both diseases overlap. Limited data are available about this topic, and the interaction between EE and GERD is a matter of debate. In this setting, upper-mid esophagus step biopsies and esophageal pH monitoring of patients on PPI therapy are pivotal to evaluate the role of each disease. A PPI trial is mandatory in patients with a histopathologic diagnosis of EE; in those unresponsive to PPI treatment, EE should be suggested. However, a clinical response to PPI may not rule out quiescent EE, as shown in this report.
authors.affiliation: Unit of Gastroenterology, Hospital San Pedro de Alcantara, Avda. Pablo Naranjo s/n 10003, Caceres, Spain. xavi_molina@hotmail.com
authors.forename: Javier
authors.initials: J
authors.lastname: Molina-Infante
authors.forename: Lucía
authors.initials: L
authors.lastname: Ferrando-Lamana
authors.forename: Jose María
authors.initials: JM
authors.lastname: Mateos-Rodríguez
authors.forename: Belén
authors.initials: B
authors.lastname: Pérez-Gallardo
authors.forename: Ana-Beatriz
authors.initials: AB
authors.lastname: Prieto-Bermejo
mesh_terms: D000328:Adult; D000730:Androstadienes / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004802:Eosinophilia / Q000175:diagnosis / Q000188:drug therapy*; D004941:Esophagitis / Q000175:diagnosis / Q000188:drug therapy*; D004942:Esophagitis, Peptic / Q000175:diagnosis / Q000188:drug therapy*; D004947:Esophagus / Q000473:pathology; D000068298:Fluticasone; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D054328:Proton Pump Inhibitors; D000068298:Fluticasone