Eosinophilic Esophagitis

Abstract

Once considered a rare condition, eosinophilic esophagitis is now one of the most common conditions diagnosed during the assessment of feeding problems in children and during the evaluation of dysphagia and food impaction in adults. 1 The entity exists worldwide but has been most extensively studied in Western countries, where its prevalence has been estimated to be 0.4% among all children and adults. 2 Whether eosinophilic esophagitis is truly a new disease or simply a recently recognized one is uncertain. 3 In this review, we consider the diagnostic criteria, pathophysiological and clinical features, and treatment of this increasingly prevalent disease. Definition and Differential DiagnosisEsophageal eosinophilia was initially considered solely a manifestation of gastroesophageal reflux disease (GERD). However, in the mid-1990s, experienced clinicians identified esophageal eosinophilia in both adults and children who had other symptoms. Neither the clinical symptoms nor the histologic changes in these patients responded to acid suppression and antireflux surgery, which suggested that the condition was distinct from GERD. Two studies of case series 4,5 and evidence of the resolution of esophageal eosinophilia in response to therapy with an elemental-formula diet 6 suggested that eosinophilic esophagitis was a unique entity. However, clear diagnostic criteria were lacking.More recently, evaluation and treatment recommendations have been developed on the basis of clinical experiences from different medical subspecialties and the increasing body of knowledge derived from clinical and basic research. 7,8 Eosinophilic esophagitis is currently defined as a chronic, immune-mediated or antigenmediated esophageal disease characterized by symptoms related to esophageal dysfunction and eosinophil-predominant inflammation. The dominant antigens that mediate this disease appear to be food-based. Clinically, eosinophilic esophagitis is defined by several components. First, symptoms include -but are not limited to -feeding problems, vomiting, and abdominal pain in children and Author Manuscript dysphagia and food impaction in adolescents and adults. Second, esophageal mucosal eosinophilia of at least 15 eosinophils per high-power field is present. Other causes of these findings, particularly GERD, must be ruled out. 7,8 However, GERD may be difficult to rule out, because neither the response to proton-pump inhibitors nor the duration of exposure to esophageal acid, measured by means of ambulatory pH monitoring, definitively distinguishes GERD from eosinophilic esophagitis. 9 Other causes of esophageal eosinophilia (e.g., parasitic infection, allergic vasculitis, esophageal leiomyomatosis, and Crohn's disease of the esophagus) are rare. HHS Public Access Pathogenesis Environmental Factors Conferring a Predisposition to Eosinophilic EsophagitisThe increasing prevalence of eosinophilic esophagitis has focused attention on environmental exposures. Birth by cesarean section, premature delivery, antibiotic exposure during ...

Eosinophilic gastroenteritis - a diagnostic enigma

“…Various allergens stimulate a chain of reactions involving the activation of Th2 cells, mast cells and eotaxin 8. There is now substantial evidence verifying the role of eotaxin with early eosinophils recruitment 9. Peripheral eosinophilia may be seen in up to 80% of cases but is not a precondition for diagnosis 8…”