PMC4748193_01
Baseline biopsies. (A) Tangential esophageal muscosa with marked eosinophilia. H&E stain x100 magnification. (B) Intraepithelial eosinophils up to 400/hpf with intercellular edema. H&E stain x400 magnification.
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F1
Initial biopsies showed 400 eosinophils per HPF from both the proximal and distal esophagus, associated with lamina propria fibrosis, despite 6 months of the 6-food elimination diet (Figure 1).
Biopsies 1 month after dexlansoprazole. (A) Esophageal mucosa with eosinophilia and intercellular edema. H&E stain x100 magnification. (B) Marked intraepithelial eosinophils, up to 200/hpf with intercellular edema and microabscesses. H&E stain x400 magnification.
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F2
Three further endoscopies and dilation followed at monthly intervals (Figure 2).
Biopsies 2 months after dexlansoprazole. H&E stain x200 magnification. (A) Proximal biopsies with up to 55 eosinophils/hpf. (B) Distal biopsies have about 15 eosinophils/hpf.
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F3
After 2 months on PPI, there was a dramatic decrease in eosinophils, but still in the abnormal range (55 distal; 15 proximal; Figure 3).
Biopsies 4 months after dexlansoprazole. (A) Distal esophageal mucosa with rare intraepithelial eosinophils (5/hpf). H&E stain x400 magnification. (B) Proximal esophageal mucosa nearly normal. H&E stain x200 magnification.
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F4
By 4 months, esophageal histology had normalized (5 distal; 2 proximal; Figure 4).