Eosinophilic gastrointestinal diseases:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia, Pa.
Saunders
2009
|
| Schriftenreihe: | Immunology and allergy clinics of North America
29,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XX, 222 S. Ill. |
| ISBN: | 9781437704891 1437704891 |
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| 650 | 4 | |a Allergy | |
| 650 | 4 | |a Eosinophil disorders | |
| 650 | 4 | |a Eosinophilia |x diagnosis | |
| 650 | 4 | |a Eosinophilia |x therapy | |
| 650 | 4 | |a Esophagitis |x diagnosis | |
| 650 | 4 | |a Esophagitis |x therapy | |
| 650 | 4 | |a Gastrointestinal Diseases |x diagnosis | |
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Datensatz im Suchindex
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|---|---|
| adam_text | Eosinophilic
Gastrointestinal
Diseases
Contents
Foreword: What Do Eosinophils Do in the Gastrointestinal
Mucosa?
xvii
Rafeul Alam
Preface
xix
Glenn T. Furuta and Dan Atkins
Eosinophilic Esophagitis
Evaluation of the Child who has Eosinophilic Esophagitis
1
Philip E. Putnam
Children who have eosinophilic esophagitis require comprehensive evalu¬
ation before treatment and ongoing assessment during treatment. When
completed at the appropriate times and under well-controlled circum¬
stances, investigation yields the correct diagnosis, assures recognition
of sequelae or recurrence of the inflammation, or confirms whether therapy
has been effective. Proper management of each child depends on compul¬
sive foilow-up until
ali
of the therapeutic goals have been achieved and the
child is on a stable regimen without esophageal inflammation. This article
summarizes the issues facing the patient and the physician during this
process.
Clinical Evaluation of the Adult who has Eosinophilic Esophagitis
11
Alex Straumann
Eosinophilic esophagitis (EoE) is a rapidly increasing, chronic,
Τ
helper
2-type inflammatory disease of the esophagus characterized by esopha¬
gus related symptoms and a dense esophageal eosinophilia, both of
which are refractory to proton pump inhibitors. The adult patient presents
with a typical history of dysphagia for solids and has often experienced
food impactions. However the general appearance shows an apparently
healthy individual; the physical examination is usually unremarkable.
The
endoscopie
findings are often subtle and misleading. The diagnosis
is therefore based on the
histologie
finding of a dense eosinophilic infiltra¬
tion of the esophageal
mucosa. In
adult patients, topical and systemic
corticosteroids, leukotriene receptor antagonists, immunomodulators,
and dilation have proven efficacy, whereas therapy with diet is still under
evaluation.
Contents
Eosinophilic Esophagitis
19
James P.
Franciosi
and Chris A. Liacouras
Eosinophilic esophagitis
is specific disease that involves an isolated
esophageal eosinophilic inflammation and clinical symptoms that do not
respond to acid-suppression therapy or are associated with normal
esophageal
pH
monitoring. To establish the diagnosis, upper endoscopy
with esophageal biopsies is required. Referral to an allergist and food aller¬
gen testing is recommended. Dietary and topical corticosteroid therapies
are commonly used and are effective in the majority of patients.
Mechanism of Eosinophilic Esophagitis
29
Anil Mishra
Eosinophilic esophagitis (EoE) is a newly recognized disease and is an
emerging entity throughout developing and developed countries, including
the United States. Therefore, understanding the causes, natural history, di¬
agnosis, and management is important for future therapeutic interven¬
tions. The pathogenesis of EoE is still not clear, but a growing body of
evidence has established that this condition represents a T-cell-mediated
immune response involving several proinflammatory mediators and che-
moattractants known to regulate eosinophilic accumulation in the esoph¬
agus, such as IL-4, IL-5, IL-3 and eotaxin-1
, -2,
and
-3.
Determining the
mechanism or mechanisms through which human esophageal-derived
factors ultimately induce the functional abnormalities observed, and to
which antigens patients who have EoE are sensitized that lead to the
manifestation of symptoms, is of significant interest.
