title: Localized esophageal eosinophilia: Is it an early manifestation of eosinophilic esophagitis or a subtype of gastroesophageal reflux disease?
abstract: OBJECTIVE
  We recently encountered patients with localized esophageal eosinophilia in a small area of the esophagus. However, this condition remains to be described in detail, and its clinical significance has not been established. We investigated the clinical, endoscopic and histological features of localized esophageal eosinophilia in comparison with diffuse esophageal eosinophilia.
  
  
  METHODS
  We investigated 10 patients with localized esophageal eosinophilia, and compared them with 23 who had diffuse esophageal eosinophilia. Whether esophageal eosinophilia was localized or diffuse was determined on the basis of endoscopic findings. Localized esophageal eosinophilia was defined endoscopically as a focal area of esophageal eosinophilia, whereas diffuse esophageal eosinophilia was defined as a widespread area of esophageal eosinophilia involving more than one of three locations: the upper, middle and lower esophagus. Histological esophageal eosinophilia in the mucosa showing endoscopic abnormality was confirmed by biopsy with a peak of ≥ 15 eosinophils/high-power field.
  
  
  RESULTS
  There were no significant differences in age, gender distribution, allergic conditions or peripheral eosinophilia between the two groups. In all cases but one, localized esophageal eosinophilia was observed in a small area above the esophagogastric junction. Esophageal symptoms such as dysphagia, heartburn or chest pain were present in 20% of the localized group and in 65% of the diffuse group, the difference being statistically significant (P<0.05). The maximum amounts of eosinophils infiltrating the esophageal mucosa did not differ between the groups.
  
  
  CONCLUSIONS
  Esophageal eosinophilia can be localized in a small area, especially above the esophagogastric junction. Gastric acid reflux or contact may influence this condition in addition to its allergic pathogenesis.
authors.affiliation: Department of Gastroenterology, Faculty of Medicine, Yamagata University, Yamagata, Japan.
authors.forename: Yasuhiko
authors.initials: Y
authors.lastname: Abe
authors.forename: Katsunori
authors.initials: K
authors.lastname: Iijima
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ohara
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Koike
authors.forename: Ryousuke
authors.initials: R
authors.lastname: Kikuchi
authors.forename: Katsuaki
authors.initials: K
authors.lastname: Kato
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shibuya
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Inomata
authors.forename: Keisuke
authors.initials: K
authors.lastname: Oikawa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ueno
mesh_terms: D000328:Adult; D000367:Age Factors; D001707:Biopsy, Needle; D015331:Cohort Studies; D003937:Diagnosis, Differential; D057765:Eosinophilic Esophagitis / Q000175:diagnosis / Q000473:pathology*; D004943:Esophagogastric Junction / Q000473:pathology*; D004945:Esophagoscopy / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors
keywords: eosinophilic esophagitis; esophageal eosinophilia; gastroesophageal reflux disease (GERD)