Guest guest Posted March 7, 2007 Report Share Posted March 7, 2007 let45ride wrote: > ... Does anyone have any other info. on EE? ... > GI Motility Online Eosinophilic esophagitis http://www.nature.com/gimo/contents/pt1/full/gimo49.html " Case reports in which full-thickness biopsies were obtained and endoscopic ultrasonographic evidence suggest extension of the eosinophilic inflammation to the submucosal and muscular layer; this finding lends support to the speculation that eosinophils and their mediators induce esophageal dysmotility " " The pathophysiology of dysphagia associated with eosinophilic esophagitis is not well understood. Many studies utilizing stationary manometry have usually showed normal peristalsis. Some series described tertiary contractions, aperistalsis, simultaneous contractions, diffuse spasm, and nutcracker esophagus. ... one patient with eosinophilic esophagitis who had esophageal spasm. ... a patient with vigorous achalasia who had underlying severe eosinophilic infiltration of the esophageal mucosa. In that case the symptoms were probably related to the achalasia, but it suggested the possibility that eosinophilic esophagitis may predispose to a motor esophageal disorder. " It isn't clear which is cause and which is effect. notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2007 Report Share Posted March 8, 2007 Hi , I just saw your e-mail. I don't really understand what this means, even after reading the response posted. I thought eosinophilic had to do with acid. Am I thinking of something else? Can you explain to me as much as you know. Thanks. Why hasn't anyone else found this? > > Hi, all! > We just got back from a follow-up appointment for (the > group's DES guy) with the neurologist. She said that his MRI and > neurological tests came back fine, indicating that he doesn't have any > underlying neurological disease (that's good). She is, however, > concerned that his immunity is low, specifically, that his IgA and IgM > levels were low, in the blood tests he had done in late November. She > thinks this can be indicating Eosinophilic Esophagitis. She sent him > for a repeat of the bloodwork, on our way out, and wants me to call > our local gastro. (she wasn't able to get ahold of him while we were > there) tomorrow, to see what he thinks of that. She also recommended > that try the elimination diet, to see if he can find out > something that he's allergic to. I'm a little confused now, because > he was tested for this in 2004 at the Univ. of Michigan. His biopsies > didn't show increased eosinophils and neither did the blood tests, > checking for that. The neurologist also wants us to fax over some of > his records from U of M and TCC. I guess we'll see what our local > gastro. says tomorrow. Does anyone have any other info. on EE? > > in Michigan > > P.S. Does anyone else get articles from Medscape e mailed to them? I > just got the weekly update of articles and there's one that discusses > the Enteric Nervous System. If I can figure out how to create a link > to the article, I'll post it, if anyone is interested. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2007 Report Share Posted March 8, 2007 Notan, Thank you, once again, for sending along some good information! I've learned a lot about searching for medical information online from this group, but you always manage to come up with much more than I can. 's neurologist (who is very thorough and comes off as a little eccentric), had me help her to search online for articles on EE, right there in her office! I put her right on PubMed. She thought she had heard of research being done at Ohio State University, but we couldn't find it. 's gastro. doc has scheduled him for EGD with biopsy (to check for EE) next Tuesday, the 13th. I'll keep the group posted on what we learn. in Michigan > > ... Does anyone have any other info. on EE? ... > > > GI Motility Online > Eosinophilic esophagitis > http://www.nature.com/gimo/contents/pt1/full/gimo49.html > > " Case reports in which full-thickness biopsies were obtained and > endoscopic ultrasonographic evidence suggest extension of the > eosinophilic inflammation to the submucosal and muscular layer; this > finding lends support to the speculation that eosinophils and their > mediators induce esophageal dysmotility " > > " The pathophysiology of dysphagia associated with eosinophilic > esophagitis is not well understood. Many studies utilizing stationary > manometry have usually showed normal peristalsis. Some series