Putting the Puzzle Together: Epidemiological and Clinical Clues in the Etiology
of Eosinophilic Esophagitis
41
Peter A.L.
Bonis
The cause of eosinophilic esophagitis remains unknown, but its epidemi¬
ology and clinical features provide pieces to the puzzle. Eosinophilic
esophagitis probably emerged in the
1
950s or early
1
960s, has an increas¬
ing incidence, occurs in most developed countries, is related to food aller¬
gies, affects adults and children, has a strong male predominance,
clusters in families, and is commonly associated with other allergic and
atopic disorders. Several theories have been proposed to explain its evo¬
lution, but none has been convincingly demonstrated.
Contents
ix
Eosinophilic Gastrointestinal
Diseases
Evaluation
of the
Patient
with Suspected
Eosinophilic
Gastrointestinal Disease
53
David
M.
Fleischer and Dan Atkins
This article focuses on the evaluation and management of eosinophilic gas¬
trointestinal diseases other than eosinophilic esophagitis. Those diseases
include eosinophilic gastritis, gastroenteritis, enteritis, and colitis. The diag¬
nosis of eosinophilic gastrointestinal disease is primarily dependent on the
clinical history and histopathology of multiple biopsy specimens after ruling
out other causes of intestinal eosinophilia. The diagnosis of eosinophilic gas¬
trointestinal diseases other than eosinophilic esophagitis is complicated by
the lack of uniformly accepted diagnostic criteria. Treatment involves evalu¬
ation for food sensitivity, elimination diets, and the use of anti-allergy and
anti-inflammatory medications with varying degrees of success. Little is
known about the natural history of eosinophilic gastrointestinal diseases,
underscoring the need for long-term follow-up studies of patients with these
disorders.
Clinical Presentation of Feeding Dysfunction in Children with Eosinophilic
Gastrointestinal Disease
65
Angela M. Haas and Nancy Creskoff
Maune
Feeding issues may affect many aspects of a child s health, development,
growth, nutrition and overall well-being. There is a developmental contin¬
uum for the acquisition of feeding skills, which includes motor skills, sensory
systems, behavioral/emotional components and communication. Food
refusal, dysphagia, reduced volume and reduced variety of intake are com¬
mon complaints associated with eosinophilic gastrointestinal diseases in
children. As the understanding of this disease process evolves, clinicians
are recognizing that feeding difficulties are a prevalent characteristic of chil¬
dren with eosinophilic gastrointestinal disease and the difficulties can dis¬
rupt a child s progress along the typical developmental feeding
continuum. Despite effective medical treatment, the residual effects on
feeding can persist and need to be addressed. Collaboration regarding
the medical, nutritional, and developmental plan of care optimizes out¬
comes for the well-being of children and families affected by this disease.
Nutritional Management of Children who have Food Allergies and Eosinophilic
Esophagitis
~П
Catherine M. Santangelo and Emily McCloud
Over the past decade, eosinophilic esophagitis has become increasingly
prevalent in the United States. One of the effective treatment approaches
Contents
is dietary management, which aims to eliminate exposure to food aller¬
gens. Approaches to dietary management include the use of elemental
diets, elimination diets, and tailored elimination diets, each of which poses
potential nutrition risks. The benefits and potential downsides of each
treatment are discussed in detail. Regardless of the diet therapy selected,
a complete nutrition assessment by a registered dietitian with expertise in
the management of food allergies is recommended for all patients diag¬
nosed with eosinophilic esophagitis.
Association of Eosinophilic Gastrointestinal Disorders with Other Atopic Disorders
85
Soma
Jyonouchi,
Terri
A. Brown-Whitehorn, and Jonathan M.
Spergel
Eosinophilic esophagitis is a chronic disease that leads to either persistent
symptoms or, at times, intermittent flares. It shares many features with
other atopic diseases (asthma, allergic rhinitis, and atopic dermatitis), in¬
cluding the following:
Τ
helper
2
cells and eosinophils play a critical role
in the pathogenesis of the disease; avoidance of allergens promotes
remission of disease and symptom control; and locally applied corticoste-
roids provide control. Finally, most patients who have eosinophilic gastro¬
intestinal disorders have an associated atopic disease.
