Eosinophilic esophagitis (EoE) is a chronic inflammatory disease that encompasses esophageal symptoms along with eosinophilic infiltration of the esophageal epithelium. EoE is an evolving disease that has been a subject of interest to many researchers since the first studies recognized this condition as a new and distinct clinicopathological entity 25 years ago. Clinical presentation in adult patients may include dysphagia, food impaction, vomiting, and reflux symptoms. The diagnosis of EoE is based on the combination of clinical history suggestive of esophageal dysfunction, endoscopic features indicative of the disease, and histology revealing eosinophilic infiltration of the esophageal epithelium that persists after a trial of proton pump inhibitor therapy along with the exclusion of other disorders that may be associated with esophageal tissue eosinophilia. The interplay between EoE and gastroesophageal reflux disease (GERD) is complex, and differentiating these two conditions continues to be difficult and challenging in clinical practice. The mainstay treatment includes dietary modification, topical steroids, and/or endoscopic dilation. The primary care physician (PCP) plays an important role in improving patient care and quality of life by ensuring early referral and participating in management and follow-up. This article provides an overview of the current knowledge base regarding the disease including epidemiology, genetics, pathogenesis, common clinical presentations, the interplay between EoE and GERD, diagnostic approaches, and therapeutic options available to the PCP.

Citations

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  Samet Tosun, Fenise Selin Karalı, Nilgün Çınar
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• Imaging Findings of Eosinophilic Gastrointestinal Diseases in Adults
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• Novel Questionnaires for Assessing Signs and Symptoms of Eosinophilic Esophagitis in Children
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Background
Gastroesophageal reflux disease is highly prevalent among overweight and obese individuals. This study aimed to investigate the effect of weight change on the development of erosive esophagitis (EE).
Methods
A retrospective review of medical records from a university hospital in South Korea identified 7,123 subjects who underwent routine health checkups in 2012 and 2014. We excluded participants with EE in 2012. Body mass index (BMI) changes were classified as loss, stable, mild gain, or moderate gain.
Results
Mild and moderate weight gain increased the odds of EE development (odds ratio [OR], 1.39; 95% confidence interval [CI], 1.06–1.84 and OR, 2.80; 95% CI, 1.87–4.21, respectively) relative to weight stability. Weight loss decreased the odds of EE development (OR, 0.58; 95% CI, 0.38–0.90) relative to weight stability. After stratifying subjects into three groups by baseline BMI, those with mild and moderate weight gain in the obese group and moderate gain in the overweight group showed increased odds of EE development relative to members of those groups whose weights remained stable (OR, 2.08; 95% CI, 1.29–3.36; OR, 3.92; 95% CI, 1.99–7.73 in obese group, and OR, 3.30; 95% CI, 1.64–6.64 in overweight group, respectively). In comparison, weight loss in the normal weight group decreased the odds of EE development relative to weight stability (OR, 0.38; 95% CI, 0.15–0.97).
Conclusion
Weight gain was positively associated with EE development in overweight or obese individuals. Weight loss was negatively associated with EE development in normal-weight individuals.

Citations

• Features of lipid metabolism in patients with erosive esophagitis during the period of martial law
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  Andro Pramana Witarto, Bendix Samarta Witarto, Shidi Laras Pramudito, Lintang Cahyaning Ratri, Nabilah Azzah Putri Wairooy, Tiffany Konstantin, Achmad Januar Er Putra, Citrawati Dyah Kencono Wungu, Annisa Zahra Mufida, Arief Gusnanto
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  Soo Young Kim
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Background
The reports that obesity could be associated with upper gastrointestinal disorders such as gastritis, gastric ulcer, duodenal ulcer, reflux esophagitis have not been consistent. Therefore, we studied the association between esophagogastroduodenoscopic (EGD) fi ndings and the related risk factors of obesity. Methods: The study subjects include 2,210 adults who visited the Health Promotion Center of one university hospital from January 2006 to December 2006. All subjects had standard physical measurements as well as resting blood pressure, fasting blood glucose, HbA1c, serum lipids, and gastroendoscopic examination. BMI was classifi ed into two groups (BMI ≥ 23 kg/m2, normal; BMI < 23 kg/m2, overweight or obese). The study subjects were classifi ed into four groups according to the EGD fi ndings; normal, gastritis, gastric or duodenal ulcer, refl ux esophagitis. Results: Mean BMI of gastritis, gastric or duodenal ulcer, and refl ux esophagitis groups were higher than normal group after adjusting age, sex, alcohol and smoking (P < 0.001). Gastritis risk (OR, 2.098; 95% CI, 1.195 to 3.682; P = 0.01), gastric or duodenal ulcer risk (OR, 2.562; 95% CI, 1.282 to 5.117; P = 0.008), and refl ux esophagitis risk (OR, 2.856; 95% CI, 1.522 to 5.360; P = 0.001) were signifi cantly higher in overweight and obesity group compare with normal weight group after adjusting age, sex, alcohol and smoking. Conclusion: We suggest that overweight or obesity is the risk factor of gastritis, gastric or duodenal ulcer, and reflux esophagitis.

Background
: Gastroesophageal reflux disease (GERD) is common in Western civilization and comprises 75% of esophageal diseases. However, there are only few studies of GERD in Korea. The aim of the study was to evaluate the clinical symptoms of GERD in Koreans and the effect of Rabeprazole on the symptoms.

