Clinical and morphological characteristics of eosinophilic esophagitis with surgical complications

Objective. To study the clinical, laboratory, endoscopic, and pathomorphological features of eosinophilic esophagitis with surgical complications. Material and methods. 113 patients with a confirmed eosinophilic esophagitis (based on esophagogastroduodenoscopy with esophageal biopsy) underwent a comprehensive examination including assessment of complaints, medical history, comorbidities, and nutritional status. Laboratory blood tests, esophagogastroduodenoscopy with endocytoscopy and esophageal biopsy, and pathomorphological examination of biopsy specimens were performed. Some patients also underwent barium esophagogram. Results. Complications leading to endoscopic and/or surgical interventions were recorded in 27.4% of patients with eosinophilic esophagitis. Complicated forms of eosinophilic esophagitis were characterized by more severe clinical manifestations (dysphagia and food impaction were observed in 96.7% of patients), changes in laboratory tests (blood eosinophilia and elevated IgE level), a high score on the EREхFS scale (more than 6 points), detection of strictures during endoscopic examination, and fibrosis in the subepithelial layer upon histopathological examination. Conclusion. One-third of eosinophilic esophagitis cases are complicated, requiring patients to seek urgent endoscopic and surgical care. Most patients with a complicated course are young men under 30 years of age, suffering from persistent dysphagia and recurrent food impaction episodes. Esophagogastroduodenoscopy in patients with eosinophilic esophagitis reveals characteristic signs of mucosal inflammation – edema, exudate, and longitudinal furrows; in cases of delayed diagnosis, rings and strictures are found in the esophagus. To prevent complications, every patient with unexplained dysphagia (especially with episodes of food impaction) should undergo endoscopic examination of the esophagus with multiple biopsies for timely diagnosis and initiation of anti-inflammatory therapy.

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