Conclusion that summarizes the letter:
The frequency of cough as an atypical symptom of eosinophilic
esophagitis is low and is characterized by the fact that it is usually
daytime and irritative, especially during or after food intake
Eosinophilic esophagitis and chronic cough originated beyond the
respiratory tree
CC affects all age groups and is a common complaint in the allergist
practice.
Eosinophilic esophagitis (EoE) is a clinicopathologic disease
characterized by esophageal dysfunction symptoms (EDS), and ≥15
eosinophils per high-power field (eos / hpf) in the esophagus after
exclusion of other disorders with eosinophilia (1). In addition to the
typical symptoms, they may have atypical and infrequent symptoms, among
which is CC (2).
CC as the main symptom of EoE, associated or not with other EDS has been
poorly studied and is not characterized. For this reason, the objective
of this study is, research the frequency of CC as an atypical symptom
and to investigate epidemiological, demographic, clinical, and
endoscopic-histological and allergic characteristics, these
co-morbidities, adherence to treatment and evolution.
Results
(Table 1 and 2)
Discussion
Atypical symptoms have also been described in EoE, although those are
less frequent. Some of them are aerodigestive as CC (2,3).
In a study on the prevalence of extraesophageal symptoms in patients
with EoE, it detets CC in 7–46% (4). It is rare but it can happen (2)
that the main symptom of EoE is CC (5.1% de our patients), with the
disadvantage that it is underdiagnosed, or its diagnosis is delayed of
EoE. In other study son recurrent croup in children, thank you 7.3%
were found to suffer from EoE.
We had not found studies which had evaluated the characteristics of the
patients’ CC with EoE. There is lower or no evidence on the
characteristics of this atypical symptom. Instead, we have observed that
cough in EoE triggering during day (worsening or starting during or
after food intakes)
As CC may be caused by an underlying EoE or merely coexistence with
other diseases. We have carried out the differential diagnosis of CC
requesting several complementary tests (Table 2). Most of the studies on
EoE and CC have performed in children (5,6), whereas in our serie, the
children are only 10%. Therefore, it is the first time that it has been
studied CC, and its characteristics in adults with EoE. Excluding
symptoms, rest of the characteristics are like other patients with
typical EoE symptoms. (1).
Almost half of de our patients had a fibrostenotic endoscopic phenotype,
compatible with a long evolution of the disease that can lead to
oesophageal structural and functional alterations (1) and provoke
serious complications (15% of our patients). CC could be influence as
the main symptom of EoE in the diagnostic delay, and we forced us to
carry out the differential diagnosis with respiratory diseases.
We highlight the good adherence to PPIs drugs of our patients, probably
because they are eager to find a remedy for their CC.
CC improved in all patients who did treatment with PPIs dugs, but it
only completely disappeared in the patients with EoE in remission. In
subsequent reviews, several patients have acknowledged the reappearance
of the cough upon cessation of adherence to treatment and its
disappearance within three months of performing it again.
This study has its limitations, we present data from an Allergology
Service, so it is possible that the results do not coincide with other
settings. One strength would be that it is a prospective study that
characterise CC secondary to EoE.
In conclusion, despite the frequency of the CC in EoE as a major symptom
is low, the doctors should consider EoE in the differential diagnosis of
CC in children and adults. Above all if it is diurnal, in relation with
food intakes to avoid delays in diagnosis and treatment which can
triggering complications that they reduce in the quality of life of
patients
References
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4. Rubinstein E, Rosen RL. Respiratory symptoms associated with
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Key words: Esophagitis; eosinophils; inflammation; food allergy
Words number : 590
Funding information : This work has not been funded by anything,
or by anyone
Acknowledgment : None
Conflict Interest : None of the authors of this work have a
conflict of interest.