title: Eosinophilic esophagitis in patients with typical gastroesophageal reflux disease symptoms refractory to proton pump inhibitor.
abstract: BACKGROUND
  TREATMEN The contribution of eosinophilic esophagitis (EoE) to refractory gastroesophageal reflux disease (GERD) remains unknown. When EoE and GERD overlap, the clinical, endoscopic and histological findings are nonspecific and cannot be used to distinguish between the two disorders. Limited data are available on this topic, and the interaction between EoE and GERD is a matter of debate.
  
  
  OBJECTIVE
  We have conducted a prospective study of adult patients with refractory GERD to evaluate the overlap of reflux and EoE.
  
  
  METHODS
  Between July 2006 and June 2008, we consecutively and prospectively enrolled 130 male and female patients aged 18 to 70 years old who experienced persistent heartburn and/or regurgitation more than twice a week over the last 30 days while undergoing at least six consecutive weeks of omeprazole treatment (at least 40 mg once a day). The patients underwent an upper digestive endoscopy with esophageal biopsy, and intraepithelial eosinophils were counted after hematoxylin/eosin staining. The diagnosis of EoE was based on the presence of 20 or more eosinophils per high-power field (eo/HPF) in esophageal biopsies.
  
  
  RESULTS
  Among the 103 studied patients, 79 (76.7%) were females. The patients had a mean age of 45.5 years and a median age of 47 years. Endoscopy was normal in 83.5% of patients, and erosive esophagitis was found in 12.6%. Only one patient presented lesions suggestive of EoE. Histological examination revealed >20 eo/HPF in this patient.
  
  
  CONCLUSIONS
  Our results demonstrated a low prevalence of EoE among patients with refractory GERD undergoing omeprazole treatment.
authors.affiliation: Department of Gastroenterology, Clinical Gastroenterology, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil.
authors.forename: Claudia Cristina de
authors.initials: CC
authors.lastname: Sá
authors.forename: Humberto Setsuo
authors.initials: HS
authors.lastname: Kishi
authors.forename: Ana Luiza
authors.initials: AL
authors.lastname: Silva-Werneck
authors.forename: Joaquim Prado Pinto de
authors.initials: JP
authors.lastname: Moraes-Filho
authors.forename: Jaime Natan
authors.initials: JN
authors.lastname: Eisig
authors.forename: Ricardo Correa
authors.initials: RC
authors.lastname: Barbuti
authors.forename: Claudio Lyioti
authors.initials: CL
authors.lastname: Hashimoto
authors.forename: Tomas
authors.initials: T
authors.lastname: Navarro-Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D057765:Eosinophilic Esophagitis / Q000150:complications* / Q000453:epidemiology / Q000473:pathology; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009853:Omeprazole / Q000627:therapeutic use; D015995:Prevalence; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D054328:Proton Pump Inhibitors; D009853:Omeprazole