Eosinophilic esophagitis
Eosinophilic esophagitis is a chronic, immune/antigen-mediated disease of the esophagus that presents with solid-food dysphagia and food impaction in young atopic men, diagnosed by endoscopic biopsy showing 15 or more eosinophils per high-power field after excluding other causes. Management follows the three D's: dietary elimination, drug therapy with a PPI and/or swallowed topical corticosteroids, and dilation for fibrostenotic strictures.
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What this article covers
- Overview
Definition: eosinophilic esophagitis (EoE) is a chronic, immune- and antigen-mediated disease of the esophagus characterized by esophageal dysfunction symptoms together with dense…
- Epidemiology
Age and sex pattern: most patients are diagnosed between the second and fifth decades of life, and EoE is more common in men.
- Risk factors
Personal history of atopy: asthma, allergic rhinitis, atopic dermatitis, and food allergy are the strongest associations.
- Pathophysiology
Antigen-driven, TH2-mediated inflammation: food or aeroallergens trigger an esophageal-restricted type 2 immune response rather than a systemic allergic reaction, distinguishing EoE from IgE-mediated food allergy.
- Clinical features
Solid-food dysphagia: the hallmark symptom in adolescents and adults, often longstanding and adapted to (slow eating, excessive chewing, liquid washdown, avoidance of dry or dense foods).
- Differential diagnosis
Gastroesophageal reflux disease: heartburn and regurgitation with possible dysphagia; endoscopy favors erosive esophagitis over rings and furrows, and reflux-related eosinophilia is typically less…
- Diagnosis
Establish the diagnosis with symptoms plus biopsy-proven eosinophilia after excluding mimics: esophageal dysfunction symptoms (dysphagia, food impaction) plus biopsy showing a peak of 15 or more…
- Management
Treat acute food bolus impaction first as an endoscopic emergency: urgent upper endoscopy for bolus removal when the patient cannot manage secretions, has complete obstruction, or symptoms persist…
- Complications
Recurrent food bolus impaction: the most frequent acute complication, requiring emergent endoscopic removal with a risk of mucosal injury during extraction.
- Prognosis
Chronic, relapsing course: EoE is a lifelong disease; symptoms and inflammation recur after treatment is stopped in most patients, so ongoing maintenance therapy is generally required.
- Prevention
Maintain effective anti-inflammatory therapy indefinitely at the lowest effective dose (continued omeprazole 20 mg twice daily, budesonide 2 mg/10 mL twice daily, or fluticasone 880 mcg twice daily)…
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