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Resumen La esofagitis eosinofilica (EE) es una enfermedad emergente, caracterizada por una densa infiltracion del esofago por leucocitos eosinofilos. Sus principales sintomas son la disfagia y las frecuentes impactaciones de alimento en el esofago, en respuesta a una reaccion de hipersensibilidad frente a distintos alimentos o aeroalergenos. La acumulacion de eosinofilos en el epitelio esofagico, en respuesta a la produccion local de citocinas y quimiocinas eosinofilotropas, se ha documentado en modelos animales, y se ha propuesto que responde a una reaccion de hipersensibilidad de tipo TH2. El epitelio esofagico contiene todos los tipos celulares necesarios para desarrollar respuestas inmunoalergicas locales, tras la estimulacion de linfocitos T CD4+. Sin embargo, cada vez hay mas pruebas del papel relevante que la inmunidad humoral desempena en esta enfermedad, a traves de la accion de la inmunoglobulina E, principalmente sobre los mastocitos. El predominio de linfocitos T CD8+ en el infiltrado inflamatorio tambien sugiere una posible reaccion TH1 en el mecanismo de la enfermedad. Las proteinas contenidas en los granulos citoplasmaticos de los eosinofilos y de los mastocitos activados podrian actuar sobre los componentes neuromusculares de la pared del esofago, desencadenando trastornos motores objetivables mediante manometria que justifican los sintomas esofagicos. En este trabajo se revisan los nuevos conceptos clinicos de la EE y los resultados de los estudios dirigidos a dilucidar la fisopatologia del trastorno. Igualmente, se realiza una revision critica de las alternativas terapeuticas disponibles.

Alterations in blood clotting are a frequent complication of serious heatstroke and may result in gastrointestinal bleeding. We report the case of a 26-year-old man who was admitted to our hospital with symptoms of hyperthermia associated with encephalopathy and disseminated intravascular coagulation (DIC) after prolonged exposure to sunlight. He presented hematemesis, after which he was diagnosed with having a bruising of the esophagus that took up the upper and lower thirds, there being no other lesions in the stomach or duodenum. After supportive treatment and following the resolution of the underlying pathology, the endoscopy-revealed injuries healed with a complete normalization of the esophageal mucosa. Esophageal submucosal bruising is an exceptional cause of hematemesis in serious heatstroke not previously described in the literature.

Background: eosinophilic esophagitis is a rare condition mainly affecting children, although the number of cases reported in adults is on the increase. It is characterized by intense infiltration of eosinophilic leukocytes in the esophageal mucosa, without involvement of other sections of the alimentary canal. Material and methods: over the past year, following the performance of endoscopies and biopsies, our service identified nine patients who were diagnosed with suffering from this disorder. Each patient sought medical help for episodes of long-term, self-limited dysphagia or food impaction in the alimentary canal. Results: endoscopy revealed esophageal stenosis in the form of simultaneous contraction rings or regular stenosis. In six cases, the manometric study showed a nonspecific motor disorder of severe intensity affecting the esophageal body, and another patient had a disorder characterized by the presence of simultaneous waves and secondary peristaltic waves in the three thirds of the organ. These disorders are presumably due to eosinophilic infiltration of the muscular layer or ganglionar cells of the esophagus, and account for symptoms in these patients. Although the etiopathogenesis of this illness is uncertain, it is clearly an immunoallergic manifestation. Conclusions: as the number of diagnosed cases is on the increase, eosinophilic esophagitis is in adults a specific entity within the differential diagnosis of dysphagia in young males with a history of allergies. Eosiniphilic esophagitis responds in a different number of ways to therapies used. We successfully used fluticasone propionate, a synthetic corticoid applied topically, which proved to be efficient in the treatment of this illness by acting on the pathophysiological basis of the process. It does not have any adverse effects, thus offering advantages over other therapies such as systematic corticoids or endoscopic dilations.