Psychological Impact of Eosinophilic Esophagitis on Children and Families
99
Mary D. Klinnert
Because eosinophilic esophagitis
(EoĘ
has only recently been recognized
and described, systematic research regarding the natural history of the
disease and the short- and long-term effects of treatment is in its infancy.
Clinical experience indicates that disease symptoms and treatments can
have profound effects on the quality of life of affected children and their
families. The responses of children and adolescents are variable, and
are dependent on developmental level, temperament, and pre-existing
psychological adjustment. Although parents of chronically ill children typ¬
ically experience increased burden and stress, it is possible that the uncer¬
tainties currently associated with EoE contribute to even higher levels of
anxiety. Research studies are needed to investigate the impact of EoE
symptoms and of current treatments on quality of life and psychological
adjustment in children and their families.
Histopathology Associated with Eosinophilic Gastrointestinal Diseases
109
Margaret H. Collins
Eosinophilic gastrointestinal diseases (EGlDs) are broadly defined as dis¬
eases that characteristically exhibit excessive numbers of eosinophils, in
normal and abnormal locations, in one or more gastrointestinal tract
Contents
segments.
EGIDs
have
multiple
possible etiologies. Pathologists must
avoid overdlagnosis of EGIDs by applying site-specific criteria for eosino-
phil density to mucosal biopsy specimens. Gastroenterologists must avoid
contributing to overdiagnosis by submitting biopsy samples from each
segment of the gastrointestinal tract separately, especially from the colon
where the maximum mucosal eosinophil density in the right side normally
exceeds that of the more distal colon. More studies of normal tissue and
tissue from patients who are known or suspected to have EGIDs, with clin-
icopathologic correlations, are required to more fully define the spectrum
of histopathology in EGIDs.
Biomarkers
for Nononcologic Gastrointestinal Diseases
119
Rohit Katial
Biomarkers
are objectively measured indicators of normal and abnormal
biologic processes and may vary with therapeutic interventions. In the
area of gastrointestinal diseases,
biomarker
research is primarily in the
area of cancer biology. Little is known about
biomarkers
in connection
with other gastrointestinal disorders. This article reviews
biomarker
data
for nononcologic gastrointestinal processes with a focus on allergic
disorders.
Functional Role of Eosinophils in Gastrointestinal Inflammation
129
Simon P. Hogan
Eosinophilic gastrointestinal (Gl) diseases (EGIDs) are characterized by
a rich eosinophilic inflammation of the Gl tract. Clinical and experimen¬
tal studies suggest that eosinophils have a pathogenic role in EGIDs;
however, the function of eosinophils in these diseases remains an
enigma. This article describes eosinophil immunoregulatory and effector
function and discusses the possible involvement of these pathways in
EGIDs.
Chemotactic Factors Associated with Eosinophilic Gastrointestinal Diseases
141
Carine
Blanchard
and Marc E. Rothenberg
The gastrointestinal (Gl) tract is in constant negotiation with the microbial
flora present in the lumen. Resident hematopoietic cells (ie, lymphocytes,
mast cells, and eosinophils) are part of this ongoing and silent homeostatic
battle. Eosinophilic Gl diseases are characterized by an increased number
of eosinophil infiltrates with no identified cause. This article describes the
past and present knowledge regarding the chemotactic factors involved in
Gl eosinophilia.
xii Contents
The Role of Lymphocytes in Eosinophilic Gastrointestinal Disorders
149
Mima Chehade and Hugh A. Sampson
Eosinophilic gastrointestinal diseases (EGlDs) encompass a variety of dis¬
orders including eosinophilic esophagitis
(EĘ,
eosinophilic gastroenteritis
(EG), and eosinophilic colitis. Although the pathogenesis of EGlDs is still
poorly understood, dietary food antigens have been shown to cause
EGlDs through several short-term clinical studies. The relationship of
EGlDs with food allergy points to a potential breach of oral tolerance in
EGlDs and to a potentially important role played by lymphocytes in re¬
sponding to the oral food antigens. This article discusses the concept of
oral tolerance, the available evidence for the role that lymphocytes play
in the induction and pathogenesis of EGlDs, and the evidence for a poten¬
tial breach in oral tolerance in EGlDs.