described > tertiary contractions, aperistalsis, simultaneous contractions, diffuse > spasm, and nutcracker esophagus. ... one patient with eosinophilic > esophagitis who had esophageal spasm. ... a patient with vigorous > achalasia who had underlying severe eosinophilic infiltration of the > esophageal mucosa. In that case the symptoms were probably related to > the achalasia, but it suggested the possibility that eosinophilic > esophagitis may predispose to a motor esophageal disorder. " > > > It isn't clear which is cause and which is effect. > > notan > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2007 Report Share Posted March 8, 2007 wrote: > ... I thought eosinophilic had to do with acid. An eosinophil is a type of white blood cell. Esophagitis is inflammation of the esophagus. Eosinophilic Esophagitis (EE) is inflammation of the esophagus, believed to be caused by allergy, resulting in dense eosinophilic infiltration of the tissue of the wall of the esophagus. EE does not respond to treatment to reduce acid production or acid reflux. For an easy to read article about EE see: MedicineNet Eosinophilic Esophagitis http://www.medicinenet.com/eosinophilic_esophagitis/article.htm > Why hasn't anyone else found this? This has been discussed before. For one of those times see the following message: achalasia/message/31464 notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2007 Report Share Posted March 8, 2007 let45ride wrote: > ... you always manage to come up with much more than I > can. ... Actually, that link was previously posted to this group by Joy, " snoodledoo " . See message # 34430 . Article: Achalasia may be associated with Eosinophilic Esophagitis achalasia/message/34430 > ... She > thought she had heard of research being done at Ohio State University, > but we couldn't find it. ... Universityof Cincinnati College of Medicine J Clin Invest 116(2): 536-547, 2006 Eotaxin-3 and a uniquely conserved gene-expression profile in eosinophilic esophagitis http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1359059 Clin Gastroenterol Hepatol. 2004 Jul;2(7):568-75. Clinical and immunopathologic effects of swallowed fluticasone for eosinophilic esophagitis. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\ 5224281 & dopt=Abstract See also: American Partnership For Eosinophilic Disorders http://www.apfed.org/ee.htm notan Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2007 Report Share Posted March 8, 2007 Dear , If you go into google and type in Ohio State University + Eosinophilic Eosophagitis there are several relevant sites listed there, including one from PubMed. Best Wishes from Ann xlet45ride <brendacoyle@...> wrote: Notan,Thank you, once again, for sending along some good information! I've learned a lot about searching for medical information online fromthis group, but you always manage to come up with much more than Ican. 's neurologist (who is very thorough and comes off as alittle eccentric), had me help her to search online for articles onEE, right there in her office! I put her right on PubMed. Shethought she had heard of research being done at Ohio State University,but we couldn't find it. 's gastro. doc has scheduled him for EGD with biopsy (tocheck for EE) next Tuesday, the 13th. I'll keep the group posted onwhat we learn. in Michigan> > ... Does anyone have any other info. on EE? ...> > > GI Motility Online> Eosinophilic esophagitis> http://www.nature.com/gimo/contents/pt1/full/gimo49.html> > "Case reports in which full-thickness biopsies were obtained and > endoscopic ultrasonographic evidence suggest extension of the > eosinophilic inflammation to the submucosal and muscular layer; this > finding lends support to the speculation that eosinophils and their > mediators induce esophageal dysmotility"> > "The pathophysiology of dysphagia associated with eosinophilic > esophagitis is not well understood. Many studies utilizing stationary > manometry have usually showed normal peristalsis. Some series described > tertiary contractions, aperistalsis, simultaneous contractions, diffuse > spasm, and nutcracker esophagus. ... one patient with eosinophilic > esophagitis who had esophageal spasm. ... a patient with vigorous > achalasia who had underlying severe eosinophilic infiltration of the > esophageal mucosa. In that case the symptoms were probably related to > the achalasia, but it suggested the possibility that eosinophilic > esophagitis may predispose to a motor esophageal disorder."