Introduction

Eosinophilic Esophagitis (EoE) is a chronic, immune-mediated esophageal disease characterized by esophageal dysfunction symptoms and histological eosinophilic infiltration. Diagnosis requires ≥15 eosinophils per high-power field and exclusion of other causes. Though its pathophysiology is not fully understood, food antigens—such as milk and wheat—are considered primary triggers, leading to chronic inflammation, mucosal damage, and fibrosis. EoE predominantly affects white males and is managed through dietary therapy, PPIs, and topical corticosteroids. Since its identification in the 1990s, prevalence has increased, especially in Western populations, with notable regional and ethnic variability. In Latin America, prevalence also varies between countries. Esophageal biopsies are essential in patients with esophageal dysfunction, even in the absence of visible endoscopic changes. However, the frequency of esophageal eosinophilia in this population remains unknown in our region and institution.

Aims & Methods

A cross-sectional, descriptive, and retrospective study was conducted on patients over 18 years of age with symptoms of esophageal dysfunction who underwent upper endoscopy with esophageal biopsies between January 2020 and October 2023. A convenience sample of 164 patients was determined based on a 4% expected prevalence of EoE. Clinical records, endoscopy reports, and pathology files were reviewed to identify cases meeting diagnostic criteria. Data were analyzed using descriptive and inferential statistics, with a significance level set at p < 0.05.

Results

Demographics and Medical Background:The study included 152 patients (72.36% women; mean age 55.28 ± 14.07). Chronic conditions were present in 60.52% of the participants, the most frequent being hypertension (16.44%), asthma (11.18%), and diabetes mellitus (9.21%).Clinical Presentation:Gastroesophageal reflux symptoms (GERD) were reported in 51.31% of patients, with 28.28% presenting alarm symptoms (mainly dysphagia). Dysphagia alone was the second most common symptom (34.86%). Food impaction occurred in 6.57%, and esophageal strictures in 4.60%. Symptoms of Esophageal Dysfunction:Dysphagia was the most common symptom (67.76%), followed by heartburn (47.36%) and regurgitation (44.73%). Less common symptoms included food impaction, globus sensation, and non-cardiac chest pain. Endoscopic Findings:Findings suggestive of eosinophilic esophagitis (EoE) were relatively uncommon: esophageal rings (26.97%), strictures (11.18%), exudates (13.81%), longitudinal furrows (9.21%), and edema (0.65%). Hiatal hernia was observed in 28.94% of patients, and a wide hiatus in 41.44%. Prevalence of EoE:EoE (≥15 eosinophils/HPF) was diagnosed in 11 patients (7.2%). The average age was 48.63 ± 16.5 years, with dysphagia (72.7%), heartburn (63.6%), and regurgitation (54.5%) as the most frequent symptoms. Endoscopic signs suggestive of EoE were present in only 36.36% of these patients.​

Conclusion

This study investigates the clinical and diagnostic characteristics of Eosinophilic Esophagitis (EoE) in a specific population. A high prevalence of chronic comorbidities (60.52%) and a predominance of female patients (72.36%) were found. GERD symptoms were common (51.31%) and overlapped with EoE, especially in dysphagia and heartburn. EoE prevalence was 7.2%, with hiatal hernia linked to symptoms and food impaction. Diagnostic indicators showed good specificity but limited sensitivity. These findings emphasize the need for a comprehensive approach, combining clinical and endoscopic data, for accurate diagnosis and effective management of EoE.

References

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Disclosure

Not conflict of interest

Clinical Case Summary

An 80-year-old woman with a history of right ovarian cancer, treated with total hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant radiotherapy in 1984, presented with tenesmus and rectal bleeding. She had long-standing radiation-induced enteritis. Colonoscopy revealed a 50mm ulcerated neoplasm in the distal rectum. Histopathological analysis confirmed a low-grade rectal adenocarcinoma with loss of nuclear expression of the mismatch repair proteins MSH2 and MSH6. Staging with thoracoabdominal CT and pelvic MRI showed a distal rectal adenocarcinoma invading the vagina and levator ani muscle (cT4), cN0, with a suspicious left inguinal lymph node (possible cM1). Given her prior exposure to pelvic radiotherapy and the presence of chronic radiation-induced injury, a multidisciplinary team, after discussion with the patient and her family, decided to initiate off-label neoadjuvant treatment with dostarlimab for six months, completing a total of eight cycles. Six weeks after completion of immunotherapy, flexible sigmoidoscopy demonstrated a clinical near-complete response (near-cCR) and pelvic MRI showed radiologic complete response (rCR), with no evidence of residual tumor or lymphadenopathy. A new flexible sigmoidoscopy is scheduled in four weeks. If cCR is confirmed, the patient will enter a Watch and Wait surveillance program. Traditionally, rectal cancer treatment has relied on a combination of chemoradiotherapy and surgery, resulting in pathologic complete response in up to 25% of patients, but frequently associated with complications and treatment-related toxicity. Recent studies have demonstrated promising results with immune checkpoint inhibitors, particularly dostarlimab as single agent, an antiprogrammed cell death protein 1 monoclonal antibody. In recent studies so far, this agent was remarkably effective in mismatch repair–deficient, locally advanced rectal cancer, showing high rates of cCR and prolonged overall survival.

