Eosinophilic oesophagitis: a common cause of dysphagia in young adults?

Abstract

Eosinophilic oesophagitis (EO) is an increasingly recognised chronic, relapsing inflammatory condition of the oesophagus. There has been a mini-epidemic of EO in the last decade. The incidence of this condition is higher in children and is commoner in males. There is either a family or personal history of atopic conditions present in a significant number of patients and can also be familial in up to 10%. The classical symptom in an adult is chronic, intermittent solid-food dysphagia and food impaction, often necessitating emergency endoscopic removal. Despite the history of dysphagia for a number of years, patients remain well with no weight loss, which can mislead clinicians to diagnose a functional problem with a resulting delay in the diagnosis. There are various endoscopic features of EO; commonly multiple rings and linear furrows, though these can be subtle and the mucosa may be macroscopically normal. The hallmark of this condition is the histological presence of > or =15 eosinophils/high power field (HPF) in the oesophageal mucosa. Therapeutic options include avoidance of dietary allergens, topical or systemic steroids, Montelukast, Mepolizumab (anti-IL-5 antibody) and endoscopic dilation of strictures unresponsive to medical therapy.

Eine impaktierte „Wiener Semmel“ im Ösophagus – Erstmanifestation einer eosinophilen Ösophagitis bei einem 17-jährigen Patienten

“…Typischerweise manifestiert sich diese Erkrankung im Kindes-bzw. jungen Erwachsenenalter mit dem Leitsymptom der Dysphagie, meist begleitet von rezidivierenden Bolusimpaktionen [2,3]. Mittlerweile ist bekannt, dass die Erkrankung alle Altersgruppen betreffen kann [4].…”

“…Weitere Symptome können Übel-keit, Erbrechen, Refluxsymptomatik und Oberbauchschmerzen sein [3]. Da bei 57% der Patienten eine Rhinokonjunktivitis und bei 46% eine Nahrungsmittelallergie vorliegen, scheint eine atopische Diathese mit der EÖ assoziiert zu sein [10].…”

“…Da bei 57% der Patienten eine Rhinokonjunktivitis und bei 46% eine Nahrungsmittelallergie vorliegen, scheint eine atopische Diathese mit der EÖ assoziiert zu sein [10]. Eine positive Familienanamnese in bis zu 85% bezüglich einer Atopie bestätigt diese Befunde [3,5]. In Einzelfällen wird auch von einer Assoziation mit einer Zöliakie berichtet [3].…”

Endoscopic Classification of Esophagic Eosinophilia

“…The preponderant age group ranges between 20 and 40 years [6] and is more frequent in men [2,3]. There is a family and personal history of allergy in a considerable number of patients and the disease may have a familiar character in up to 10% of cases [7]. Some studies demonstrate the association of EoE with GERD (gastroesophageal reflux disease) in up to 40% of cases [8].…”

A Novel Therapy of Eosinophilic Esophagitis-Treatment of Eosinophilic Esophagitis Using a Single Dose of Intramuscular Corticosteroid and Proton Pump Inhibitor

“…It is the most common cause of food impaction in young adults [6]. In up to 10% of cases, there is a family or personal history of allergic disease [7]. Ee has also been shown to be associated with GERD (gastroesophageal reflux disease) [8], celiac disease [9], and other allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis [10].…”