Eosinophilic and Infectious Esophagitis

• Audio chapter
  Single-voice audio, listen on the commute.
• ABIM-format MCQs
  5-option vignettes with full wrong-answer teaching.
• Study guide
  Tables, decision trees, primary sources.
• AI tutor
  Chapter-grounded, answers the question you're stuck on.

What this chapter covers

• Section 5.1: EoE pathogenesis, diagnosis, and EREFS

  Eosinophilic esophagitis is a Th2 allergic disease of the esophageal mucosa that begins with food allergen exposure in a genetically susceptible host and ends with fibrosis, rings, and food impaction if it is left untreated.

• Section 5.2: EoE treatment ladder

  EoE is treated with one of three drug classes or a dietary strategy, and the choice of first therapy is driven by adherence, allergic phenotype, and patient preference rather than by superiority of one option over the others.

• Section 5.3: EoE refractory disease and biologics

  Refractory EoE is disease that fails to achieve histologic or clinical remission after an adequate trial of first-line therapy, and the modern definition increasingly includes patients who achieve histologic remission but have persistent dysphagia from established fibrostenotic change.

• Section 5.4: Candida esophagitis

  Candida esophagitis is overgrowth of Candida albicans (and less commonly other Candida species) on a esophageal mucosa whose local defenses have failed.

• Section 5.5: HSV and CMV esophagitis

  HSV and CMV esophagitis are distinguished by where the virus lives in the mucosa, because the cellular tropism dictates the endoscopic ulcer morphology, the biopsy site, the histology, and the treatment.

• Section 5.6: Pill esophagitis and caustic injury

  Pill esophagitis and caustic injury are mucosal chemical injuries that share a single mechanistic principle: the depth and extent of injury are determined by the agent and by the contact time.

Podcast episodes

1. 01

   Eosinophilic Esophagitis: Diagnosis and Treatment

   Eosinophilic esophagitis is a food-driven Th2 allergic disease that scars the esophagus if it is left untreated, so the episode is organized around telling inflammation from fibrosis. It starts with a young man's food impaction and the rule to biopsy every adult impaction. It then covers the mechanism, the diagnosis at fifteen eosinophils per high-power field with no PPI trial, and EREFS scoring with its inflammatory and fibrostenotic split. First-line options are a high-dose PPI, a swallowed steroid, or a step-up diet, with biopsy-confirmed remission and ongoing maintenance. A second patient who is refractory leads to adequacy checks, dupilumab, and dilation.

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2. 02

   Infectious Esophagitis: Infection and Injury

   Each infection or injury in this episode is explained by where the agent acts and how long it stays. Candida takes hold when local defenses fail, so unexplained disease prompts an HIV test, and severe or atypical cases are scoped before treatment. Persistent pain after Candida clears suggests cytomegalovirus, biopsied at the ulcer base, while herpes is biopsied at the ulcer edge. Chemical injury follows the chemical and contact time: alkali penetrates the esophagus, the airway comes first, nothing is given that adds injury, and endoscopy at 24 to 48 hours grades the damage and sets disposition. Survivors need stricture care and long-term cancer surveillance. Pill esophagitis is prevented by upright dosing with a full glass of water.

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Key topics

• ·Biopsy of adult food impaction
• ·Typical patient and presentation
• ·Th2 mechanism and fibrosis
• ·Diagnostic criteria and biopsy sampling
• ·Reflux versus eosinophilic esophagitis on pathology
• ·No PPI trial needed for diagnosis
• ·EREFS scoring
• ·PPI, swallowed steroid, and elimination diet
• ·Maintenance after remission
• ·Refractory disease, dupilumab, and dilation
• ·Candida esophagitis and failed host defenses
• ·HIV testing and empiric versus endoscopic approach
• ·Confirming and treating Candida
• ·Cytomegalovirus ulcers and base biopsy
• ·Herpes simplex esophagitis and edge biopsy
• ·Alkali versus acid caustic injury
• ·Airway and what not to do after ingestion
• ·Zargar grading and disposition
• ·Stricture and cancer surveillance
• ·Pill esophagitis and upright dosing