References

Andrea Cercek et al, A Phase Two, Single-Arm, Open-Label Study With Dostarlimab Monotherapy in Participants With Untreated Stage II/III dMMR/MSI-H Locally Advanced Rectal Cancer (AZUR-1), Clinical Colorectal Cancer

A. Cercek, M. Lumish, J. Sinopoli, J. Weiss, J. Shia, M. Lamendola-Essel, I.H. El Dika, N. Segal, M. Shcherba, R. Sugarman, Z. Stadler, R. Yaeger, J.J. Smith, B. Rousseau, G. Argiles, M. Patel, A. Desai, L.B. Saltz, M. Widmar, K. Iyer, J. Zhang, N. Gianino, C. Crane, P.B. Romesser, E.P. Pappou, P. Paty, J. Garcia-Aguilar, M. Gonen, M. Gollub, M.R. Weiser, K.A. Schalper, L.A. Diaz Jr. PD-1 BLockade in Mismatch Repair-deficient, Locally Advanced Rectal Cancer

Introduction

Delayed bleeding remains a significant complication after endoscopic resection procedures in the gastrointestinal tract. Effective strategies to prevent post-procedural bleeding and promote optimal healing are critical for improving patient’s outcomes. Self-assembling peptide (SAP) is a new hemostatic agent that forms protective nanofibers scaffold after contact with body fluids. Its application may reduce delayed bleeding and support tissue healing after endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD). Early clinical data has shown promising results, but evidence is still limited.

Aims & Methods

This study evaluates the impact of SAP use on delayed bleeding rates and healing process after advanced endoscopic therapies. The findings may support the integration of SAP into standard post-endoscopic care protocols.
A retrospective analysis was conducted on patients after EMR or ESD at a single tertiary endoscopy center. Two primary outcomes were assessed: delayed bleeding and post-resection defect healing. Delayed bleeding was defined as clinically evident bleeding occurring within 30 days following the index endoscopy. Healing was evaluated endoscopically using the Sakita-Fukutomi classification at 4, 8, and 24 weeks. The size of the resection defect was measured during the procedure using endoscopic forceps or a polypectomy snare for reference. Data were collected from medical reports.​​​​​​​​

Results

A total of 141 patients (55 women, 86 men) were included in the analysis. The majority underwent ESD (n=96; 68 %), followed by piece-meal EMR (n=36; 26 %), hybrid procedure EMR+ESD (n=7; 5 %), and en-bloc EMR (n=2; 1 %). 35 lesions (25 %) were located in upper GI tract, 106 lesions (75 %) in colon and rectum with an average lesion size of 48 mm. R0 resection was achieved in 71 (78 %) of all 91 en-bloc resections. Delayed bleeding occurred in 6 patients (4.3%), with an average onset of 4 days after the procedure. All these patients had subsequent endoscopy with various hemostatic approaches, including SAP alone (n=3), SAP with coagulation (n=1), coagulation with hemoclips (n=1), and coagulation with hemospray (n=1). In all cases hemostasis was achieved. 2 patients required transfusion. The post-resection defect averaged 51 mm after index endoscopy. At 4, 8, and 24 weeks post-procedure, its size decreased to 20 mm, 14.5 mm, and 10 mm, marking reductions of 61%, 72%, and 80%, respectively.

Conclusion

SAP is effective in preventing delayed bleeding and healing post-resection defects. Its use can increase overall safety of advanced endoscopic procedures. Further studies are needed to establish optimal indications and integration into standard post-procedure protocol.
Supported by program projects of the Ministry of Health of the Czech Republic with reg. no. NU22-08-00424, MO1012 and Cooperatio.