Methods : The study subjects were included 353 patients who were diagnosed endoscopically with reflux esophagitis (316) or non-erosive reflux disease who have complained of intermittent heartburn during the past 3 months or more. All patients received Rabeprazole 20 mg daily for 8 weeks. Symptoms according to 8 symptom categories of GERD were evaluated. Patients recorded the severity of GERD associated symptoms at baseline, 4 weeks and 8 weeks after treatment. Presenting symptoms in Korean, frequency and severity of each symptom was evaluated. Efficacy of Rabeprazole treatment was analyzed.

Results : The most common symptoms of GERD were regurgitation (60.9%), heartburn (52.7%), epigastric pain/ soreness (49.6%) and other epigastric discomfort (47.0%). Symptom severity was rated in order of epigastric pain/ soreness, epigastric discomfort, and heartburn. The proportion of all symptoms, except for heart burn and cough, increased in relation to the severity of endoscopic grading, but the severity of symptoms was not significantly different between subgroups according to endoscopic findings. Symptoms, except for hoarseness, globus sensation and cough, significantly improved in 4 weeks after treatment. Cough did not improve after 4 weeks irrespective of smoking status, All symptoms significantly improved after 8 weeks.

Conclusion : Regurgitation was more common, and epigastric symptoms were more severe than heartburn in Koreans. The 8-week Rabeprazole treatment was effective on all symptoms associated with GERD.

Background
: A habit of lying-down after eating is known as a risk factor of reflux esophagitis. However the association between gastrointestinal disorders and a postprandial lying-down habit has not yet been identified. Some people believe that lying-down after meals is helpful for their health. We intended to investigate the relationship between such a habit and the health lifestyles, gastrointestinal symptoms, disorders using a questionnaires and gastrofiberscopic results of patients who visited our general health screening center.

Methods : We examined 1,030 subjects (the frequent postprandial lying-down group was 576 persons (57.7%), the rare group was 436 persons (42.3%) who visited our general health screening center for a routine check-up including a gastrofiberoscopy during the period between January 2001 to December 2002. After frequency matching by age and sex, health lifestyles (such as smoking, alcohol consumption, exercise, eating habits, night time sleep duration and awakening frequency, nap, and coffee intake), gastrointestinal symptoms (dyspepsia, epigastric pain, heart burn, chest pain, and constipation) and gastrofiberoscopic findings were compared using results from the questionnaires and gastrofiberscopic findings. Factors such as gastritis and reflux esophagitis were set as dependent variables, while postprandial lying-down was set as an independent variable. The frequent postprandial lying-down group and the rare group were analysed through stepwised multiple logistic regression analysis.

Results : Subjects with a frequent postprandial lying- down habit showed a significantly greater degree in alcohol consumption (P=0.010), irregular eating habits (P＜0.001), eating between meals (P＜0.001), napping (P＜0.001), and night time awakening frequency (P= 0.016) than the rare group did. In addition, chest pain (P=0.031) and constipation (P=0.010) were more common in the frequent postprandial lying-down group. However, prevalence of dyspepsia (P=0.147), epigastric pain (P=0.085), and heartburn (P=0.700) showed no differences between the two groups. Being controlled with age, sex, education level, body mass index, and life style factors, postprandial lying-down group showed higher prevalence ratios in erythematous gastritis (OR 1.59; P=0.090), atrophic gastritis (OR 1.71; P= 0.059), and reflux esophagitis (OR 1.78; P=0.103).

Conclusion : A postprandial lying-down habit is associated with undesirable lifestyles and some gastrointestinal disorders. Therefore, a modification of the postprandial lying-down habit should be recommended. Further investigation is needed to clarify the causal relationships between a postprandial lying down habit and gastrointestinal symptoms and disorders.

Background
: It was known that the prevalence of reflux esophagitis in Korea was below 5% and there were few epidemiological data on reflux esophagitis in Korea. It was reported that the associated factors of reflux esophagitis were sex, smoking, alcohol consumption, obesity, drugs, exercise, diet habits, but the number of systematic studies on these factors was small. Thus, we studied to estimate the prevalence and associated factors of reflux esophagitis in Korea.

Methods : We examined 5,487 subjects (male 3,450, female 2,037, age;18-82 year) visiting health promotion center for routine check-up including esophagogastroduodenoscopy. All of them were given a questionnaire about past medical history, use of drugs, smoking, alcohol consumption, social history, diet habits. We recruited 275 cases with reflux esophagitis and 550 controls without reflux esophagitis on esophagogastroduodenoscopy. We estimated the prevalence of reflux esophagitis and performed retrospectively a cross-sectional study to evaluate the associated factors of reflux esophagitis.

Results : The prevalence of reflux esophagitis was 5.01%, 7.10% in male, 1.47% in female. The prevalence in male was significantly higher than that in female(p<0.05). The associated factors of reflux esophagitis were smoking, alcohol consumption, serum total cholesterol, triglyceride (p<0.005). It was investigated that the cases with reflux esophagitis in relation to diet habits ate more frequently fried foods in oil, Chinese dishes than controls (p<0.05)

Conclusion : The prevalence of reflux esophagitis in routine check-up subjects was 5.01%. The associated factors of reflux esophagitis were smoking, alcohol consumption, serum total cholesterol, triglyceride.