> > > It isn't clear which is cause and which is effect.> > notan> New is the ultimate force in competitive emailing. Find out more at the Championships. Plus: play games and win prizes. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2007 Report Share Posted March 8, 2007 Dear Fellow Achalasians, I read, with interest, the article sent in by Notan and I did have Eosinophilic Esopha- gitis before I was diagnosed with Achalasia. I had had swallowing problems on and off for a while, probably longer than I realized, when I finally got the diagnosis from my gastro. guy. He suggested botox injections and dilations as courses of treatment. I never have liked the idea of botox being shot into me in any place, but since I have a friend whose father-in-law had just had some dysphagia, was treated with botox, and then his throat just kind of clamped down and he can't swallow anything at all, now. He has since been living on a feeding tube. So, I said "No" to botox. Then I found this group and got a lot of questions answered. Thank Gawd. I had my Heller's in late January of 2006. Post-op. my biggest problem has been pooling of saliva in my mouth, almost 24/7, and recently, I am coughing more at night (again) and I have a few problems with pain in my throat and tum. I can live with it. It's so much better, and so much more attractive, than eating delicious Chinese noodles and having them bounce back out my nostrils. Good articles, everyone. Thank you. all best, Deborah Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 8, 2007 Report Share Posted March 8, 2007 Here is a good article on the possible causes of Achalasia and DES. It discusses the evidence of a connection with EE. If anyone want parts of it explained let me know. notan GI Motility online (2006) doi:10.1038/gimo22 Published 16 May 2006 Ikuo Hirano, M.D. Pathophysiology of achalasia and diffuse esophageal spasm http://www.nature.com/gimo/contents/pt1/full/gimo22.html "...Interestingly, 52% of 42 specimens from esophageal resections for achalasia had eosinophilia of the muscularis propria. Tottrup et al.21 detected increased expression of eosinophilic cationic protein in achalasia, suggesting a possible pathogenic role for activated eosinophils in achalasia. Although eosinophils are not present in the esophagus of control specimens, no relationship between the increasingly recognized entity of eosinophilic esophagitis and achalasia has been established. ..." "... Inflammatory infiltration of the myenteric plexus was present in 100% of specimens from a histologic analysis of 42 achalasia esophagectomy specimens.11 Immunohistochemical staining characterized the infiltrative cells as T cells positive for CD3 and CD8.81 A significant eosinophilic infiltration has been demonstrated in some patients with achalasia.16, 21 An association between achalasia and class II histocompatability antigen has been described, specifically identifying a higher genotypic frequency of the human leukocyte antigen (HLA)-DQw1, DQA1*0101, DQA1*103, DQB1*0602, and DQB1*0603 alleles in achalasia patients compared with controls.82, 83, 84, 85 Class II antigen expression on myenteric neurons could be targeted as foreign antigens. Storch et al.86 demonstrated antibodies against myenteric plexus in serum of 37 of 58 patients with achalasia and in only four of 54 healthy controls. ..." "... The majority of pathologic studies, however, have found that the predominant abnormalities exist within the myenteric plexus with marked diminution or complete absence of ganglion cells as well as intense inflammatory infiltration of the myenteric plexus.9, 11 Neural inflammation has not been described in other parts of the autonomic or central nervous system of achalasia patients arguing against these being the primary site of denervation. Furthermore, defects in vagal innervation would be expected to lead to prominent clinical abnormalities outside the esophagus including gastric emptying disorders, which are uncommonly seen in achalasia. ..." "... Additional evidence to support the neurodegenerative hypothesis comes from the description of Lewy bodies, intracytoplasmic inclusions characteristically found in Parkinson's disease, in the myenteric plexus and dorsal motor nucleus of achalasia patients.90 It is likely that the neurodegenerative changes in achalasia are secondary to viral or autoimmune-mediated destruction of the enteric ganglia. ..." Quote Link to comment Share on other sites More sharing options...
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