The Role of the High-Affinity
Ig
E
Receptor, FceRI, in Eosinophilic
Gastrointestinal Diseases
159
Eleonora
Dehlink and
Edda Fiebiger
Primary eosinophilic gastrointestinal diseases (EGlDs) are a heteroge¬
neous group of diseases including eosinophilic esophagitis, eosinophilic
gastritis, eosinophilic gastroenteritis, eosinophilic enteritis, and eosino¬
philic colitis. The unifying hallmark and diagnostic marker of EGlDs is
an eosinophil-rich inflammatory infiltrate of the Gl
mucosa,
in the ab¬
sence of known causes for eosinophilia. The etiology of EGlDs is not
yet fully understood. The pathogenesis however seems to involve a com¬
plex interplay of genetic predisposition, exposure to food- and environ¬
mental allergens and IgE-mediated activation of the immune system.
Accumulating evidence relates EGlDs to the group of
Т
-helper
(Th)
2
mediated immune disorders, like IgE-mediated allergy. In this article
we discuss a possible role of IgE-mediated immune-activation via the
high affinity receptor for IgE, FceRI, in the pathogenesis of primary
EGlDs. Beyond its defined role in type I allergic reactions, we here hy¬
pothesize that activation of tetrameric FceRI on mast cells and basophils
as well as
trimeric
FceRI on human eosinophils and antigen presenting
cells in the gastrointestinal
mucosa
is critically involved in the pathology
of EGlDs. We also discuss how IgE-independent triggering of FceRI
could be a mechanisms responsible for activation of the immune system
in patients with
EGID.
Epithelial Function in Eosinophilic Gastrointestinal Diseases
171
Sophie Fillon, Zachary D. Robinson, Sean P. Colgan, and Glenn T. Furuta
Eosinophilic gastrointestinal diseases (EGlDs) are characterized by a wide
variety of gastrointestinal symptoms that occur in conjunction with in¬
creased numbers of eosinophils in intestinal tissues. With the precise
Contents
role or roles of eosinophils in gastrointestinal dysfunction incompletely
understood, this subject remains an area of intense investigation. Most
studies suggest that the intimate anatomic association of eosinophils
with the intestinal epithelium implicates participation in the pathophysiol-
ogy of EGlDs. This article reviews the limited evidence suggesting that
the epithelium and eosinophils interact in the gastrointestinal tract and In
other organ systems and describes how the epithelium and eosinophils
might participate in gastrointestinal inflammatory diseases.
Role of Tolerance in the Development of Eosinophilic Gastrointestinal Diseases
179
Pooja Varshney and A. Wesley Burks
Although the precise link is not completely understood, eosinophilic gas¬
trointestinal diseases have been shown to be highly associated with atopy.
Oral tolerance describes the specific suppression of immune responses to
an antigen by prior administration of the antigen by the oral route. Like
other allergic gastrointestinal diseases, eosinophilic gastrointestinal disor¬
ders may result from a loss of oral tolerance or a failure in the induction of
tolerance. Further study to clarify the role of tolerance in the development
of eosinophilic gastrointestinal diseases can help identify potential preven¬
tion strategies and therapeutic targets.
Exploring the Role of Mast Cells in Eosinophilic Esophagitis
189
Barry K. Wershil
The mast cell plays a critical role in allergic responses in the gastrointesti¬
nal tract and other sites. Emerging evidence indicates that mast cells also
participate in the pathogenesis of eosinophilic esophagitis, although their
precise role has not been defined. This article reviews the biology of mast
cells and examines the potential involvement of the cell as an effector of
the inflammatory response and tissue remodeling, and as a cell that has
the potential to function as an immunomodulator and limit inflammation.
