ATILLA ERTAN, MD, FACP, AGAF, MACG. F.G.# 02020323-8. A 87 y/o male with a h/o mild fluctuating HTN & over 50 yrs GERD who was diagnosed as having S.S. Barrett’s esophagus with intramucosal ca & multifocal HGD on 07/22/03. MED: Aciphex, Lisinopril & ASA.
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ATILLA ERTAN, MD, FACP, AGAF, MACG
A 87 y/o male with a h/o mild fluctuating HTN & over 50 yrs GERD who was diagnosed as having S.S. Barrett’s esophagus with intramucosal ca & multifocal HGD on 07/22/03.
MED: Aciphex, Lisinopril & ASA.
PMH, PSH, SH, FH, ROS & PE: Essentially unremarkable.
Chest/abd./pelvic CT scan & esophageal EUS findings were c/w intramucosal Barrett’s cancer.
He was referred for PDT & performed on 08/23/03.
F G # 02020323-8
Barrett’s Ca, T1N0MX, 8/23/2003
Post-PDT F/U EGD, 3/01/2004
Post-PDT F/U EGD, 2/03/2005
S.S. Barrett’s with recurrent HGD
S/P HALO-360 ablation
A 47 y/o male with a more than 9 yrs h/o GERD & intermittent dysphagia who has had 6-7 episodes of food impaction within last 2 years. He has been diagnosed as having L.S. Barrett’s with HGD/LGD & eosinophilic esophagitis.
MED: Zegerid 40 mg BID
PMH/PSH & FH: Unremarkable.
SH: Married, IT technician, no tobacco, ETOH or IVDA.
ROS: Gained 40 lbs within last 10 yrs.
PE: Essentially unremarkable except moderate obesity.
LAB: Unremarkable CBC-diff, SMA-6 & other blood tests. Chest/abd CT scan
Previous history of food impactions:
Basal zone hyperplasia, increased eosinophilsLuminal accumulation
not the spectrum of EE, other than perhaps as coincidental occurences” (2).
Natural history & long-term follow-up studies are needed to provide more information in this relation.
1. Am J Gastroenterol, 101: 1900, 2006.
2. Gastroenterology, 133: 1342, 2007.
A 37 y/o male with a 5 yrs h/o intermittent solid food dysphagia, food impaction episodes who had many related ER visits. He has had minimal GERD complaints between
these episodes. During one of these episodes, he came to TMH ER.
ALL: Penn, shellfish
SH: Married, lawyer, denied T, ETOH & IVDA
Emergent EGD & biopsy findings
Post food impaction 3-20-2003
Food impaction 3-20-2003
EOSINOPHILIC ESOPHAGITIS [EE]
___________________________________________________During the last decade, we saw a rapid increase of patients with esophageal intraepithelial eosinophilia who were thought to be GERD but who did not respond to GERD management. Subsequent studies showed that these patients had a “new “ disease termed EE which is a disease characterized by:
Symptoms including but not restricted to food impaction & dysphagia in adults , and feeding intolerance & GERD symptoms in children.
≥15 intraepithelial eosinophilis/HPF
Exclusion of other disorders associated with similar clinical, histological, or endoscopic features, especially GERD.
FIGERS; Gastroenterol 133:1342-63, 2007.
FIGERS: Gastroenterol, 133: 1342, 2007 (modified).
* None of the features are pathogonomic of EE.
Differential Diagnosis of Eosinophilic Esophagitis
Connective tissue disorders*
Infections [herpes & candida]*
Drug sensitivity response
*These diseases may have intraepithelial eosinophilia but less than
15/HPF in one or more biopsy specimens.
ClinGastroenterol Hepatol 3:1198-206, 2005.
J Pediatr Gastroenterol Nutr 42:22-6, 2006.
1. Clin Gastroenterol Hepatol 4: 1097-102, 2006.
2. Am J Gastroenterol 101: 1666-70, 2006.
3. Gastrointest Endosc 63:3-12, 2006.
4 & 5. Gastroenterology 127: 364-5, 2004; 133:1342, 2007.