Diagnosis of eosinophilic esophagitis after fundoplication for 'refractory reflux': implications for preoperative evaluation.
A small percentage of patients who carry the diagnosis of refractory gastroesophageal reflux disease (GERD) actually have eosinophilic esophagitis (EoE). The purpose of this study was to describe a series of patients who underwent fundoplication for presumed refractory GERD, but subsequently were found to have EoE. We performed a retrospective analysis of our EoE database. Patients diagnosed with EoE after Nissen were identified. Cases were defined according to recent consensus guidelines. Five patients underwent anti-reflux surgery for refractory GERD, but were subsequently diagnosed with EoE. None had esophageal biopsies prior to surgery, and in all subjects, symptoms persisted afterward, with no evidence of wrap failure. The diagnosis of EoE was typically delayed (range: 3-14 years), and when made, there were high levels of esophageal eosinophilia (range: 30-170 eos/hpf). A proportion of patients undergoing fundoplication for incomplete resolution of GERD symptoms will be undiagnosed cases of EoE. Given the rising prevalence of EoE, we recommend obtaining proximal and distal esophageal biopsies in such patients prior to performing anti-reflux surgery.
Center for Esophageal Diseases and Swallowing, Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA. edellon@med.unc.edu
Evan S
ES
Dellon
Timothy M
TM
Farrell
Eugene M
EM
Bozymski
Nicholas J
NJ
Shaheen
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D015331:Cohort Studies; D004802:Eosinophilia / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D004941:Esophagitis / Q000175:diagnosis* / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure
D054328:Proton Pump Inhibitors