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• W3176352207 abstract "A 23-year-old male patient presented for esophago-gastro-duodenoscopy (EGD) due to severe heartburn and intermittent dysphagia refractory to proton pump inhibitor treatment. While the complaints had been present for more than 12 months, two preceding attempts at performing EGD were terminated due to analgosedation complications at outside endoscopy units. The recent EGD was safely performed using a propofol/midazolam combination. The esophageal mucosa was significant for diffuse mucosal pallor with linear furrows and minor exudates in the proximal third (Figure 1A). Intriguingly, there was a marked transition to the middle esophagus additionally exhibiting vertical furrowing lending an overall appearance of what has been designated “cobblestone esophagus” (Figure 1B). In the absence of rings and/or strictures, a total EREFS score (EoE endoscopic reference score) of 4 was assigned under the assumption of full-blown PPI refractory eosinophilic esophagitis (EoE). Esophageal biopsies using an adequate protocol (>6 biopsies, at least two heights, targeting exudates and/or furrows) confirmed the presence of marked eosinophilic infiltration well >15/HPF in squamous mucosa with surface concentration in conjunction with eosinophilic degranulation and microabscesses (Figure 1C,D; H&E; ×10, ×20, respectively). The patient was started on oro-dispersible budesonide 1 mg bid for 6 weeks as induction treatment. Clinical treatment response was rapid and complete. Endoscopic and histological follow-up is pending. Cobblestone esophagus has rarely been reported in the literature among others in obstruction-related severe reflux esophagitis, Barrett esophagus, and candida esophagitis.1, 2 Albeit not specific to EoE, cobblestone appearance has been described in few Japanese EoE patients, however, seems to represent an unappreciated, though uncommon endoscopic presentation of EoE, mandating an adequate biopsy protocol (at least five biopsies in at least to heights of the esophagus) to pinpoint the diagnosis.3 While linear furrows and/or concentric rings are within the more appreciated findings in advanced EoE, the distinct pathogenesis of a cobblestone-like appearance in EoE remains elusive but most likely within the scope of inflammation-related esophageal tissue remodeling. Topical budesonide formulations have become the mainstay treatment in EoE with only a fraction of patients responding to acid suppression by proton pump inhibition and dietary strategies, such as 6- or 4-food elimination diets, being cumbersome, thus limiting these alternative treatment options to highly selected patients. The authors declare no conflict of interest." @default.
• W3176352207 created "2021-07-05" @default.
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• W3176352207 date "2021-07-22" @default.
• W3176352207 modified "2023-09-26" @default.
• W3176352207 title "Cobblestone esophagus in eosinophilic esophagitis" @default.
• W3176352207 cites W1908948631 @default.
• W3176352207 cites W2220860359 @default.
• W3176352207 doi "https://doi.org/10.1002/aid2.13288" @default.
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