Relationships Between Eosinophilic Inflammation, Tissue Remodeling,
and Fibrosis in Eosinophilic Esophagitis
197
Seema S. Aceves and Steven J. Ackerman
The clinical and pathologic features of eosinophilic esophagitis
(ЕЕ)
in¬
clude extensive tissue remodeling. Increasing evidence supports a key
role for the eosinophil in multiple aspects of the esophageal remodeling
and fibrosis seen in this allergic disease. This article reviews the clinical
implications of esophageal remodeling and fibrosis in
ЕЕ
and discusses
the possible pathogenic mechanisms inducing and regulating these
xiv Contents
responses.
The focus is specifically on eosinophil and cytokine interac¬
tions with the esophageai epithelium, vascular endothelium, resident fibro-
blasts, and smooth muscle. Current and potential therapeutic
interventions are discussed that may impact the development or resolution
of chronic esophageai remodeling and fibrosis in
ЕЕ.
Index
213
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| series | Immunology and allergy clinics of North America |
| series2 | Immunology and allergy clinics of North America |
| spelling | Eosinophilic gastrointestinal diseases guest eds.: Glenn T. Furuta ... Philadelphia, Pa. Saunders 2009 XX, 222 S. Ill. txt rdacontent n rdamedia nc rdacarrier Immunology and allergy clinics of North America 29,1 Allergy Eosinophil disorders Eosinophilia diagnosis Eosinophilia therapy Esophagitis diagnosis Esophagitis therapy Gastrointestinal Diseases diagnosis Gastrointestinal Diseases therapy Gastrointestinal system Diseases Eosinophilie (DE-588)4324125-6 gnd rswk-swf Gastrointestinale Krankheit (DE-588)4114483-1 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Gastrointestinale Krankheit (DE-588)4114483-1 s Eosinophilie (DE-588)4324125-6 s DE-604 Furuta, Glenn T. Sonstige oth Immunology and allergy clinics of North America 29,1 (DE-604)BV000645505 29,1 Digitalisierung UB Regensburg application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017164624&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Eosinophilic gastrointestinal diseases Immunology and allergy clinics of North America Allergy Eosinophil disorders Eosinophilia diagnosis Eosinophilia therapy Esophagitis diagnosis Esophagitis therapy Gastrointestinal Diseases diagnosis Gastrointestinal Diseases therapy Gastrointestinal system Diseases Eosinophilie (DE-588)4324125-6 gnd Gastrointestinale Krankheit (DE-588)4114483-1 gnd |
| subject_GND | (DE-588)4324125-6 (DE-588)4114483-1 (DE-588)4143413-4 |
| title | Eosinophilic gastrointestinal diseases |
| title_auth | Eosinophilic gastrointestinal diseases |
| title_exact_search | Eosinophilic gastrointestinal diseases |
| title_full | Eosinophilic gastrointestinal diseases guest eds.: Glenn T. Furuta ... |
| title_fullStr | Eosinophilic gastrointestinal diseases guest eds.: Glenn T. Furuta ... |
| title_full_unstemmed | Eosinophilic gastrointestinal diseases guest eds.: Glenn T. Furuta ... |
| title_short | Eosinophilic gastrointestinal diseases |
| title_sort | eosinophilic gastrointestinal diseases |
| topic | Allergy Eosinophil disorders Eosinophilia diagnosis Eosinophilia therapy Esophagitis diagnosis Esophagitis therapy Gastrointestinal Diseases diagnosis Gastrointestinal Diseases therapy Gastrointestinal system Diseases Eosinophilie (DE-588)4324125-6 gnd Gastrointestinale Krankheit (DE-588)4114483-1 gnd |
| topic_facet | Allergy Eosinophil disorders Eosinophilia diagnosis Eosinophilia therapy Esophagitis diagnosis Esophagitis therapy Gastrointestinal Diseases diagnosis Gastrointestinal Diseases therapy Gastrointestinal system Diseases Eosinophilie Gastrointestinale Krankheit Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=017164624&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000645505 |
| work_keys_str_mv | AT furutaglennt eosinophilicgastrointestinaldiseases |